RT Journal Article
SR Electronic
T1 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
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e026380
DO 10.1136/bmjopen-2018-026380
VO 9
IS 5
A1 Emmanuel Cognat
A1 François Mouton Liger
A1 Anne-Cécile Troussière
A1 David Wallon
A1 Julien Dumurgier
A1 Eloi Magnin
A1 Emmanuelle Duron
A1 Audrey Gabelle
A1 Bernard Croisile
A1 Vincent de la Sayette
A1 Alain Jager
A1 Frederic Blanc
A1 Elodie Bouaziz-Amar
A1 Carole Miguet-Alfonsi
A1 Muriel Quillard
A1 Susanna Schraen
A1 Nathalie Philippi
A1 Emilie Beaufils
A1 Florence Pasquier
A1 Didier Hannequin
A1 Philippe Robert
A1 Jacques Hugon
A1 Claire Paquet
A1 ,
YR 2019
UL http://bmjopen.bmj.com/content/9/5/e026380.abstract
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.