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

doi:10.1016/j.dadm.2018.07.003

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 journal › Article › Scientific › peer-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 language	English
Pages (from-to)	509-518
Journal	Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring
Volume	10
DOIs	https://doi.org/10.1016/j.dadm.2018.07.003
Publication status	Published - 1 Jan 2018
MoE publication type	Not 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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Bruun, M., Rhodius-Meester, H. F. M., Koikkalainen, J., Baroni, M., Gjerum, L., Lemstra, A. W., Barkhof, F., Remes, A. M., Urhemaa, T., Tolonen, A., Rueckert, D., van Gils, M., Frederiksen, K. S., Waldemar, G., Scheltens, P., Mecocci, P., Soininen, H., Lötjönen, J., Hasselbalch, S. G., & van der Flier, W. M. (2018). Evaluating combinations of diagnostic tests to discriminate different dementia types. Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring, 10, 509-518. https://doi.org/10.1016/j.dadm.2018.07.003

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title = "Evaluating combinations of diagnostic tests to discriminate different dementia types",

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.",

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

author = "Marie Bruun and Rhodius-Meester, {Hanneke F.M.} and Juha Koikkalainen and Marta Baroni and Le Gjerum and Lemstra, {Afina W.} and Frederik Barkhof and Remes, {Anne M.} and Timo Urhemaa and Antti Tolonen and Daniel Rueckert and {van Gils}, Mark and Frederiksen, {Kristian S.} and Gunhild Waldemar and Philip Scheltens and Patrizia Mecocci and Hilkka Soininen and Jyrki L{\"o}tj{\"o}nen and Hasselbalch, {Steen G.} and {van der Flier}, {Wiesje M.}",

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year = "2018",

month = jan,

day = "1",

doi = "10.1016/j.dadm.2018.07.003",

language = "English",

volume = "10",

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Bruun, M, Rhodius-Meester, HFM, Koikkalainen, J, Baroni, M, Gjerum, L, Lemstra, AW, Barkhof, F, Remes, AM, Urhemaa, T, Tolonen, A, Rueckert, D, van Gils, M, Frederiksen, KS, Waldemar, G, Scheltens, P, Mecocci, P, Soininen, H, Lötjönen, J, Hasselbalch, SG & van der Flier, WM 2018, 'Evaluating combinations of diagnostic tests to discriminate different dementia types', Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring, vol. 10, pp. 509-518. https://doi.org/10.1016/j.dadm.2018.07.003

TY - JOUR

T1 - Evaluating combinations of diagnostic tests to discriminate different dementia types

AU - Bruun, Marie

AU - Rhodius-Meester, Hanneke F.M.

AU - Koikkalainen, Juha

AU - Baroni, Marta

AU - Gjerum, Le

AU - Lemstra, Afina W.

AU - Barkhof, Frederik

AU - Remes, Anne M.

AU - Urhemaa, Timo

AU - Tolonen, Antti

AU - Rueckert, Daniel

AU - van Gils, Mark

AU - Frederiksen, Kristian S.

AU - Waldemar, Gunhild

AU - Scheltens, Philip

AU - Mecocci, Patrizia

AU - Soininen, Hilkka

AU - Lötjönen, Jyrki

AU - Hasselbalch, Steen G.

AU - van der Flier, Wiesje M.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Alzheimer's disease

KW - Biomarkers

KW - Clinical decision support system

KW - CSF

KW - Dementia with Lewy bodies

KW - Diagnostic test assessment

KW - Differential diagnosis

KW - Frontotemporal dementia

KW - MRI

KW - Vascular dementia

UR - http://www.scopus.com/inward/record.url?scp=85054439727&partnerID=8YFLogxK

U2 - 10.1016/j.dadm.2018.07.003

DO - 10.1016/j.dadm.2018.07.003

M3 - Article

C2 - 30320203

AN - SCOPUS:85054439727

SN - 2352-8729

VL - 10

SP - 509

EP - 518

JO - Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring

JF - Alzheimer's and Dementia: Diagnosis, Assessment and Disease Monitoring

ER -

Evaluating combinations of diagnostic tests to discriminate different dementia types

Abstract

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Keywords

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