Biomarkers study in atypical dementia: proof of a diagnostic work-up

  • Gemma Lombardi
  • Cristina Polito
  • Valentina Berti
  • Camilla Ferrari
  • Giulia Lucidi
  • Silvia Bagnoli
  • Irene Piaceri
  • Benedetta Nacmias
  • Alberto Pupi
  • Sandro Sorbi
Original Article
  • 24 Downloads

Abstract

An early differentiation between Alzheimer’s Disease (AD) and other dementias is crucial for an adequate patients’ management, albeit it may result difficult for the occurrence of “atypical presentations.” Current diagnostic criteria recognize the importance of biomarkers for AD diagnosis, but still an optimal diagnostic work-up isn’t available. Evaluate the utility and reproducibility of biomarkers and propose an “optimal” diagnostic work-up in atypical dementia: (1) a retrospective selection of “atypical dementia cases”; (2) a repetition of diagnostic assessment by two neurologists following two different diagnostic work-ups, each consisting of multiple steps; (3) a comparison between diagnostic accuracy and confidence reached at each step by both neurologists and evaluation of the inter-rater agreement. In AD, regardless of the undertaken diagnostic work-up, a significant gain in accuracy was reached by both neurologists after the second step, whereas in frontotemporal dementia (FTD), adding subsequent steps was not always sufficient to increase significantly the baseline accuracy. A relevant increment in diagnostic confidence was detectable after studying pathophysiological markers in AD, and after assessing brain metabolism in FTD. The inter-rater agreement was higher at the second step for the AD group when the pathophysiological markers were available and for the FTD group when the results of FDG-PET were accessible. In atypical cases of dementia, biomarkers significantly raise diagnostic accuracy, confidence, and agreement. This study introduces a proof of diagnostic work-up that combines imaging and CSF biomarkers and suggests distinct ways to proceed on the basis of a greater diagnostic likelihood.

Keywords

Biomarker Diagnostic work-up Alzheimer’s Disease Frontotemporal Dementia Cerebrospinal fluid PET imaging 

Notes

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  • Gemma Lombardi
    • 1
  • Cristina Polito
    • 2
  • Valentina Berti
    • 2
  • Camilla Ferrari
    • 1
  • Giulia Lucidi
    • 1
    • 3
  • Silvia Bagnoli
    • 1
  • Irene Piaceri
    • 1
  • Benedetta Nacmias
    • 1
  • Alberto Pupi
    • 2
  • Sandro Sorbi
    • 1
    • 3
  1. 1.Department of Neuroscience, Psychology, Drug Research and Child HealthUniversity of FlorenceFlorenceItaly
  2. 2.Department of Biomedical, Experimental and Clinical Sciences “Mario Serio,” Nuclear Medicine UnitUniversity of FlorenceFlorenceItaly
  3. 3.IRCCS Don GnocchiFlorenceItaly

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