title: Utility of CSF biomarkers in psychiatric disorders: a national multicentre prospective study.
abstract: Affective and psychotic disorders are mental or behavioural patterns resulting in an inability to cope with life's ordinary demands and routines. These conditions can be a prodromal event of Alzheimer's disease (AD). The prevalence of underlying AD lesions in psychiatric diseases is unknown, and it would be helpful to determine them in patients. AD cerebrospinal fluid (CSF) biomarkers (amyloid β, tau and phosphorylated tau) have high diagnostic accuracy, both for AD with dementia and to predict incipient AD (mild cognitive impairment due to AD), and they are sometimes used to discriminate psychiatric diseases from AD. Our objective in the present study was to evaluate the clinical utility of CSF biomarkers in a group of patients with psychiatric disease as the main diagnosis.
  
  
  
  In a multicentre prospective study, clinicians filled out an anonymous questionnaire about all of their patients who had undergone CSF biomarker evaluation. Before and after CSF biomarker results were obtained, clinicians provided a diagnosis with their level of confidence and information about the treatment. We included patients with a psychiatric disorder as the initial diagnosis. In a second part of the study conducted retrospectively in a followed subgroup, clinicians detailed the psychiatric history and we classified patients into three categories: (1) psychiatric symptoms associated with AD, (2) dual diagnosis and (3) cognitive decline not linked to a neurodegenerative disorder.
  
  
  
  Of 957 patients, 69 had an initial diagnosis of a psychiatric disorder. Among these 69 patients, 14 (20.2 %) had a CSF AD profile, 5 (7.2 %) presented with an intermediate CSF profile and 50 (72.4 %) had a non-AD CSF profile. Ultimately, 13 (18.8 %) patients were diagnosed with AD. We show that in the AD group psychiatric symptoms occurred later and the delay between the first psychiatric symptoms and the cognitive decline was shorter.
  
  
  
  This study revealed that about 20 % of patients with a primary psychiatric disorder diagnosis before undergoing a CSF exploration for cognitive disorder displayed a CSF biomarker AD profile. In memory clinics, it seems important to consider AD as a possible diagnosis before finalizing a diagnosis of a psychiatric disorder.
authors.affiliation: INSERM UMR-S942 Université Paris Diderot, 75010, Paris, France. claire.paquet@inserm.fr.|Centre Mémoire (CMRR) Paris Nord Ile de France, Groupe Hospitalier Lariboisiere FW Saint-Louis, APHP, Université Paris Diderot, 200, rue du Faubourg Saint Denis, 75010, Paris, France. claire.paquet@inserm.fr.|Unité d'Histologie et de Biologie du Vieillissement, Groupe Hospitalier Lariboisiere FW Saint Louis APHP, Université Paris Diderot, 75010, Paris, France. claire.paquet@inserm.fr.
authors.forename: Claire
authors.initials: C
authors.lastname: Paquet
authors.affiliation: Centre Mémoire (CMRR) de Besançon, Hôpital Universitaire de Besançon, 25000, Besançon, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Magnin
authors.affiliation: Centre Mémoire (CMRR) and INSERM UMR1079, Hôpital Universitaire de Rouen, 76000, Rouen, France.
authors.forename: David
authors.initials: D
authors.lastname: Wallon
authors.affiliation: Centre Mémoire (CMRR) de Lille, Université Lille Nord de France, UDSL, 59000, Lille, France.
authors.forename: Anne-Cécile
authors.initials: AC
authors.lastname: Troussière
authors.affiliation: INSERM UMR-S942 Université Paris Diderot, 75010, Paris, France.|Centre Mémoire (CMRR) Paris Nord Ile de France, Groupe Hospitalier Lariboisiere FW Saint-Louis, APHP, Université Paris Diderot, 200, rue du Faubourg Saint Denis, 75010, Paris, France.|Unité d'Histologie et de Biologie du Vieillissement, Groupe Hospitalier Lariboisiere FW Saint Louis APHP, Université Paris Diderot, 75010, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Dumurgier
authors.affiliation: Centre de Neurologie, 6 place Luxembourg, 57100, Thionville, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Jager
authors.affiliation: INSERM UMR-S1144 and Service de Psychiatrie, Groupe Hospitalier Lariboisiere FW Saint-Louis, APHP, Université Paris Diderot, 75010, Paris, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Bellivier
authors.affiliation: Service de Biochimie, Groupe Hospitalier Lariboisiere FW Saint-Louis, APHP, Université Paris Diderot, 75010, Paris, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Bouaziz-Amar
authors.affiliation: Université de Strasbourg, CNRS, Laboratoire ICube UMR 7357 and Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000, Strasbourg, France.|Centre Mémoire (CMRR), Hôpital Universitaire de Strasbourg, Département de Gériatrie, Hôpital de Jour Gériatrique, 67000, Strasbourg, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Blanc
authors.affiliation: Centre Mémoire (CMRR) de Tours, Hôpital Universitaire Tours, 37000, Tours, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Beaufils
authors.affiliation: Service de Biochimie, Hôpital Universitaire de Besançon, 25000, Besançon, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Miguet-Alfonsi
authors.affiliation: Service de Biochimie, Hôpital Universitaire de Rouen, 76000, Rouen, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Quillard
authors.affiliation: Université Lille, CHU-Lille, Inserm, UF de Neurobiologie, CBPG, Lille, France.
authors.forename: Susanna
authors.initials: S
authors.lastname: Schraen
authors.affiliation: Centre Mémoire (CMRR) de Lille, Université Lille Nord de France, UDSL, 59000, Lille, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Pasquier
authors.affiliation: Centre Mémoire (CMRR) and INSERM UMR1079, Hôpital Universitaire de Rouen, 76000, Rouen, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Hannequin
authors.affiliation: CMRR COBTEK research unit, Université de Nice Sophia Antipolis, 06100, Nice, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Robert
authors.affiliation: INSERM UMR-S942 Université Paris Diderot, 75010, Paris, France.|Centre Mémoire (CMRR) Paris Nord Ile de France, Groupe Hospitalier Lariboisiere FW Saint-Louis, APHP, Université Paris Diderot, 200, rue du Faubourg Saint Denis, 75010, Paris, France.|Unité d'Histologie et de Biologie du Vieillissement, Groupe Hospitalier Lariboisiere FW Saint Louis APHP, Université Paris Diderot, 75010, Paris, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Hugon
authors.affiliation: INSERM UMR-S942 Université Paris Diderot, 75010, Paris, France.|Centre Mémoire (CMRR) Paris Nord Ile de France, Groupe Hospitalier Lariboisiere 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
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000134:cerebrospinal fluid; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000134:cerebrospinal fluid* / Q000150:complications; D019636:Neurodegenerative Diseases / Q000134:cerebrospinal fluid / Q000150:complications; D011446:Prospective Studies; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers
keywords: Alzheimer’s disease; Biomarkers; Cerebrospinal fluid; Clinical practice; Psychiatric disease