Clinical utility of cerebrospinal fluid Alzheimer’s disease biomarkers in the diagnostic workup of complex patients with cognitive impairment
Abstract Cerebrospinal fluid (CSF) biomarkers have been widely adopted in Alzheimer’s disease (AD) diagnosis. However, no studies focused on the application of CSF biomarkers in the clinical practice of complex and atypical patients with cognitive impairment in China. This study aimed to evaluate th...
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| Format: | Article |
| Language: | English |
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Nature Publishing Group
2025-04-01
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| Series: | Translational Psychiatry |
| Online Access: | https://doi.org/10.1038/s41398-025-03345-z |
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| author | Ming-Yu Wang Ke-Liang Chen Yu-Yuan Huang Shu-Fen Chen Rong-Ze Wang Yi Zhang He-Ying Hu Ling-Zhi Ma Wei-Shi Liu Jun Wang Jia-Wei Xin Xue Zhang Meng-Meng Li Yu Guo Qiang Dong Wei Cheng Lan Tan Mei Cui Ya-Ru Zhang Jin-Tai Yu |
| author_facet | Ming-Yu Wang Ke-Liang Chen Yu-Yuan Huang Shu-Fen Chen Rong-Ze Wang Yi Zhang He-Ying Hu Ling-Zhi Ma Wei-Shi Liu Jun Wang Jia-Wei Xin Xue Zhang Meng-Meng Li Yu Guo Qiang Dong Wei Cheng Lan Tan Mei Cui Ya-Ru Zhang Jin-Tai Yu |
| author_sort | Ming-Yu Wang |
| collection | DOAJ |
| description | Abstract Cerebrospinal fluid (CSF) biomarkers have been widely adopted in Alzheimer’s disease (AD) diagnosis. However, no studies focused on the application of CSF biomarkers in the clinical practice of complex and atypical patients with cognitive impairment in China. This study aimed to evaluate the added value of CSF AD biomarkers in cognitively impaired patients with complex conditions in a memory clinical setting. A total of 633 participants were included from the National Center for Neurological Disorders in Shanghai, China. The CSF AD biomarkers were measured with ELISA. Cutoff values were firstly identified using Youden’s index. The neurologists proposed etiology diagnosis with a percentage estimate of their confidence and prescribed medication before and after CSF disclosure. Changes in etiological diagnosis, diagnostic confidence, and management plan were compared across the groups. Of the 633 patients (mean [SD] age, 61.1 [11.3] years; 295 males [46.6%]), 372 (58.8%) were diagnosed with dementia, 103 (16.3%) with mild cognitive impairment, and 158 (24.9%) with subjective cognitive decline. Using those pre-defined cutoffs, we categorized patients into 3 groups: Alzheimer’s continuum (68.1%), non-AD pathologic change (11.1%), and normal AD biomarkers (20.8%). After CSF disclosure, the proposed etiology changed in 158 (25.0%) participants and the prescribed medication changed in 200 (31.6%) patients. Mean diagnostic confidence increased from 69.5–83.0% (+13.5%; P < 0.001). In conclusion, CSF AD biomarkers significantly impacted the diagnosis, diagnostic confidence, and treatment plans for Chinese patients with complex cognitive impairment. CSF AD biomarkers are a useful tool for clinicians beyond routine clinical assessment. |
| format | Article |
| id | doaj-art-1e1a0960243e4e78a22fac5bf583e246 |
| institution | DOAJ |
| issn | 2158-3188 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Nature Publishing Group |
| record_format | Article |
| series | Translational Psychiatry |
| spelling | doaj-art-1e1a0960243e4e78a22fac5bf583e2462025-08-20T03:10:14ZengNature Publishing GroupTranslational Psychiatry2158-31882025-04-0115111010.1038/s41398-025-03345-zClinical utility of cerebrospinal fluid Alzheimer’s disease biomarkers in the diagnostic workup of complex patients with cognitive impairmentMing-Yu Wang0Ke-Liang Chen1Yu-Yuan Huang2Shu-Fen Chen3Rong-Ze Wang4Yi Zhang5He-Ying Hu6Ling-Zhi Ma7Wei-Shi Liu8Jun Wang9Jia-Wei Xin10Xue Zhang11Meng-Meng Li12Yu Guo13Qiang Dong14Wei Cheng15Lan Tan16Mei Cui17Ya-Ru Zhang18Jin-Tai Yu19Department of Neurology, Qingdao Municipal Hospital, Qingdao UniversityDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityDepartment of Neurology, Qingdao Municipal Hospital, Qingdao UniversityDepartment of Neurology, Qingdao Municipal Hospital, Qingdao UniversityDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityDepartment of Neurology and Centre for Clinical Neuroscience, Daping Hospital, Third Military Medical UniversityDepartment of Neurology, Fujian Institute of Geriatrics, Fujian Medical University Union HospitalDepartment of Neurology, Qingdao Central Hospital, University of Health and Rehabilitation SciencesDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityDepartment of Neurology, Qingdao Municipal Hospital, Qingdao UniversityDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityDepartment of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan UniversityAbstract Cerebrospinal fluid (CSF) biomarkers have been widely adopted in Alzheimer’s disease (AD) diagnosis. However, no studies focused on the application of CSF biomarkers in the clinical practice of complex and atypical patients with cognitive impairment in China. This study aimed to evaluate the added value of CSF AD biomarkers in cognitively impaired patients with complex conditions in a memory clinical setting. A total of 633 participants were included from the National Center for Neurological Disorders in Shanghai, China. The CSF AD biomarkers were measured with ELISA. Cutoff values were firstly identified using Youden’s index. The neurologists proposed etiology diagnosis with a percentage estimate of their confidence and prescribed medication before and after CSF disclosure. Changes in etiological diagnosis, diagnostic confidence, and management plan were compared across the groups. Of the 633 patients (mean [SD] age, 61.1 [11.3] years; 295 males [46.6%]), 372 (58.8%) were diagnosed with dementia, 103 (16.3%) with mild cognitive impairment, and 158 (24.9%) with subjective cognitive decline. Using those pre-defined cutoffs, we categorized patients into 3 groups: Alzheimer’s continuum (68.1%), non-AD pathologic change (11.1%), and normal AD biomarkers (20.8%). After CSF disclosure, the proposed etiology changed in 158 (25.0%) participants and the prescribed medication changed in 200 (31.6%) patients. Mean diagnostic confidence increased from 69.5–83.0% (+13.5%; P < 0.001). In conclusion, CSF AD biomarkers significantly impacted the diagnosis, diagnostic confidence, and treatment plans for Chinese patients with complex cognitive impairment. CSF AD biomarkers are a useful tool for clinicians beyond routine clinical assessment.https://doi.org/10.1038/s41398-025-03345-z |
| spellingShingle | Ming-Yu Wang Ke-Liang Chen Yu-Yuan Huang Shu-Fen Chen Rong-Ze Wang Yi Zhang He-Ying Hu Ling-Zhi Ma Wei-Shi Liu Jun Wang Jia-Wei Xin Xue Zhang Meng-Meng Li Yu Guo Qiang Dong Wei Cheng Lan Tan Mei Cui Ya-Ru Zhang Jin-Tai Yu Clinical utility of cerebrospinal fluid Alzheimer’s disease biomarkers in the diagnostic workup of complex patients with cognitive impairment Translational Psychiatry |
| title | Clinical utility of cerebrospinal fluid Alzheimer’s disease biomarkers in the diagnostic workup of complex patients with cognitive impairment |
| title_full | Clinical utility of cerebrospinal fluid Alzheimer’s disease biomarkers in the diagnostic workup of complex patients with cognitive impairment |
| title_fullStr | Clinical utility of cerebrospinal fluid Alzheimer’s disease biomarkers in the diagnostic workup of complex patients with cognitive impairment |
| title_full_unstemmed | Clinical utility of cerebrospinal fluid Alzheimer’s disease biomarkers in the diagnostic workup of complex patients with cognitive impairment |
| title_short | Clinical utility of cerebrospinal fluid Alzheimer’s disease biomarkers in the diagnostic workup of complex patients with cognitive impairment |
| title_sort | clinical utility of cerebrospinal fluid alzheimer s disease biomarkers in the diagnostic workup of complex patients with cognitive impairment |
| url | https://doi.org/10.1038/s41398-025-03345-z |
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