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. 2015 May;11(5):533-540.e2.
doi: 10.1016/j.jalz.2014.04.517. Epub 2014 Jul 9.

The influence of cerebrospinal fluid (CSF) biomarkers on clinical dementia evaluations

Jonathan Gooblar  1 , Brian D Carpenter  2 , Mary A Coats  3 , John C Morris  4 , B Joy Snider  5
Affiliations

The influence of cerebrospinal fluid (CSF) biomarkers on clinical dementia evaluations

Jonathan Gooblar et al. Alzheimers Dement. 2015 May.

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.

Keywords: Alzheimer's disease; Biomarkers; Cerebrospinal fluid; Dementia; Diagnosis.

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Conflict of interest statement

Conflict of interest disclosure: Dr. John C. Morris reports disclosures: Neither Dr. Morris nor his family owns stock or has equity interest (outside of mutual funds or other externally directed accounts) in any pharmaceutical or biotechnology company. Dr. Morris has participated or is currently participating in clinical trials of antidementia drugs sponsored by the following companies: Janssen Immunotherapy, and Pfizer. Dr. Morris has served as a consultant for Lilly USA and receives research support from Eli Lilly/Avid Radiopharmaceuticals. No other authors report conflicts of interest. Dr. B. Joy Snider reports disclosures: Neither Dr. Sndier nor her family owns stock or has equity interest (outside of mutual funds or other externally directed accounts) in any pharmaceutical or biotechnology company. Dr. Snider has participated or is currently participating in clinical trials of antidementia drugs sponsored by the following companies: Hoffman LaRoche, Lilly, Janssen Immunotherapy, and Pfizer.

Figures

Figure 1
Figure 1
Percentage of clinicians choosing diagnostic categories by CSF condition for the borderline and mild AD dementia vignettes. Adjusted standardized residuals, signifying difference from expected chi-square distribution, are significant at the ***p < 001 level.
See this image and copyright information in PMC

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