Cited by 71Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsCerebrospinal fluid and hydrocephalus

Diagnostic Performance and Clinical Applicability of Blood-Based Biomarkers in a Prospective Memory Clinic Cohort

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Sarto, Jordi, Ruiz-García, Raquel, Guillén, Núria, Ramos-Campoy, Óscar, Falgàs, Neus, Esteller, Diana, Contador, José, Fernández, Guadalupe +14 more·2023·Neurology

Abstract

BACKGROUND AND OBJECTIVES: Blood-based biomarkers have emerged as minimally invasive options for evaluating cognitive impairment. Most studies to date have assessed them in research cohorts, limiting their generalization to everyday clinical practice. We evaluated their diagnostic performance and clinical applicability in a prospective, real-world, memory clinic cohort. METHODS: All patients referred with suspected cognitive impairment between July 2019 and June 2021 were prospectively invited to participate. Five plasma biomarkers (tau phosphorylated at threonine 181 [p-tau181], glial fibrillary acidic protein [GFAP], neurofilament light chain [NfL], total tau [t-tau], and ubiquitin C-terminal hydrolase L1 [UCH-L1]) were determined with single-molecule array. Performance was assessed in comparison to clinical diagnosis (blinded to plasma results) and amyloid status (CSF/PET). A group of cognitively unimpaired (CU) controls was also included. RESULTS: Three hundred forty-nine participants (mean age 68, SD 8.3 years) and 36 CU controls (mean age 61.7, SD 8.2 years) were included. In the subcohort with available Alzheimer disease (AD) biomarkers (n = 268), plasma p-tau181 and GFAP had a high diagnostic accuracy to differentiate AD from non-neurodegenerative causes (area under the receiver operating characteristic curve 0.94 and 0.92, respectively), with p-tau181 systematically outperforming GFAP. Plasma p-tau181 levels predicted amyloid status (85% sensitivity and specificity) with accurate individual prediction in approximately 60% of the patients. Plasma NfL differentiated frontotemporal dementia (FTD) syndromes from CU (0.90) and non-neurodegenerative causes (0.93), whereas the discriminative capacity with AD and between all neurodegenerative and non-neurodegenerative causes was less accurate. A combination of p-tau181 and NfL identified FTD with 82% sensitivity and 85% specificity and had a negative predictive value for neurodegenerative diagnosis of 86%, ruling out half of the non-neurodegenerative diagnoses. In the subcohort without AD biomarkers, similar results were obtained. T-tau and UCH-L1 did not offer added diagnostic value. DISCUSSION: Plasma p-tau181 predicted amyloid status with high accuracy and could have potentially avoided CSF/amyloid PET testing in approximately 60% of subjects in a memory clinic setting. NfL was useful for identifying FTD from non-neurodegenerative causes but behaved worse than p-tau181 in all other comparisons. Combining p-tau181 and NfL improved diagnostic performance for FTD and non-neurodegenerative diagnoses. However, the 14% false-negative results suggest that further improvement is needed before implementation outside memory clinics. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that plasma p-tau181 correlates with the presence or absence of AD and a combination of plasma p-tau181 and NfL correlates moderately well with a diagnosis of FTD.

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Crossref · 10.1212/wnl.0000000000201597

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Authors
Sarto, J., Ruiz-García, R., Guillén, N., Ramos-Campoy, Ó., Falgàs, N., Esteller, D., Contador, J., Fernández, G., González, Y., Tort-Merino, A., Juncà-Parella, J., Bosch, B., Borrego-Écija, S., Molina-Porcel, L., Castellví, M., Vergara, M., Antonell, A., Augé, J. M., Naranjo, L., Sanchez-Valle, R., Lladó, A., & Balasa, M.
Affiliations
  • University of California, San Francisco (US)
  • From the Alzheimer's Disease and Other Cognitive Disorders Unit (J.S., N.G., O.R.-C., N.F., D.E., J.C., G.F., Y.G., A.T.-M., J.J.-P., B.B., S.B.-É., L.M.-P., M.C., M.V., A.A., R.S.-V., A.L., M.B.), Neurology Service, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona; Immunology Service (R.R.-G., L.N.), Biomedical Diagnostic Center, Hospital Clínic de Barcelona, Spain; Atlantic Fellow for Equity in Brain Health (N.F., M.B.),...
Corresponding author
  • Lladó, Albert
  • Balasa, Mircea
Venue
Neurology
Published
2023-02-21
Volume
100
Issue
8
Pages
e860-e873
ISSN
  • 0028-3878 (ISSN-L)
  • 1526-632X
OpenAlex
W4310568507
Cited by
71
References
39
Citations by year
2026: 11 · 2025: 22 · 2024: 28 · 2023: 10
FWCI
9.78
Type
journal article
Language
en
Open access
Locations
  • Neurology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, public-domain)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Cerebrospinal fluid and hydrocephalus
Keywords
blood-based biomarkers, plasma biomarkers, Alzheimer's disease, frontotemporal dementia, p-tau181, neurofilament light chain, glial fibrillary acidic protein, total tau, UCHL1, amyloid status, cognitive impairment, differential diagnosis of dementia, memory clinic patients, diagnostic accuracy, single molecule array, neurodegeneration, clinical applicability
MeSH terms
Aged, Alzheimer Disease, Humans, Middle Aged, Biomarkers, Amyloid beta-Peptides, tau Proteins, Pick Disease of the Brain, Frontotemporal Dementia, Memory, Episodic

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