Investigating the relationship between patient demographics and diagnostic workup in patients with Creutzfeldt-Jakob Disease (CJD).

This was a single-center retrospective analysis conducted at Stanford University. 38 patients with ICD10 diagnosis of CJD were identified. Demographic information, including sex (F=27, M=11), ethnicity (35 white (4 Hispanic), 3 Asian), age (56-82), and insurance type were obtained to evaluate whether these factors led to significantly different neurodiagnostic workup (MRI, LP, RT-Quic, 14-3-3, EEG, autoimmune encephalitis (AE) panel). Difference of proportions hypothesis test was conducted.  Age of diagnosis, and time-to-diagnosis from first symptom onset were retrospectively reviewed and a two-tailed t-test was used to investigate whether these differed significantly among different demographic groups.

Average age of diagnosis was 67.0, and average time-to-diagnosis from symptom onset was 4.4 months. 97% of patients got MRI; 95% EEG; 92% LP; 71% RT-Quic; 71% 14-3-3; 63% AE panel. Male patients were diagnosed faster than female patients based on first symptom-onset (2.7 vs. 5.0 months), but got less RT-Quic (45% vs. 81%) and 14-3-3 (45% vs. 81%). Hispanic patients got less RT-Quic (25% vs. 76%) and 14-3-3 (50% vs. 74%) compared to non-Hispanic patients. Patients older than 65 took longer to diagnose (4.6 vs. 4.2 months). Lastly, patients with private insurance compared to public had more RT-Quic sent (86% vs. 63%), and were diagnosed at a younger age (61.7 vs. 70.0), but took longer to diagnose (5.8 vs. 3.5 months).

Our single-center study demonstrates that demographic features may play an important role in diagnostic pursuits in patients with CJD. Further multicenter studies, including patients of differing backgrounds to better reflect the larger service community, will elucidate the intricate relationships among each social determinants of health.