PT  - JOURNAL ARTICLE
AU  - Emmanuel Cognat
AU  - François Mouton Liger
AU  - Anne-Cécile Troussière
AU  - David Wallon
AU  - Julien Dumurgier
AU  - Eloi Magnin
AU  - Emmanuelle Duron
AU  - Audrey Gabelle
AU  - Bernard Croisile
AU  - Vincent de la Sayette
AU  - Alain Jager
AU  - Frederic Blanc
AU  - Elodie Bouaziz-Amar
AU  - Carole Miguet-Alfonsi
AU  - Muriel Quillard
AU  - Susanna Schraen
AU  - Nathalie Philippi
AU  - Emilie Beaufils
AU  - Florence Pasquier
AU  - Didier Hannequin
AU  - Philippe Robert
AU  - Jacques Hugon
AU  - Claire Paquet
ED  - ,
TI  - What is the clinical impact of cerebrospinal fluid biomarkers on final diagnosis and management in patients with mild cognitive impairment in clinical practice? Results from a nation-wide prospective survey in France
AID  - 10.1136/bmjopen-2018-026380
DP  - 2019 May 01
TA  - BMJ Open
PG  - e026380
VI  - 9
IP  - 5
4099  - http://bmjopen.bmj.com/content/9/5/e026380.short
4100  - http://bmjopen.bmj.com/content/9/5/e026380.full
SO  - BMJ Open2019 May 01; 9
AB  - 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.