P1‐393: The Incremental Value of Amyloid Pet Versus CSF Biomarkers for the Diagnosis of Alzheimer's Disease (India–fbb Study)

Ramusino, Matteo Cotta; Altomare, Daniele; Assal, Frédéric; Mendes, Aline; Costa, Alfredo; Morbelli, Silvia; Bauckneht, Matteo; Picco, Agnese; Dottorini, Massimo E.; Farotti, Lucia; Moretti, Davide; Savelli, Giordano; Tarallo, Anna; Parnetti, Lucilla; Nobili, Flavio; Parapini, Maura; Salvatore, Elena; Salvatore, Marco; Boccardi, Marina; Frisoni, Giovanni B.

doi:10.1016/j.jalz.2018.06.401

Cited by 2 publications

(11 citation statements)

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“…Most (12 of 17, 71%) of the included studies were prospective observational studies [30][31][32][33][34][35][36][37][38][39][40] .…”

Section: Methodsmentioning

confidence: 99%

“…Outcome measures are described in Supplementary Table 2. The majority (13 of 17, 76%) of studies required the clinician to complete a pre-and post-CSF results questionnaire, listing initial and final diagnoses respectively [30][31][32][33][34][36][37][38][39][40][41]46,47 . Of these studies, eight examined how CSF biomarker results changed diagnostic confidence [32][33][34][35][36]40,41,46 , and seven assessed their impact on patient management, defined as the initiation or discontinuation of dementia medications such as cholinesterase inhibitors, the ability to enrol in clinical trials, and/or length of follow-up [32][33][34]37,39,41,46 .…”

Section: Outcome Measuresmentioning

confidence: 99%

“…Most (14 of 17, 83%) studies were assessed as being of moderate quality [30][31][32][33][34][35][36][37][38][39][40][41][45][46][47] and three studies were assessed as being of high quality [42][43][44] . No studies were assessed to be of low quality (Supplementary Table 1)High quality studies comprised the cost-effectiveness analysis, which included in the study design methods to reduce confounding and selection bias.…”

Section: Quality Assessmentmentioning

confidence: 99%

“…Eleven studies, comprising 1891 patient participants and 395 clinician participants, reported on the percentage change in clinicians' diagnosis after the availability of fluid biomarker results [31][32][33][35][36][37][38][39][40]45,46 , which ranged between 7-61%. The overall pooled percentage change in diagnoses was 25% (95% CI: 14-37) and there was substantial heterogeneity (I 2 97%, p < 0.001) (Fig.…”

Section: Findings Change In Diagnosismentioning

confidence: 99%

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Clinical utility of cerebrospinal fluid biomarkers in the evaluation of cognitive impairment: a systematic review and meta-analysis

Hazan

Wing

Liu

et al. 2022

J Neurol Neurosurg Psychiatry

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BackgroundThe analytical and clinical validity of cerebrospinal (CSF) biomarkers has been extensively researched in dementia. Further work is needed to assess the ability of these biomarkers to improve diagnosis, management and health outcomes in the clinical settingObjectivesTo assess the added value and clinical utility of CSF biomarkers in the diagnostic assessment of cognitively impaired patients under evaluation for Alzheimer’s disease (AD).MethodsSystematic literature searches of Medline, EMBASE, PsycINFO and Web of Science research databases were conducted on 17 December 2022. Data from relevant studies were extracted and independently screened for quality using a tool for bias. Clinical utility was measured by clinicians’ changes in diagnosis, diagnostic confidence and patient management (when available), after their examination of patients’ CSF biomarkers. Cost-effectiveness was assessed by consideration of additional cost per patient and quality-adjusted life years.ResultsSearches identified 17 studies comprising 2090 patient participants and 593 clinicians. The meta-analysis revealed that clinicians’ use of CSF biomarkers resulted in a pooled percentage change in diagnosis of 25% (95% CI 14 to 37), an increase in diagnostic confidence of 14% (95% CI 9 to 18) and a pooled proportion of patients whose management changed of 31% (95% CI 12 to 50). CSF biomarkers were deemed cost-effective, particularly in memory services, where pre-test AD prevalence is higher compared with a primary care setting.ConclusionsCSF biomarkers can be a helpful additional diagnostic tool for clinicians assessing patients with cognitive impairment. In particular, CSF biomarkers consistently improved clinicians’ confidence in diagnosing AD and influenced on diagnostic change and patient management. Further research is needed to study the clinical utility of blood-based biomarkers in the clinical setting.

