Abstract
AbstractBackgroundThe analytical and clinical validity of fluid biomarkers, measured typically in cerebrospinal (CSF) serum or plasma, has been extensively researched in dementia. Further work is needed to assess the ability of these biomarkers to improve diagnosis, management, and health outcomes in the clinical settingObjectivesTo assess the added value and clinical utility of fluid biomarkers in the diagnostic assessment of cognitively impaired patients under evaluation for Alzheimer’s disease (AD).MethodsSystematic literature searches of Medline, EMBASE, PsycINFO, Web of Science research databases were conducted on 17th December 2022. Data from relevant studies were extracted and independently screened for quality using a tool for bias. Clinical utility was measured by clinicians’ changes in diagnosis, diagnostic confidence, and patient management (when available), after their examination of patients’ fluid biomarkers. Cost-effectiveness was assessed by consideration of additional cost per patient and quality-adjusted life years (QALY).ResultsSearches identified 18 studies comprising 2199 patient participants and 599 clinicians. The meta-analysis revealed that clinicians’ use of fluid biomarkers resulted in a pooled percentage change in diagnosis of 25% (95% CI: 14–37), an increase in diagnostic confidence of 14% (95% CI: 9–18) and a pooled proportion of patients whose management changed of 31% (95% CI 12–50). CSF biomarkers were deemed cost effective, particularly in memory services, where pre-test AD prevalence is higher compared to a primary care setting.ConclusionsFluid biomarkers can be a helpful additional diagnostic tool for clinicians assessing patients with cognitive impairment. In particular, CSF biomarkers consistently improved clinicians’ confidence in diagnosing AD and influenced on diagnostic change and patient management. Further research is needed to study the clinical utility of blood-based biomarkers in the clinical setting.
Publisher
Cold Spring Harbor Laboratory