Format

Send to

Choose Destination
Eur J Neurol. 2019 Nov 6. doi: 10.1111/ene.14117. [Epub ahead of print]

Italian consensus recommendations for the biomarker-based etiological diagnosis in MCI patients.

Author information

1
IRCCS-S.Giovanni di Dio-Fatebenefratelli, Brescia, Italy.
2
University of Geneva, Geneva, Switzerland.
3
University of Brescia, Brescia, Italy.
4
Istituto Clinico S.Anna, Brescia, Italy.
5
Italian Psychogeriatric Association (AIP).
6
University Institute of Higher Studies, Pavia, Italy.
7
Italian Society of Neurology for the Study of the Dementias (SINdem).
8
University of Perugia, Perugia, Italy.
9
Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC).
10
IRCCS San Raffaele Scientific Institute, Milan, Italy.
11
Vita-Salute San Raffaele University, Milan, Italy.
12
Italian Association of Neuroradiology (AINR).
13
Poliambulanza Foundation, Brescia, Italy.
14
Italian Association of Nuclear Medicine (AIMN).
15
University Of Genoa, Genoa, Italy.
16
IRCCS Ospedale Policlinico San Martino, Genova, Italy.
17
Brescia University Hospital, Brescia, Italy.
18
Fondazione Policlinico Tor Vergata, Rome, Italy.
19
University of Perugia, Ospedale S. Maria della Misericordia, Perugia, Italy.
20
IRCCS "Carlo Besta", Milan, Italy.
21
Verona University Hospital, Verona, Italy.
22
IRCCS "Sacro Cuore-Don Calabria", Negrar, Verona, Italy.
23
Federazione Alzheimer Italia, Italy.
24
University of Palermo, Palermo, Italy.
25
University Tor Vergata, Rome, Italy.
26
IRCCS-Neuromed, Pozzilli, Italy.

Abstract

BACKGROUND:

Biomarkers support the etiological diagnosis of neurocognitive disorders in vivo. Incomplete evidence is available to drive clinical decisions; available diagnostic algorithms are generic and poorly helpful in clinical practice. We aim to develop a biomarker-based diagnostic algorithm for MCI 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: SINDEM; Neuroradiology: AINR; Biochemistry: SIBioC; Psychogeriatrics: AIP; Nuclear Medicine: AIMN) defined theoretical framework, relevant literature, the diagnostic issues to be addressed, and the diagnostic algorithm. N-1 majority defined consensus achievement.

RESULTS:

Panelists chose the 2011 NIA-AA diagnostic criteria as the reference theoretical framework and defined the algorithm in 7 Delphi rounds. The algorithm includes: baseline clinical and cognitive assessment, blood examination, and MRI with exclusionary and inclusionary role; DaT-SPECT (if no/unclear parkinsonism) or 123 I-MIBG cardiac scintigraphy for suspected dementia with Lewy bodies with clear parkinsonism [R-VII, 3-1(1)]; FDG-PET for suspected Frontotemporal Lobar Degeneration and low diagnostic confidence of AD [R-VII,4-0 (1 abstained)]; CSF for suspected Alzheimer's disease (AD) [Round-IV, votes:4-1-0]; amyloid-PET if CSF was not possible/accepted [R-V,4-1] or inconclusive [R-VI,5-0].

CONCLUSIONS:

These consensus recommendations can guide clinicians in the biomarker-based etiological diagnosis of MCI, while guidelines cannot be defined with evidence-to-decision procedures due to incomplete evidence.

KEYWORDS:

Alzheimer's disease; Diagnosis; MCI; biomarker; biomarker-based diagnosis; consensus recommendations; diagnostic algorithm; implementation; multiple biomarkers

PMID:
31692118
DOI:
10.1111/ene.14117

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center