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“…Most (12 of 17, 71%) of the included studies were prospective observational studies [30][31][32][33][34][35][36][37][38][39][40] .…”

Section: Methodsmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

Section: Findings Change In Diagnosismentioning

confidence: 99%

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Clinical utility of cerebrospinal fluid biomarkers in the evaluation of cognitive impairment: a systematic review and meta-analysis

Hazan

Wing

Liu

et al. 2022

J Neurol Neurosurg Psychiatry

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“…For the “single-case analysis,” we considered 198 MCI subjects from ADNI (118 MCI stable and 80 MCI converters to AD) with a 24-month clinical follow up as a training set. The independent subjects' data for the clinical testing came from the FBB-HUG-2014 Piramal study ( 38 ) (alias, testing set) led by the University of Geneva, with 38 MCI possibly due to AD subjects ( 6 ).…”

Section: Methodsmentioning

confidence: 99%

Medical Informatics Platform (MIP): A Pilot Study Across Clinical Italian Cohorts

et al. 2020

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Introduction: With the shift of research focus to personalized medicine in Alzheimer's Dementia (AD), there is an urgent need for tools that are capable of quantifying a patient's risk using diagnostic biomarkers. The Medical Informatics Platform (MIP) is a distributed e-infrastructure federating large amounts of data coupled with machine-learning (ML) algorithms and statistical models to define the biological signature of the disease. The present study assessed (i) the accuracy of two ML algorithms, i.e., supervised Gradient Boosting (GB) and semi-unsupervised 3C strategy (Categorize, Cluster, Classify-CCC) implemented in the MIP and (ii) their contribution over the standard diagnostic workup. Methods: We examined individuals coming from the MIP installed across 3 Italian memory clinics, including subjects with Normal Cognition (CN, n = 432), Mild Cognitive Impairment (MCI, n = 456), and AD (n = 451). The GB classifier was applied to best discriminate the three diagnostic classes in 1,339 subjects, and the CCC strategy was used to refine the classical disease categories. Four dementia experts provided their diagnostic confidence (DC) of MCI conversion on an independent cohort of 38 patients. DC was based on clinical, neuropsychological, CSF, and structural MRI information and again with addition of the outcome from the MIP tools. Results: The GB algorithm provided a classification accuracy of 85% in a nested 10-fold cross-validation for CN vs. MCI vs. AD discrimination. Accuracy increased to 95% in the holdout validation, with the omission of each Italian clinical cohort out in turn. CCC Redolfi et al. MIP Pilot Study identified five homogeneous clusters of subjects and 36 biomarkers that represented the disease fingerprint. In the DC assessment, CCC defined six clusters in the MCI population used to train the algorithm and 29 biomarkers to improve patients staging. GB and CCC showed a significant impact, evaluated as +5.99% of increment on physicians' DC. The influence of MIP on DC was rated from "slight" to "significant" in 80% of the cases. Discussion: GB provided fair results in classification of CN, MCI, and AD. CCC identified homogeneous and promising classes of subjects via its semi-unsupervised approach. We measured the effect of the MIP on the physician's DC. Our results pave the way for the establishment of a new paradigm for ML discrimination of patients who will or will not convert to AD, a clinical priority for neurology.

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P1‐393: The Incremental Value of Amyloid Pet Versus CSF Biomarkers for the Diagnosis of Alzheimer's Disease (India–fbb Study)

Cited by 2 publications

References 0 publications

Clinical utility of cerebrospinal fluid biomarkers in the evaluation of cognitive impairment: a systematic review and meta-analysis

Clinical utility of cerebrospinal fluid biomarkers in the evaluation of cognitive impairment: a systematic review and meta-analysis

Medical Informatics Platform (MIP): A Pilot Study Across Clinical Italian Cohorts

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