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Multicenter Study
. 2016 Jun 13:8:27.
doi: 10.1186/s13195-016-0192-z.

Utility of CSF biomarkers in psychiatric disorders: a national multicentre prospective study

Claire Paquet  1   2   3 , Eloi Magnin  4 , David Wallon  5 , Anne-Cécile Troussière  6 , Julien Dumurgier  7   8   9 , Alain Jager  10 , Frank Bellivier  11 , Elodie Bouaziz-Amar  12 , Frédéric Blanc  13   14 , Emilie Beaufils  15 , Carole Miguet-Alfonsi  16 , Muriel Quillard  17 , Susanna Schraen  18 , Florence Pasquier  6 , Didier Hannequin  5 , Philippe Robert  19 , Jacques Hugon  7   8   9 , François Mouton-Liger  7   8 ; For ePLM network and collaborators
Affiliations
Multicenter Study

Utility of CSF biomarkers in psychiatric disorders: a national multicentre prospective study

Claire Paquet et al. Alzheimers Res Ther. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Alzheimer’s disease; Biomarkers; Cerebrospinal fluid; Clinical practice; Psychiatric disease.

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Figures

Fig. 1
Fig. 1
Flowchart of the operational mode for patient inclusion. AD Alzheimer’s disease, CSF cerebrospinal fluid, FTD frontotemporal dementia, MCI mild cognitive impairment
Fig. 2
Fig. 2
Comparison of the three categories of patients in the study: (1) psychiatric symptoms associated with Alzheimer’s disease (AD), (2) cognitive impairment not linked to neurodegenerative disease (No Neurodeg) and (3) dual diagnosis (patient with a primary psychiatric disease who subsequently developed AD) (dual). a Differences in age of onset of psychiatric symptoms between the three categories. b Differences in delay between the first psychiatric symptoms and cognitive decline in the three categories ***: p<0.001
See this image and copyright information in PMC

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