Relevance of Follow-Up in Patients with Core Clinical Criteria for Alzheimer Disease and Normal CSF Biomarkers

Title:Relevance of Follow-Up in Patients with Core Clinical Criteria for Alzheimer Disease and Normal CSF Biomarkers

Volume: 15 Issue: 7

Author(s): Olivier Vercruysse, Claire Paquet, Audrey Gabelle, Xavier Delbeuck, Frederic Blanc, David Wallon, Julien Dumurgier, Eloi Magnin, Olivier Martinaud, Barbara Jung, Olivier Bousiges, Sylvain Lehmann, Constance Delaby, Muriel Quillard-Murain, Katell Peoc`h, Jean-Louis Laplanche, Elodie Bouaziz-Amar, Didier Hannequin, Bernard Sablonniere, Luc Buee, Jacques Hugon, Susanna Schraen, Florence Pasquier, Stephanie Bombois* for the e-PLM group

Affiliation:

• University Lille, Inserm U1171, Centre Mémoire de Ressources et de Recherche & CNR-MAJ, CHU Lille, F-59000 Lille,France

Keywords: Alzheimer disease, dementia, mild cognitive impairment, biomarker, cerebrospinal fluid, vascular dementia, frontotemporal dementia, depression.

Abstract: Background: Few patients with a normal cerebrospinal fluid (CSF) biomarker profile fulfill the clinical criteria for Alzheimer disease (AD).

Objective: The aim of this study was to test the hypothesis of misdiagnoses for these patients.

Method: Patients from the e-PLM centers fulfilling the core clinical criteria for probable AD dementia or mild cognitive impairment due to AD (AD-MCI), with normal CSF Aβ1-42, T-tau and P-tau biomarkers and clinical follow-up, were included. Clinical and imaging data were reviewed by an independent board, from baseline (visit with clinical evaluation and CSF analysis) to the end of the follow-up, for a final diagnosis.

Results: In the e-PLM cohort of 1098 AD patients with CSF analysis, 37 (3.3%) patients (20 with AD dementia core clinical criteria and 17 with AD-MCI core clinical criteria) had normal CSF biomarker profile and a clinical follow-up. All patients presented with episodic memory impairment and 27 (73%) had medial temporal lobe atrophy on MRI-scan. After a median follow-up of 36 months (range 7-74), the final diagnosis was AD MCI or dementia for 9 (24%) patients, and unlikely due to AD for 28 (76%) patients. A misdiagnosis was corrected in 18 (49%) patients (mood disorders, non-AD degenerative dementia, vascular cognitive impairment, alcohol cognitive disorders, temporal epilepsy and hippocampal sclerosis), and 10 (27%) patients had cognitive disorders of undetermined etiology.

Conclusion: AD diagnosis (MCI or dementia) with normal CSF biomarkers is a rare condition. A clinical follow- up is particularly recommended to consider an alternative diagnosis.

Cite this article as:

Vercruysse Olivier , Paquet Claire, Gabelle Audrey , Delbeuck Xavier , Blanc Frederic , Wallon David , Dumurgier Julien , Magnin Eloi , Martinaud Olivier , Jung Barbara , Bousiges Olivier, Lehmann Sylvain , Delaby Constance , Quillard-Murain Muriel, Peoc`h Katell, Laplanche Jean-Louis, Bouaziz-Amar Elodie , Hannequin Didier, Sablonniere Bernard , Buee Luc , Hugon Jacques, Schraen Susanna , Pasquier Florence, Bombois Stephanie *, for the e-PLM group , Relevance of Follow-Up in Patients with Core Clinical Criteria for Alzheimer Disease and Normal CSF Biomarkers, Current Alzheimer Research 2018; 15 (7) . https://dx.doi.org/10.2174/1567205015666180110113238