Laura E Korthauer, Zachary T Gemelli, Deirdre O'Shea, Brian R Ott, Jennifer D Davis
{"title":"临床环境中神经心理评估与淀粉样蛋白状态之间的关联。","authors":"Laura E Korthauer, Zachary T Gemelli, Deirdre O'Shea, Brian R Ott, Jennifer D Davis","doi":"10.1037/neu0000938","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Large research cohorts show robust associations between neuropsychological tests and Alzheimer's disease (AD) biomarkers, but studies in clinical settings are limited. The increasing availability of AD biomarkers to the practicing clinician makes it important to understand the relationship between comprehensive clinical neuropsychological assessment and biomarker status. This study examined concordance between practicing clinical neuropsychologists' diagnostic impressions and AD biomarker status in patients seen at an outpatient medical center, with a secondary aim of defining the characteristics of discordant cases.</p><p><strong>Method: </strong>Participants (<i>N</i> = 79) seen for clinical neuropsychological assessment who subsequently underwent lumbar puncture or amyloid positron emission tomography imaging were identified via retrospective chart review. Concordance between clinical neuropsychological diagnosis (non-AD, indeterminate, possible/probable AD) and AD biomarker status (negative, indeterminate, positive) was determined. Individual test score data were used to examine between-group differences based on amyloid status.</p><p><strong>Results: </strong>AD biomarker positive and negative patients did not differ on individual neuropsychological tests after correcting for multiple comparisons, though the small number of AD biomarker indeterminate individuals performed better than biomarker positive patients. However, there was 76.7% concordance between neuropsychologists' diagnostic impressions and AD biomarker status (88% sensitivity and 55% specificity of neuropsychological assessment in detecting AD biomarker status). AD biomarker negative patients diagnosed as possible/probable AD (discordant) versus non-AD (concordant) had significantly lower Neuropsychological Assessment Battery Story Delayed Recall, higher Wechsler Adult Intelligence Scale-Fourth Edition Coding, and higher Trail-Making A (i.e., an amnestic memory profile).</p><p><strong>Conclusions: </strong>Comprehensive neuropsychological assessment showed modest concordance with AD biomarker status in patients seen in an outpatient medical center for routine clinical care. Low specificity for the clinical diagnosis of AD could be explained by the multiplicity of etiologies that cause memory impairment (i.e., TAR DNA-binding protein 43, suspected non-AD pathology). (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>","PeriodicalId":19205,"journal":{"name":"Neuropsychology","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association between neuropsychological assessment and amyloid status in a clinical setting.\",\"authors\":\"Laura E Korthauer, Zachary T Gemelli, Deirdre O'Shea, Brian R Ott, Jennifer D Davis\",\"doi\":\"10.1037/neu0000938\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Large research cohorts show robust associations between neuropsychological tests and Alzheimer's disease (AD) biomarkers, but studies in clinical settings are limited. The increasing availability of AD biomarkers to the practicing clinician makes it important to understand the relationship between comprehensive clinical neuropsychological assessment and biomarker status. This study examined concordance between practicing clinical neuropsychologists' diagnostic impressions and AD biomarker status in patients seen at an outpatient medical center, with a secondary aim of defining the characteristics of discordant cases.</p><p><strong>Method: </strong>Participants (<i>N</i> = 79) seen for clinical neuropsychological assessment who subsequently underwent lumbar puncture or amyloid positron emission tomography imaging were identified via retrospective chart review. Concordance between clinical neuropsychological diagnosis (non-AD, indeterminate, possible/probable AD) and AD biomarker status (negative, indeterminate, positive) was determined. Individual test score data were used to examine between-group differences based on amyloid status.</p><p><strong>Results: </strong>AD biomarker positive and negative patients did not differ on individual neuropsychological tests after correcting for multiple comparisons, though the small number of AD biomarker indeterminate individuals performed better than biomarker positive patients. However, there was 76.7% concordance between neuropsychologists' diagnostic impressions and AD biomarker status (88% sensitivity and 55% specificity of neuropsychological assessment in detecting AD biomarker status). AD biomarker negative patients diagnosed as possible/probable AD (discordant) versus non-AD (concordant) had significantly lower Neuropsychological Assessment Battery Story Delayed Recall, higher Wechsler Adult Intelligence Scale-Fourth Edition Coding, and higher Trail-Making A (i.e., an amnestic memory profile).