title: Impact of cerebro-spinal fluid biomarkers of Alzheimer's disease in clinical practice: a multicentric study.
abstract: CSF biomarkers of Alzheimer's disease are well validated in clinical research; however, their pragmatic utility in daily practice is still unappreciated. These biomarkers are used in routine practice according to Health Authority Recommendations. In 604 consecutive patients explored for cognitive disorders, questionnaires were prospectively proposed and filled. Before and after CSF biomarker results, clinicians provided a diagnosis and an estimate of their diagnostic confidence. Analysis has compared the frequency of diagnosis before and after CSF biomarker results using the net reclassification improvement (NRI) method. We have evaluated external validity comparing with data of French Bank National of AD (BNA). A total of 561 patients [Alzheimer's disease (AD), n = 253; non-AD, n = 308] were included (mean age, 68.6 years; women, 52 %). Clinically suspected diagnosis and CSF results were concordant in 65.2 % of cases. When clinical hypothesis and biological results were discordant, a reclassification occurred in favour of CSF biomarkers results in 76.9 %. The NRI was 39.5 %. In addition, the results show a statistically significant improvement in clinician confidence for their diagnosis. In comparison with BNA data, patients were younger and more frequently diagnosed with AD. Clinicians tend to heavily rely on the CSF AD biomarkers results and are more confident in their diagnoses using CSF AD biomarkers. Thus, these biomarkers appear as a key tool in clinical practice.
authors.affiliation: Centre Mémoire de Ressources et de Recherche (CMRR) Paris Nord Ile de France, Groupe hospitalier Lariboisière FW Saint Louis, APHP, Université Paris Diderot, 200, rue du Faubourg Saint Denis, 75010, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Mouton-Liger
authors.forename: David
authors.initials: D
authors.lastname: Wallon
authors.forename: Anne-Cécile
authors.initials: AC
authors.lastname: Troussière
authors.forename: Rachida
authors.initials: R
authors.lastname: Yatimi
authors.forename: Julien
authors.initials: J
authors.lastname: Dumurgier
authors.forename: Eloi
authors.initials: E
authors.lastname: Magnin
authors.forename: Vincent
authors.initials: V
authors.lastname: de la Sayette
authors.forename: Emannuelle
authors.initials: E
authors.lastname: Duron
authors.forename: Nathalie
authors.initials: N
authors.lastname: Philippi
authors.forename: Emilie
authors.initials: E
authors.lastname: Beaufils
authors.forename: Audrey
authors.initials: A
authors.lastname: Gabelle
authors.forename: Bernard
authors.initials: B
authors.lastname: Croisile
authors.forename: Philippe
authors.initials: P
authors.lastname: Robert
authors.forename: Florence
authors.initials: F
authors.lastname: Pasquier
authors.forename: Didier
authors.initials: D
authors.lastname: Hannequin
authors.forename: Jacques
authors.initials: J
authors.lastname: Hugon
authors.forename: Claire
authors.initials: C
authors.lastname: Paquet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000134:cerebrospinal fluid* / Q000150:complications / Q000175:diagnosis*; D015415:Biomarkers / Q000134:cerebrospinal fluid*; D003072:Cognition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers