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Alzheimers Dement (Amst). 2018 Nov 12;11:1-9. doi: 10.1016/j.dadm.2018.10.004. eCollection 2019 Dec.

Decision tree supports the interpretation of CSF biomarkers in Alzheimer's disease.

Author information

1
Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, VU University Medical Center, Amsterdam UMC, Amsterdam, the Netherlands.
2
Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.
3
Department of Neurology, Spaarne Gasthuis location Haarlem, Haarlem, the Netherlands.
4
Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands.
5
Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, the Netherlands.

Abstract

Introduction:

We developed and validated a clinically applicable decision tree for the use of cerebrospinal fluid biomarkers in the diagnosis of Alzheimer's disease (AD).

Methods:

Subjects with probable AD (n = 1004) and controls (n = 442) were included. A decision tree was modeled using Classification And Regression Tree analysis in a training cohort (AD n = 221; controls n = 221) and validated in an independent cohort (AD n = 783; controls n = 221). Diagnostic performance was compared to previously defined cutoffs (amyloid β 1-42 < 813 pg/ml; tau>375 pg/ml).

Results:

Two cerebrospinal fluid AD biomarker profiles were revealed: the "classical" AD biomarker profile (amyloid β 1-42: 647-803 pg/ml; tau >374 pg/ml) and an "atypical" AD biomarker profile with strongly decreased amyloid β 1-42 (<647 pg/ml) and normal tau concentrations (<374 pg/ml). Compared to previous cutoffs, the decision tree performed better on diagnostic accuracy (86% [84-88] vs 80% [78-83]).

Discussion:

Two cerebrospinal fluid AD biomarker profiles were identified and incorporated in a readily applicable decision tree, which improved diagnostic accuracy.

KEYWORDS:

Alzheimer's disease; Amyloid β 1-42; CART; CSF; Cerebrospinal fluid; Clinical implementation; Cutoff; Decision tree; Tau

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