Article Text
Abstract
Objectives New diagnostic criteria for Alzheimer’s disease (AD) include cerebrospinal fluid (CSF) biomarkers that allow diagnosis at the stage of mild cognitive impairment (MCI). However, the impact of CSF biomarkers in MCI populations in clinical practice has been poorly evaluated. The objective of this study is to assess the use and impact in clinical practice of AD CSF biomarkers in French memory clinics.
Design We performed a nation-wide, prospective survey between March 2012 and September 2014. Data over the same period was extracted from the French National Database (Banque Nationale Alzheimer, BNA) and compared with the results of the survey.
Setting 29 secondary and tertiary memory clinics in France.
Participants Clinicians prescribing lumbar puncture (LP) in order to measure AD CSF biomarkers. Clinicians completed a two-part questionnaire for each of their patients undergoing LP.
Primary and secondary outcome measures Assessment of diagnosis, level of confidence before and after CSF biomarkers and impact on management in patients who underwent LP for CSF AD biomarkers in clinical routine.
Results 977 questionnaires were completed, of which 61 were excluded because of unknown initial/final diagnosis or non-contributory CSF results. Of 916 patients reported, 153 (16.7%) had MCI as the initial diagnosis, of which 51 (33.3%) displayed an AD profile. CSF biomarkers resulted in a change in diagnosis in 44 patients (28.8%). Confidence level significantly increased after LP (8.3±1.4vs 6.73±1.18, p<0.0001), and CSF results modified management in 71/156 patients (46.4%), including 36 (23.5%) enrolled in clinical trials. Comparison of change in diagnosis with the BNA population revealed no difference (32.24%, p=0.4).
Conclusion This nation-wide survey, reflecting clinical practice in French memory clinics, describes the impact of CSF AD biomarkers in patients with MCI in clinical practice.
- cerebrospinal fluid
- biomarkers
- Alzheimer’s disease
- mild cognitive impairment
- clinical practice
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Footnotes
Contributors EC analysed the data and wrote the manuscript. FML contributed to the constitution of the database and wrote the first draft of the manuscript. A-CT contributed to the constitution of the database. DW, JD, EM, ED, AG, BC, VdlS, AJ, FB, EA-B, CM-A, MQ, SS, NP, EB, FP, DH, JH and ePLM participants performed lumbar puncture, managed the patients and filled in the questionnaires. PR extracted the data from the French National Alzheimer Database. CP conceived and coordinated the study and supervised the writing of the manuscript. All authors revised the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.
Patient consent for publication Not required.