Challenges in Alzheimer's Disease Diagnostic Work-Up: Amyloid Biomarker Incongruences.

Autor:	Lombardi G; Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.; Fondazione Filippo Turati, Pistoia, Italy., Pupi A; Fondazione Filippo Turati, Pistoia, Italy., Bessi V; Neurology Unit AOU Careggi, Florence, Italy., Polito C; Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', Nuclear Medicine Unit, University of Florence, Florence, Italy., Padiglioni S; Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy., Ferrari C; Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy., Lucidi G; Fondazione IRCCS Don Carlo Gnocchi, Florence, Italy., Berti V; Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', Nuclear Medicine Unit, University of Florence, Florence, Italy., De Cristofaro MT; Nuclear Medicine Unit, AOU Careggi, Florence, Italy., Piaceri I; Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy., Bagnoli S; Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy., Nacmias B; Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.; Fondazione IRCCS Don Carlo Gnocchi, Florence, Italy., Sorbi S; Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.; Fondazione IRCCS Don Carlo Gnocchi, Florence, Italy.
Jazyk:	angličtina
Zdroj:	Journal of Alzheimer's disease : JAD [J Alzheimers Dis] 2020; Vol. 77 (1), pp. 203-217.
DOI:	10.3233/JAD-200119
Abstrakt:	Background: Discordance among amyloid biomarkers is a challenge to overcome in order to increase diagnostic accuracy in dementia. Objectives: 1) To verify that cerebrospinal fluid (CSF) Aβ42/Aβ40 ratio (AβR) better agrees with Amyloid PET (Amy-PET) results compared to CSF Aβ42; 2) to detect differences among concordant positive, concordant negative, and discordant cases, basing the concordance definition on the agreement between CSF AβR and Amy-PET results; 3) to define the suspected underlying pathology of discordant cases using in vivo biomarkers. Method: We retrospectively enrolled 39 cognitively impaired participants in which neuropsychological tests, apolipoprotein E genotype determination, TC/MRI, FDG-PET, Amy-PET, and CSF analysis had been performed. In all cases, CSF analysis was repeated using the automated Lumipulse method. In discordant cases, FDG-PET scans were evaluated visually and using automated classifiers. Results: CSF AβR better agreed with Amy-PET compared to CSF Aβ42 (Cohen's K 0.431 versus 0.05). Comparisons among groups did not show any difference in clinical characteristics except for age at symptoms onset that was higher in the 6 discordant cases with abnormal CSF AβR values and negative Amy-PET (CSF AβR+/AmyPET-). FDG-PET and all CSF markers (Aβ42, AβR, p-Tau, t-Tau) were suggestive of Alzheimer's disease (AD) in 5 of these 6 cases. Conclusion: 1) CSF AβR is the CSF amyloid marker that shows the better level of agreement with Amy-PET results; 2) The use of FDG-PET and CSF-Tau markers in CSFAβR+/Amy-PET-discordant cases can support AD diagnosis; 3) Disagreement between positive CSF AβR and negative Amy-PET in symptomatic aged AD patients could be due to the variability in plaques conformation and a negative Amy-PET scan cannot be always sufficient to rule out AD.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu