title: The influence of cerebrospinal fluid (CSF) biomarkers on clinical dementia evaluations.
abstract: BACKGROUND
  Cerebrospinal fluid (CSF) proteins have become accepted biomarkers of Alzheimer's disease (AD) in research settings. The extent of their use, perceived utility, and influence on decision making in clinical settings, however, are less well studied.
  
  
  METHODS
  Clinicians who evaluate older adults (N = 193) were randomized to view normal, borderline, AD-consistent, or no CSF information in two vignettes portraying patients with borderline and mild AD symptoms. Clinicians also reported on the use and perceived utility of CSF biomarkers.
  
  
  RESULTS
  Although clinicians reported infrequent use and low perceived utility of CSF biomarkers, viewing AD-consistent CSF values made clinicians more likely to make an AD-related diagnosis, increased diagnostic confidence, and led clinicians to initiate treatment more often than clinicians who had no CSF information.
  
  
  CONCLUSIONS
  CSF biomarkers influence decision making depending on the extent to which biomarkers reflect AD pathology, consistency between clinical-pathologic information, and the ambiguity of protein values.
authors.affiliation: Department of Psychology, St. Louis, MO, USA. Electronic address: jgooblar@wustl.edu.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Gooblar
authors.affiliation: Department of Psychology, St. Louis, MO, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Carpenter
authors.affiliation: Knight Alzheimer's Disease Research Center, St. Louis, MO, USA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Coats
authors.affiliation: Knight Alzheimer's Disease Research Center, St. Louis, MO, USA; Department of Neurology, St. Louis, MO, USA; Department of Pathology and Immunology, St. Louis, MO, USA; Department of Physical Therapy, St. Louis, MO, USA; Department of Occupational Therapy of the School of Medicine, Washington University, St. Louis, MO, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Morris
authors.affiliation: Knight Alzheimer's Disease Research Center, St. Louis, MO, USA; Department of Neurology, St. Louis, MO, USA.
authors.forename: B Joy
authors.initials: BJ
authors.lastname: Snider
mesh_terms: D000328:Adult; D000368:Aged; D016229:Amyloid beta-Peptides / Q000134:cerebrospinal fluid; D015415:Biomarkers / Q000134:cerebrospinal fluid*; D003704:Dementia / Q000134:cerebrospinal fluid* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011897:Random Allocation; D016875:tau Proteins / Q000134:cerebrospinal fluid
chemical_list: D016229:Amyloid beta-Peptides; D015415:Biomarkers; D016875:tau Proteins
keywords: Alzheimer's disease; Biomarkers; Cerebrospinal fluid; Dementia; Diagnosis