Evaluating combinations of diagnostic tests to discriminate different dementia types

Marie Bruun*, Hanneke F.M. Rhodius-Meester, Juha Koikkalainen, Marta Baroni, Le Gjerum, Afina W. Lemstra, Frederik Barkhof, Anne M. Remes, Timo Urhemaa, Antti Tolonen, Daniel Rueckert, Mark van Gils, Kristian S. Frederiksen, Gunhild Waldemar, Philip Scheltens, Patrizia Mecocci, Hilkka Soininen, Jyrki Lötjönen, Steen G. Hasselbalch, Wiesje M. van der Flier

*Corresponding author for this work

    Research output: Contribution to journalArticleScientificpeer-review

    29 Citations (Scopus)

    Abstract

    Introduction: We studied, using a data-driven approach, how different combinations of diagnostic tests contribute to the differential diagnosis of dementia. Methods: In this multicenter study, we included 356 patients with Alzheimer's disease, 87 frontotemporal dementia, 61 dementia with Lewy bodies, 38 vascular dementia, and 302 controls. We used a classifier to assess accuracy for individual performance and combinations of cognitive tests, cerebrospinal fluid biomarkers, and automated magnetic resonance imaging features for pairwise differentiation between dementia types.

    Results: Cognitive tests had good performance in separating any type of dementia from controls. Cerebrospinal fluid optimally contributed to identifying Alzheimer's disease, whereas magnetic resonance imaging features aided in separating vascular dementia, dementia with Lewy bodies, and frontotemporal dementia. Combining diagnostic tests increased the accuracy, with balanced accuracies ranging from 78% to 97%.

    Discussion: Different diagnostic tests have their distinct roles in differential diagnostics of dementias. Our results indicate that combining different diagnostic tests may increase the accuracy further.
    Original languageEnglish
    Pages (from-to)509-518
    JournalAlzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring
    Volume10
    DOIs
    Publication statusPublished - 1 Jan 2018
    MoE publication typeNot Eligible

    Funding

    This project has received funding from the European Union's Seventh Framework Programme for research, technological development and demonstration under grant agreements no 611005 (PredictND). For development of the PredictND tool, the VTT Technical Research Center of Finland Ltd has received funding from European Union's Seventh Framework Programme for research, technological development, and demonstration under grant agreements 601055 (VPH-DARE@IT), 224328, and 611005. F.B. is supported by the NIHR UCLH Biomedical Research Centre. P.S. received funding for travel from Pfizer, Elan, Janssen, and Danone Research. J.L. and J.K. are shareholders in Combinostics Oy. W.M.v.d.F. performs contract research for Biogen. Research programs of W.M.v.d.F. have been funded by ZonMW, NWO, EU-FP7, Alzheimer Nederland, CardioVascular Onderzoek Nederland, Stichting Dioraphte, Gieskes-Strijbis fonds, Boehringer Ingelheim, Piramal Neuroimaging, Roche BV, Janssen Stellar, and Combinostics. All funding is paid to her institution.

    Keywords

    • Alzheimer's disease
    • Biomarkers
    • Clinical decision support system
    • CSF
    • Dementia with Lewy bodies
    • Diagnostic test assessment
    • Differential diagnosis
    • Frontotemporal dementia
    • MRI
    • Vascular dementia

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