Italian consensus recommendations for a biomarker-based aetiological diagnosis in mild cognitive impairment patients
Italian consensus recommendations for a biomarker-based aetiological diagnosis in mild cognitive impairment patients
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DOI：
10.1111/ene.14117
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发表时间：
2019-12-18
影响因子：
5.1
通讯作者：
Frisoni, G. B.
中科院分区：
文献类型：
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作者：
Boccardi, M.;Nicolosi, V.;Frisoni, G. B.
背景和目的生物标志物支持神经认知障碍的体内病因学诊断。不完整的证据可用于驱动临床决策;可用的诊断算法是通用的，在临床实践中没有很大的帮助。其目的是利用公认的国家专家的知识，为轻度认知障碍患者开发一种基于生物标志物的诊断算法。方法采用德尔菲法，由代表意大利5个科学学会、在临床实践中使用生物标志物的经验丰富的临床医生（神经学-意大利神经学协会;神经放射学-意大利神经放射学协会;生物化学-意大利临床生物化学协会;老年精神病学-意大利精神病协会;核医学协会（Associazione Italiana di Medicina Nucleare）定义了理论框架、相关文献、要解决的诊断问题和诊断算法。N-1多数定义了达成共识。结果小组成员选择2011年美国国家老龄化研究所和阿尔茨海默病协会的诊断标准作为参考理论框架，并在七轮德尔菲中定义了算法。该算法包括基线临床和认知评估、血液检查和具有排除和包容作用的磁共振成像;多巴胺转运蛋白单光子发射计算机断层扫描（如果无/不清楚帕金森综合征）或间碘苄胍心脏血管造影，用于疑似路易体痴呆伴明显帕金森综合征（第七轮，投票（赞成-反对-弃权）：3-1-1）; F-18-氟脱氧葡萄糖正电子发射断层扫描用于疑似额颞叶变性和阿尔茨海默病诊断置信度低（第七轮，4-0-1）;脑脊液疑似阿尔茨海默病（第四轮，4-1-0）;和淀粉样蛋白正电子发射断层扫描，如果脑脊液是不可能/接受（第五轮，4-1-0）或不确定（第六轮，5-0-0）。结论这些共识建议可以指导临床医生在轻度认知功能障碍的生物标志物为基础的病因诊断，而指南不能定义与证据决策程序，由于证据不完整。
Background and purpose Biomarkers support the aetiological diagnosis of neurocognitive disorders in vivo. Incomplete evidence is available to drive clinical decisions; available diagnostic algorithms are generic and not very helpful in clinical practice. The aim was to develop a biomarker-based diagnostic algorithm for mild cognitive impairment patients, leveraging on knowledge from recognized national experts. Methods With a Delphi procedure, experienced clinicians making variable use of biomarkers in clinical practice and representing five Italian scientific societies (neurology - Societa Italiana di Neurologia per le Demenze; neuroradiology - Associazione Italiana di Neuroradiologia; biochemistry - Societa Italiana di Biochimica Clinica; psychogeriatrics - Associazione Italiana di Psicogeriatria; nuclear medicine - Associazione Italiana di Medicina Nucleare) defined the theoretical framework, relevant literature, the diagnostic issues to be addressed and the diagnostic algorithm. An N-1 majority defined consensus achievement. Results The panellists chose the 2011 National Institute on Aging and Alzheimer's Association diagnostic criteria as the reference theoretical framework and defined the algorithm in seven Delphi rounds. The algorithm includes baseline clinical and cognitive assessment, blood examination, and magnetic resonance imaging with exclusionary and inclusionary roles; dopamine transporter single-photon emission computed tomography (if no/unclear parkinsonism) or metaiodobenzylguanidine cardiac scintigraphy for suspected dementia with Lewy bodies with clear parkinsonism (round VII, votes (yes-no-abstained): 3-1-1); F-18-fluorodeoxyglucose positron emission tomography for suspected frontotemporal lobar degeneration and low diagnostic confidence of Alzheimer's disease (round VII, 4-0-1); cerebrospinal fluid for suspected Alzheimer's disease (round IV, 4-1-0); and amyloid positron emission tomography if cerebrospinal fluid was not possible/accepted (round V, 4-1-0) or inconclusive (round VI, 5-0-0). Conclusions These consensus recommendations can guide clinicians in the biomarker-based aetiological diagnosis of mild cognitive impairment, whilst guidelines cannot be defined with evidence-to-decision procedures due to incomplete evidence.