Current Approaches and Clinician Attitudes to the Use of Cerebrospinal Fluid Biomarkers in Diagnostic Evaluation of Dementia in Europe

Article type: Research Article

Authors: Miller, Anne-Marie^a | Balasa, Mircea^b | Blennow, Kaj^c | Gardiner, Mary^d | Rutkowska, Aleksandra^a | Scheltens, Philip^e | Teunissen, Charlotte E.^f | Visser, Pieter Jelle^{e; g} | Winblad, Bengt^h | Waldemar, Gunhildⁱ | Lawlor, Brian^{b; j; *}

Affiliations: [a] Medical Gerontology, School of Medicine, Trinity College, Dublin, Ireland | [b] Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland | [c] Clinical Neurochemistry Lab, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden | [d] Immunology Laboratory, St. James’s Hospital, Dublin, Ireland | [e] Department of Neurology/Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands | [f] Department of Clinical Chemistry, Neurochemistry Lab and Biobank, Neurocampus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands | [g] Department of Psychiatry and Neuropsychology, Alzheimer Centre Limburg, Maastricht University Medical Centre, School for Mental Health and Neuroscience, Maastricht, The Netherlands | [h] Department NVS, Karolinska Institute, Centre for Alzheimer Research, Division of Neurogeriatrics, Huddinge, Sweden | [i] Department of Neurology, Danish Dementia Research Centre, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark | [j] Mercer’s Institute for Successful Ageing, St. James’s Hospital, Dublin, Ireland

Correspondence: [*] Correspondence to: Prof. Brian Lawlor, Room 345 Lloyd Building, Trinity College Institute of Neuroscience, Dublin 2, Ireland. Tel.: +00 353 1 8968576; E-mail: lawlorba@tcd.ie.

Abstract: Background:BIOMARKAPD seeks to diminish the barriers associated with the clinical use of cerebrospinal fluid (CSF) biomarker analysis by reducing variation in CSF laboratory methodologies and generating consensus recommendations on their clinical interpretation and application for dementia diagnosis. Objective:To examine the disparity in practitioner attitudes and clinical practice relating to the use of CSF biomarkers for dementia diagnosis across Europe. Methods:Clinical dementia experts were surveyed on the prevalence of national consensus guidelines and analytical reimbursement across Europe, their biomarker platform preferences, lumbar puncture methodologies and application of reference values and cut-offs for CSF analysis. Results:74% of respondents (total n = 51) use CSF biomarkers in clinical practice and 69% perform lumbar punctures on an outpatient basis. Most use CSF biomarkers to diagnose atypical (84%) and early-onset cases of cognitive impairment (71%) and for the differential diagnosis of other dementias (69%). 82% state they are sufficiently informed about CSF biomarkers yet 61% report a lack of national consensus guidelines on their use for dementia diagnosis. 48% of countries represented do not reimburse clinical CSF analysis costs. 43% report using normal reference ranges derived from publications. Conclusion:Variations in attitude and practice relating to CSF biomarkers, widely recognised as barriers to their clinical acceptance, remain evident within and between countries across Europe, even in expert centres. These shortcomings must be addressed by developing consensus guidelines on CSF-related methodologies and their clinical application, to further their use for the diagnostic evaluation of dementia.

Keywords: Alzheimer’s disease, attitudes, biomarkers, cerebrospinal fluid, dementia

DOI: 10.3233/JAD-170502

Journal: Journal of Alzheimer's Disease, vol. 60, no. 1, pp. 201-210, 2017