Aβ status assessment in a hypothetical scenario prior to treatment with disease‐modifying therapies: Evidence from 10‐year real‐world experience at university memory clinics

Brendel, Matthias ; Parvizi, Tandis; Gnörich, Johannes ; Topfstedt, Christof Elias; Buerger, Katharina ; Janowitz, Daniel ; Rauchmann, Boris‐Stephan; Perneczky, Robert ; Kurz, Carolin; Mehrens, Dirk ; Kunz, Wolfgang G. ; Kusche‐Palenga, Julia; Kling, Agnes Bernadette; Buchal, Antonia; Nestorova, Elizabet; Silvaieh, Sara; Wurm, Raphael; Traub‐Weidinger, Tatjana; Klotz, Sigrid; Regelsberger, Günther; Rominger, Axel; Drzezga, Alexander; Levin, Johannes ; Stögmann, Elisabeth; Franzmeier, Nicolai und Höglinger, Günter U. (2024): Aβ status assessment in a hypothetical scenario prior to treatment with disease‐modifying therapies: Evidence from 10‐year real‐world experience at university memory clinics. In: Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, Vol. 16, No. 4, e70031

Abstract

INTRODUCTION

With the advent of disease-modifying therapies, accurate assessment of biomarkers indicating the presence of disease-associated amyloid beta (Aβ) pathology becomes crucial in patients with clinically suspected Alzheimer's disease (AD). We evaluated Aβ levels in cerebrospinal fluid (Aβ CSF) and Aβ levels in positron emission tomography (Aβ PET) biomarkers in a real-world memory-clinic setting to develop an efficient algorithm for clinical use.

METHODS

Patients were evaluated for AD-related Aβ pathology from two independent cohorts (Ludwig Maximilian University [LMU], n = 402, and Medical University of Vienna [MUV], n = 144). Optimal thresholds of CSF biomarkers were deduced from receiver operating characteristic curves and validated against Aβ PET positivity.

RESULTS

In both cohorts, a CSF Aβ42/40 ratio ≥ 7.1% was associated with a low risk of a positive Aβ PET scan (negative predictive value: 94.3%). Implementing two cutoffs revealed 14% to 16% of patients with intermediate results (CSF Aβ42/40 ratio: 5.5%–7.1%), which had a strong benefit from Aβ PET imaging (44%–52% Aβ PET positivity).

DISCUSSION

A two-cutoff approach for CSF Aβ42/40 including Aβ PET imaging at intermediate results provides an effective assessment of Aβ pathology in real-world settings.

• Item Type: Journal article
• Faculties: Medicine > Munich Cluster for Systems Neurology (SyNergy); Medicine > Institute for Stroke and Dementia Research (ISD); Medicine > Medical Center of the University of Munich > Neurological Clinic and Polyclinic with Friedrich Baur Institute; Medicine > Medical Center of the University of Munich > Clinic and Polyclinic for Nuclear Medicine; Medicine > Medical Center of the University of Munich > Clinic and Polyclinic for Psychiatry and Psychotherapy
• Subjects: 600 Technology > 610 Medicine and health
• ISSN: 2352-8729
• Language: English
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 390857198