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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.

SUBMITTER: Bruun M

PROVIDER: S-EPMC6180596 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Evaluating combinations of diagnostic tests to discriminate different dementia types.

Bruun Marie M Rhodius-Meester Hanneke F M HFM Koikkalainen Juha J Baroni Marta M Gjerum Le L Lemstra Afina W AW Barkhof Frederik F Remes Anne M AM Urhemaa Timo T Tolonen Antti A Rueckert Daniel D van Gils Mark M Frederiksen Kristian S KS Waldemar Gunhild G Scheltens Philip P Mecocci Patrizia P Soininen Hilkka H Lötjönen Jyrki J Hasselbalch Steen G SG van der Flier Wiesje M WM

Alzheimer's & dementia (Amsterdam, Netherlands) 20180817

<h4>Introduction</h4>We studied, using a data-driven approach, how different combinations of diagnostic tests contribute to the differential diagnosis of dementia.<h4>Methods</h4>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 autom ...[more]

PMID: 30320203

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Project description:BACKGROUND:Discrimination between early-stage dementia and other cognitive impairment diagnoses is central to enable appropriate interventions. Previous studies indicate that dual-task testing may be useful in such differentiation. The objective of this study was to investigate whether dual-task test outcomes discriminate between groups of individuals with dementia disorder, mild cognitive impairment, subjective cognitive impairment, and healthy controls. METHODS:A total of 464 individuals (mean age 71?years, 47% women) were included in the study, of which 298 were patients undergoing memory assessment and 166 were cognitively healthy controls. Patients were grouped according to the diagnosis received: dementia disorder, mild cognitive impairment, or subjective cognitive impairment. Data collection included participants' demographic characteristics. The patients' cognitive test results and diagnoses were collected from their medical records. Healthy controls underwent the same cognitive tests as the patients. The mobility test Timed Up-and-Go (TUG single-task) and two dual-task tests including TUG (TUGdt) were carried out: TUGdt naming animals and TUGdt months backwards. The outcomes registered were: time scores for TUG single-task and both TUGdt tests, TUGdt costs (relative time difference between TUG single-task and TUGdt), number of different animals named, number of months recited in correct order, number of animals per 10?s, and number of months per 10?s. Logistic regression models examined associations between TUG outcomes pairwise between groups. RESULTS:The TUGdt outcomes "animals/10?s" and "months/10?s" discriminated significantly (p <?0.001) between individuals with an early-stage dementia diagnosis, mild cognitive impairment, subjective cognitive impairment, and healthy controls. The TUGdt outcome "animals/10?s" showed an odds ratio of 3.3 (95% confidence interval 2.0-5.4) for the groups dementia disorders vs. mild cognitive impairment. TUGdt cost outcomes, however, did not discriminate between any of the groups. CONCLUSIONS:The novel TUGdt outcomes "words per time unit", i.e. "animals/10?s" and "months/10?s", demonstrate high levels of discrimination between all investigated groups. Thus, the TUGdt tests in the current study could be useful as complementary tools in diagnostic assessments. Future studies will be focused on the predictive value of TUGdt outcomes concerning dementia risk for individuals with mild cognitive impairment or subjective cognitive impairment.

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Evaluating combinations of diagnostic tests to discriminate different dementia types.

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Evaluating combinations of diagnostic tests to discriminate different dementia types.

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