Evaluating combinations of diagnostic tests to discriminate different dementia types

doi:10.1016/j.dadm.2018.07.003

. 2018 Aug 17:10:509-518.

doi: 10.1016/j.dadm.2018.07.003. eCollection 2018.

Evaluating combinations of diagnostic tests to discriminate different dementia types

Marie Bruun¹, Hanneke F M Rhodius-Meester², Juha Koikkalainen³, Marta Baroni⁴, Le Gjerum¹, Afina W Lemstra², Frederik Barkhof^{5

6}, Anne M Remes^{7

8}, Timo Urhemaa⁹, Antti Tolonen⁹, Daniel Rueckert¹⁰, Mark van Gils⁹, Kristian S Frederiksen¹, Gunhild Waldemar¹, Philip Scheltens², Patrizia Mecocci⁴, Hilkka Soininen¹¹, Jyrki Lötjönen³, Steen G Hasselbalch¹, Wiesje M van der Flier^{2

12}

Affiliations

¹ Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
² Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, the Netherlands.
³ Combinostics Ltd., Tampere, Finland.
⁴ Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy.
⁵ Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, the Netherlands.
⁶ UCL Institutes of Neurology and Healthcare Engineering, London, United Kingdom.
⁷ Medical Research Center, Oulu University Hospital, Oulu, Finland.
⁸ Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.
⁹ VTT Technical Research Center of Finland Ltd, Tampere, Finland.
¹⁰ Department of Computing, Imperial College, London, United Kingdom.
¹¹ Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.
¹² Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, the Netherlands.

PMID: 30320203
PMCID: PMC6180596
DOI: 10.1016/j.dadm.2018.07.003

Free PMC article

Evaluating combinations of diagnostic tests to discriminate different dementia types

Marie Bruun et al. Alzheimers Dement (Amst). 2018.

Free PMC article

. 2018 Aug 17:10:509-518.

doi: 10.1016/j.dadm.2018.07.003. eCollection 2018.

Authors

Affiliations

¹ Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
² Alzheimer Center, Department of Neurology, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, the Netherlands.
³ Combinostics Ltd., Tampere, Finland.
⁴ Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy.
⁵ Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, the Netherlands.
⁶ UCL Institutes of Neurology and Healthcare Engineering, London, United Kingdom.
⁷ Medical Research Center, Oulu University Hospital, Oulu, Finland.
⁸ Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland.
⁹ VTT Technical Research Center of Finland Ltd, Tampere, Finland.
¹⁰ Department of Computing, Imperial College, London, United Kingdom.
¹¹ Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland.
¹² Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Neuroscience, Amsterdam, the Netherlands.

PMID: 30320203
PMCID: PMC6180596
DOI: 10.1016/j.dadm.2018.07.003

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; CSF; Clinical decision support system; Dementia with Lewy bodies; Diagnostic test assessment; Differential diagnosis; Frontotemporal dementia; MRI; Vascular dementia.

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References

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[1] World Health Organization. Global action plan on the public health response to dementia 2017-2025. World Health Organization. 2017:1–44. Available at: http://www.who.int/mental_health/neurology/dementia/action_plan_2017_202...

[2] World Health Organization. Global action plan on the public health response to dementia 2017-2025. World Health Organization. 2017:1–44. Available at: http://www.who.int/mental_health/neurology/dementia/action_plan_2017_202...

[3] Lobo A., Launer L.J., Fratiglioni L., Andersen K., Di Carlo A., Breteler M.M. Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54:S4–S9. - PubMed

[4] Lobo A., Launer L.J., Fratiglioni L., Andersen K., Di Carlo A., Breteler M.M. Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54:S4–S9. - PubMed

[5] McKhann G.M., Knopman D.S., Chertkow H., Hyman B.T., Jack C.R., Jr., Kawas C.H. The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7:263–269. - PMC - PubMed

[6] McKhann G.M., Knopman D.S., Chertkow H., Hyman B.T., Jack C.R., Jr., Kawas C.H. The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011;7:263–269. - PMC - PubMed

[7] Roman G.C., Tatemichi T.K., Erkinjuntti T., Cummings J.L., Masdeu J.C., Garcia J.H. Vascular dementia: Diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology. 1993;43:250–260. - PubMed

[8] Roman G.C., Tatemichi T.K., Erkinjuntti T., Cummings J.L., Masdeu J.C., Garcia J.H. Vascular dementia: Diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology. 1993;43:250–260. - PubMed

[9] Rascovsky K., Hodges J.R., Knopman D., Mendez M.F., Kramer J.H., Neuhaus J. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 2011;134:2456–2477. - PMC - PubMed

[10] Rascovsky K., Hodges J.R., Knopman D., Mendez M.F., Kramer J.H., Neuhaus J. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 2011;134:2456–2477. - PMC - PubMed

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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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