title: Enhancing Diagnostic Accuracy of aMCI in the Elderly: Combination of Olfactory Test, Pupillary Response Test, BDNF Plasma Level, and APOE Genotype.
abstract: Background. Amnestic Mild Cognitive Impairment (aMCI) often progresses to Alzheimer's disease. There are clinical markers and biomarkers to identify the degenerative process in the brain. Objectives. To obtain the diagnostic values of olfactory test, pupillary response to tropicamide 0.01%, BDNF plasma level, and APOE ε 4 in diagnosing aMCI. Methods. Cross-sectional, comparative analysis. Results. There were 109 subjects enrolled (aMCI: 51, normal cognition: 58) with age 64 ± 5.54 years. For diagnosing aMCI, cut-off point for the olfactory score was <7 out of 10 and >22% for pupil dilatation response. Low BDNF plasma level was related significantly with olfactory deficits and aMCI (P < 0.05). Four of five subjects with homozygote e4 presented with multiple-domain aMCI. This group displayed the lowest means of olfactory score and the highest means of pupillary hypersensitivity response (P < 0.0001). Combination of olfactory deficit and pupillary hypersensitivity response in detection of aMCI was beneficial with Sp 91% and PPV 87%. In conjunction with clinical markers, BDNF plasma level and presence of APOE e4+ improved Sp and PPV. Conclusions. Combination of olfactory test and pupillary response test was useful as diagnostic tool in aMCI. In conjunction with clinical markers, low level of BDNF plasma and presence of APOE e4 improved the diagnostic value.
authors.affiliation: Department of Neurology, Faculty of Medicine, Atma Jaya Catholic University of Indonesia, Jl. Pluit Raya No. 2, North Jakarta 14440, Indonesia.
authors.forename: Yuda
authors.identifier: 0000-0003-4527-0285
authors.initials: Y
authors.lastname: Turana
authors.affiliation: Department of Neurology, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Central Jakarta 10430, Indonesia.
authors.forename: Teguh Asaat S
authors.initials: TA
authors.lastname: Ranakusuma
authors.affiliation: Department of Neurology, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Central Jakarta 10430, Indonesia.
authors.forename: Jan Sudir
authors.initials: JS
authors.lastname: Purba
authors.affiliation: Department of Psychiatry, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Central Jakarta 10430, Indonesia.
authors.forename: Nurmiati
authors.initials: N
authors.lastname: Amir
authors.affiliation: Department of Neurology, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Central Jakarta 10430, Indonesia.
authors.forename: Siti Airiza
authors.initials: SA
authors.lastname: Ahmad
authors.affiliation: Department of Neurology, Faculty of Medicine, University of Airlangga, Kampus A, Jl. Mayjen. Prof. Dr. Moestopo No. 47, Surabaya 60131, Indonesia.
authors.forename: Moh Hasan
authors.initials: MH
authors.lastname: Machfoed
authors.affiliation: Center of Health Research, Atma Jaya Catholic University of Indonesia, Jl. Pluit Raya No. 2, North Jakarta 14440, Indonesia.
authors.forename: Yvonne Suzy
authors.initials: YS
authors.lastname: Handayani
authors.affiliation: Department of Biology, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Central Jakarta 10430, Indonesia.
authors.lastname: Asmarinah
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Jl. Salemba Raya No. 6, Central Jakarta 10430, Indonesia.
authors.forename: Sarwono
authors.initials: S
authors.lastname: Waspadji