Evaluating combinations of diagnostic tests to discriminate different dementia types

Abstract

Introduction We studied, using a data-driven approach, how different combinations of diagnostic tests contribute to the differential diagnosis of dementia. Methods In this multicenter study, we included 356 patients with Alzheimer's disease, 87 frontotemporal dementia, 61 dementia with Lewy bodies, 38 vascular dementia, and 302 controls. We used a classifier to assess accuracy for individual performance and combinations of cognitive tests, cerebrospinal fluid biomarkers, and automated magnetic resonance imaging features for pairwise differentiation between dementia types. Results Cognitive tests had good performance in separating any type of dementia from controls. Cerebrospinal fluid optimally contributed to identifying Alzheimer's disease, whereas magnetic resonance imaging features aided in separating vascular dementia, dementia with Lewy bodies, and frontotemporal dementia. Combining diagnostic tests increased the accuracy, with balanced accuracies ranging from 78% to 97%. Discussion Different diagnostic tests have their distinct roles in differential diagnostics of dementias. Our results indicate that combining different diagnostic tests may increase the accuracy further.

Gait Disturbances are Associated with Increased Cognitive Impairment and Cerebrospinal Fluid Tau Levels in a Memory Clinic Cohort

“…We included 142 participants from the EU-funded project Predict ND (Grant Agreement 611005) [17] from three European memory clinics (Amsterdam UMC, location VUmc in Amsterdam, The Netherlands [18], Rigs hospitalet in Copenhagen, Denmark, and the University of Eastern-Finland in Kuopio, Finland). The PredictND study was set up with the aim to develop computer tools to support the clinician in the differential diagnosis of dementia [3].…”

“…As part of the study protocol [17], subjects underwent elaborate testing including medical examination, neuropsychological assessment, and an MRI scan. A lumbar puncture to collect CSF was performed in a subgroup of 76 participants.…”

Selection of memory clinic patients for CSF biomarker assessment can be restricted to a quarter of cases by using computerized decision support, without compromising diagnostic accuracy

“…If the clinician considers the PCC (= the confidence in the correct diagnosis) high enough, no additional testing is needed. This was frequently the case for controls and VaD [11]. When the PCC is too low, simulated normal or AD-like CSF values are added, enabling the clinicians to decide whether the change in PCC is enough for them to order additional testing.…”

“…types of dementia [9,10]. The DSI classifier can achieve high probability of correct diagnosis even without CSF biomarkers, by using an optimal combination of tests [11,12].…”

Characteristic Biomarker and Cognitive Profile in Incipient Mixed Dementia

“…Several studies have examined differential diagnostics in dementia patients using biomarkers and cognitive testing [6]. Pathological levels of the cerebrospinal fluid (CSF) markers amyloid-␤ (A␤) 42 , total-tau (T-tau), and phosphorylated tau (P-tau) are typical for AD but deviation from normal levels may also be seen in SVD [7].…”