Abstract Details

Title Application of Appropriate Use Criteria for Cerebrospinal Fluid Testing for Alzheimer Disease Biomarkers: A Retrospective, Real-World Assessment in a Dementia Specialty Clinic

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 024

Objective To investigate the real-world use of lumbar puncture (LP) and cerebrospinal fluid (CSF) testing for Alzheimer disease (AD) biomarkers.

Background Consensus-driven appropriate use criteria (AUC) for CSF testing in the diagnosis of AD were published in 2018. It is unclear how well clinical practice followed these AUC in the years biomarkers were obtained prior to AUC dissemination. At the Brigham and Women’s Hospital Alzheimer Center, approximately 600 new patients are seen annually for diagnostic evaluation.

Design/Methods A retrospective review of records at the Alzheimer Center was conducted for patients who underwent LP for CSF AD biomarkers from 2010 to 2015. During this period, 109 patients had their CSF tested for AD biomarkers. Test results were available for 100 patients, and clinical data was available for 105 patients.

Results Of the 105 patients for whom clinical data was available, all met AUC. The most common criteria were “mild cognitive impairment or dementia with onset before age 65” (53.3%), “symptoms that suggest possible AD” (21.0%), and “a dominant symptom of behavior change where AD is being considered” (12.4%). 99 patients (94.3%) followed up post-LP at the Alzheimer Center. In 48.5% of cases, the results of CSF testing (and other concurrent testing) resulted in a change of diagnostic impression. In 51.5% of cases, the results of CSF testing affirmed the pre-test diagnosis. The least stable diagnostic impressions were “dementia,” “neurodegenerative process,” and “cognitive impairment of unknown etiology” (83.3%, 80.0%, and 76.92% of pre-test diagnoses were changed, respectively), while the most stable was AD (7.7% of pre-test diagnoses were changed).

Conclusions The indications used by sub-specialty neurologists to obtain CSF AD biomarkers during the early years of CSF AD testing were very closely aligned with later-established, consensus-based AUC. Understanding clinical care before and after guidelines are established and disseminated is essential in optimizing their real-world implementation.

Authors/Disclosures
Taylor Krivanek (Brigham and Women's Hospital) PRESENTER	Miss Krivanek has nothing to disclose.
Seth Gale, MD (Brigham and Womens Hospital)	Dr. Gale has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cowen. The institution of Dr. Gale has received research support from Brigham And Women's Hospital.

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