The clinical use of Alzheimer’s biomarkers in patients with mild cognitive impairment

Abstract

AbstractBackgroundAlzheimer’s disease (AD) is defined as a clinic‐biological disease characterized by the abnormal deposition of amyloid and tau in the brain. AD biomarkers offer the perspective to confirm the presence of amyloid and tau pathology in vivo and supports their increasing use in clinical practice. The aim of this study is to investigate the clinical use of the main AD biomarkers, focusing on amyloid‐PET and tau‐PET, by examining the beliefs and preferences of clinicians (neurologists, geriatricians, psychiatrists) as well as biomarker experts (nuclear medicine, radiology, laboratory physicians) participating in the European Alzheimer’s Disease Consortium (EADC). In the present abstract, we focus on clinicians.MethodThe survey was made accessible from May to September 2020. The questionnaire assessed, among others: respondent’s profile (level of expertise, type of practice), frequency of use of biomarkers, beliefs about the pathogenic role of amyloid and tau in Alzheimer's disease, and perceived clinical utility of amyloid‐PET and tau‐PET.ResultIn total, 150 professionals filled in the survey, with an overall answer rate of 49% (150/306): among them, 100 were clinician experts in the field of neurodegenerative disorders. These clinicians reported a frequent‐to‐constant use of medial temporal atrophy (MTA) in 77% of cases, CSF in 45%, FDG‐PET in 32%, amyloid‐PET in 8%, and tau‐PET in 2%. Clinicians attributed a prevalent pathogenic role in AD pathology and symptoms to amyloid (42%) more frequently than tau (20%, p=0.001). The perceived clinical utility of amyloid‐PET and tau‐PET in supporting an etiological diagnosis in MCI and mild dementia patients was more balanced (35% vs 24%, p=0.121) then clinicians’ beliefs about the pathogenic role of amyloid and tau.ConclusionThese results highlight the frequent use of traditional AD biomarker (i.e. MTA, FDG‐PET, CSF) and a non‐negligible use of amyloid‐PET. Clinicians consistently attributed a greater pathogenic role in AD pathology and symptoms to amyloid rather than tau. However, when the focus switched from the belief about the pathogenic role of amyloid and tau to their diagnostic contribution, amyloid‐ PET and tau‐PET scans were considered equally useful.