</p><p><strong>Conclusions: </strong>Comprehensive neuropsychological assessment showed modest concordance with AD biomarker status in patients seen in an outpatient medical center for routine clinical care. Low specificity for the clinical diagnosis of AD could be explained by the multiplicity of etiologies that cause memory impairment (i.e., TAR DNA-binding protein 43, suspected non-AD pathology). (PsycInfo Database Record (c) 2024 APA, all rights reserved).</p>\",\"PeriodicalId\":19205,\"journal\":{\"name\":\"Neuropsychology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neuropsychology\",\"FirstCategoryId\":\"102\",\"ListUrlMain\":\"https://doi.org/10.1037/neu0000938\",\"RegionNum\":3,\"RegionCategory\":\"心理学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/2/8 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"NEUROSCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuropsychology","FirstCategoryId":"102","ListUrlMain":"https://doi.org/10.1037/neu0000938","RegionNum":3,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/2/8 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"NEUROSCIENCES","Score":null,"Total":0}
引用次数: 0
摘要
目的:大型研究队列显示神经心理测试与阿尔茨海默病(AD)生物标志物之间存在密切联系,但临床环境中的研究却十分有限。随着临床医生越来越多地使用阿尔茨海默病生物标志物,了解综合临床神经心理学评估与生物标志物状态之间的关系就显得尤为重要。本研究调查了在一家医疗中心门诊就诊的患者中,临床神经心理学家的诊断印象与AD生物标记物状态之间的一致性,其次是为了确定不一致病例的特征:方法:通过回顾性病历审查确定接受临床神经心理学评估并随后接受腰椎穿刺或淀粉样蛋白正电子发射断层扫描成像的参与者(N = 79)。确定临床神经心理诊断(非 AD、不确定、可能/疑似 AD)与 AD 生物标记物状态(阴性、不确定、阳性)之间的一致性。根据淀粉样蛋白状态,使用单项测试得分数据来检验组间差异:结果:经多重比较校正后,AD生物标志物阳性和阴性患者在单项神经心理学测试中没有差异,但少数AD生物标志物不确定者的表现优于生物标志物阳性患者。不过,神经心理学家的诊断印象与AD生物标记物状态之间的一致性为76.7%(神经心理评估在检测AD生物标记物状态方面的敏感性为88%,特异性为55%)。被诊断为可能/疑似注意力缺失症(不一致)与非注意力缺失症(一致)的注意力缺失症生物标志物阴性患者的神经心理评估电池故事延迟回忆率明显较低、韦氏成人智能量表-第四版编码率较高,而追踪记忆A(即失忆记忆)较高:综合神经心理学评估显示,在门诊医疗中心接受常规临床护理的患者中,AD 生物标记物状态与综合神经心理学评估结果略有吻合。导致记忆障碍的病因多种多样(如TAR DNA结合蛋白43、疑似非AD病理),因此临床诊断AD的特异性较低。(PsycInfo Database Record (c) 2024 APA,版权所有)。
Association between neuropsychological assessment and amyloid status in a clinical setting.
Objective: Large research cohorts show robust associations between neuropsychological tests and Alzheimer's disease (AD) biomarkers, but studies in clinical settings are limited. The increasing availability of AD biomarkers to the practicing clinician makes it important to understand the relationship between comprehensive clinical neuropsychological assessment and biomarker status. This study examined concordance between practicing clinical neuropsychologists' diagnostic impressions and AD biomarker status in patients seen at an outpatient medical center, with a secondary aim of defining the characteristics of discordant cases.
Method: Participants (N = 79) seen for clinical neuropsychological assessment who subsequently underwent lumbar puncture or amyloid positron emission tomography imaging were identified via retrospective chart review. Concordance between clinical neuropsychological diagnosis (non-AD, indeterminate, possible/probable AD) and AD biomarker status (negative, indeterminate, positive) was determined. Individual test score data were used to examine between-group differences based on amyloid status.
Results: AD biomarker positive and negative patients did not differ on individual neuropsychological tests after correcting for multiple comparisons, though the small number of AD biomarker indeterminate individuals performed better than biomarker positive patients. However, there was 76.7% concordance between neuropsychologists' diagnostic impressions and AD biomarker status (88% sensitivity and 55% specificity of neuropsychological assessment in detecting AD biomarker status). AD biomarker negative patients diagnosed as possible/probable AD (discordant) versus non-AD (concordant) had significantly lower Neuropsychological Assessment Battery Story Delayed Recall, higher Wechsler Adult Intelligence Scale-Fourth Edition Coding, and higher Trail-Making A (i.e., an amnestic memory profile).
Conclusions: Comprehensive neuropsychological assessment showed modest concordance with AD biomarker status in patients seen in an outpatient medical center for routine clinical care. Low specificity for the clinical diagnosis of AD could be explained by the multiplicity of etiologies that cause memory impairment (i.e., TAR DNA-binding protein 43, suspected non-AD pathology). (PsycInfo Database Record (c) 2024 APA, all rights reserved).
期刊介绍:
Neuropsychology publishes original, empirical research; systematic reviews and meta-analyses; and theoretical articles on the relation between brain and human cognitive, emotional, and behavioral function.