Department of Geriatric Medicine, NoordWest Hospital Group, Alkmaar, The Netherlands,
Department of Geriatric Medicine, NoordWest Hospital Group, Alkmaar, The Netherlands.
Dement Geriatr Cogn Disord. 2020;49(1):2-7. doi: 10.1159/000506332. Epub 2020 Mar 30.
BACKGROUND/AIMS: Research guidelines on predicting and diagnosing Alzheimer's disease (AD) acknowledge cerebrospinal fluid (CSF) levels as pivotal biomarkers. We studied the usefulness of CSF biomarkers in the diagnostic workup of patients in a geriatric outpatient memory clinic of a community-based hospital, attempted to determine a cutoff age for the use of CSF biomarkers in this group of patients, and compared the total τ/Aβ ratio as an alternative CSF diagnostic rule with the usual rules for interpreting CSF levels.
This was a prospective study of consecutively referred patients. Inclusion criteria were described on the basis of previous study results in the same setting. The CSF tool was applied either to differentiate between AD and no AD or to increase certainty having made the diagnosis of AD. Clinicians were asked to judge whether the CSF results were helpful to them or not.
The reasons to use the CSF tool in the diagnostic workup were in 78/106 patients to decide between the diagnosis "AD" and "no AD" and in 28/106 patients to increase the certainty regarding the diagnosis. In 75% of cases the CSF levels were considered diagnostically helpful to the clinicians. Results in the present setting suggest 65 years as the cutoff age to use CSF as a diagnostic tool. The sensitivity and specificity of the total τ/Aβ ratio using the clinical diagnosis as the gold standard were at least as good as the usual categorization rule.
Our study results corroborate earlier findings that the CSF tool is of added value to the diagnostic workup in daily clinical practice outside tertiary referral centers. CSF levels can best be used in patients under 66 years of age. Given the limited use of this tool in settings outside research facilities, we recommend that the usefulness of CSF biomarkers is studied in a multicenter study. When in the future CSF levels can be reliably measured in plasma, this may become even more relevant.
背景/目的：预测和诊断阿尔茨海默病（AD）的研究指南承认脑脊液（CSF）水平是关键的生物标志物。我们研究了在社区医院老年门诊记忆诊所的患者的诊断工作中 CSF 生物标志物的有用性，尝试确定在该组患者中使用 CSF 生物标志物的截止年龄，并比较总 τ/Aβ 比值作为替代 CSF 诊断规则与解释 CSF 水平的常用规则。
这是一项连续转诊患者的前瞻性研究。纳入标准是根据同一环境中先前的研究结果描述的。CSF 工具用于区分 AD 和非 AD，或增加 AD 诊断的确定性。临床医生被要求判断 CSF 结果是否对他们有帮助。
在诊断工作中使用 CSF 工具的原因是在 106 名患者中的 78 名患者中决定“AD”和“非 AD”之间的诊断，在 106 名患者中的 28 名患者中增加对诊断的确定性。在 75%的情况下，CSF 水平被认为对临床医生具有诊断帮助。本研究结果表明，65 岁是将 CSF 作为诊断工具的截止年龄。使用临床诊断作为金标准时，总 τ/Aβ 比值的敏感性和特异性至少与常规分类规则一样好。
我们的研究结果证实了 CSF 工具在三级转诊中心以外的日常临床实践中对诊断工作具有附加价值的早期发现。CSF 水平最适合年龄在 66 岁以下的患者使用。鉴于该工具在研究设施外的使用有限，我们建议在多中心研究中研究 CSF 生物标志物的有用性。当将来能够在血浆中可靠地测量 CSF 水平时，这可能会变得更加相关。
