scholarly journals Views on Early Diagnosis of Alzheimer’s Disease Among Dutch Physicians: A Qualitative Interview Study

2020 ◽  
pp. 1-11
Author(s):  
Krista Tromp ◽  
Marthe Smedinga ◽  
Edo Richard ◽  
Marieke Perry ◽  
Maartje H.N. Schermer

Background: Hope for future treatments to prevent or slow down dementia motivates researchers to strive for ever-earlier diagnoses of Alzheimer’s disease (AD) based on biomarkers, even before symptoms occur. But is a biomarker-based early diagnosis desirable in clinical practice? Objective: This study explores the ethical considerations that shape current clinical practice regarding early AD diagnostics and the use of biomarkers. Methods: In this qualitative study, Dutch physicians were interviewed. Topics included physicians’ views concerning early AD diagnosis in persons with no or mild cognitive impairment, physicians’ considerations regarding current and expected future practices of early AD diagnosis, the use of biomarkers, and the use of the concepts preclinical and prodromal AD. We analyzed the transcripts using directed content analysis. Results: 15 general practitioners, neurologists, and geriatricians in the Netherlands were interviewed. Most of them interpreted an early AD diagnosis with an early diagnosis of dementia. We identified six clusters of considerations sometimes in favor but most often against pursuing an early AD diagnosis in people with no or mild cognitive impairment that influence physicians’ diagnostic decision-making: preferences and characteristics of persons, test characteristics, impact on care, type of setting, disease concepts, and issues on a societal level. Conclusion: The discussion concerning an early AD diagnosis based on biomarkers which is widely held in the scientific field, has not entered clinical practice structurally. A biomarker-based early diagnosis does not fit within Dutch physicians’ views on what good care for people with no, subjective, or mild cognitive impairment should entail.

Author(s):  
Eva Carro ◽  
Fernando Bartolomé ◽  
Félix Bermejo‐Pareja ◽  
Alberto Villarejo‐Galende ◽  
José Antonio Molina ◽  
...  

2020 ◽  
Author(s):  
Peter Lee ◽  
Hang-Rai Kim ◽  
Yong Jeong

Abstract There have been several MR imaging biomarkers of Alzheimer’s disease (AD) for early diagnosis. Cortical mean diffusivity (MD) is one of them for the study of the cortical microstructural change in AD. However, several factors may overshadow the feasibility of MD as AD biomarker. Thus, current study investigated feasible gray matter microstructure biomarker with higher sensitivity for early AD detection. With the aim of facilitating the early detection of AD, the Alzheimer’s Disease Neuroimaging Initiative (ADNI) proposed two stages based on the memory performance: early mild cognitive impairment (EMCI) and late mild cognitive impairment (LMCI). We propose single shell DTI measure, ‘ radiality ’, for early AD biomarker. It is a dot product between cortical surface normal vector and primary diffusion direction, which presumably reflects the fiber orientation within the cortical column. Here, we gathered images from ADNI phase 2 & 3; 78 cognitive normal, 51 EMCI, 34 LMCI, and 39 AD patients. Then, we evaluated cortical thickness (CTh), MD, amount of amyloid and tau accumulations using PET, which are conventional AD biomarkers. Radiality was projected on gray matter surface to compare and validate the changes along other neuroimage biomarkers. Results showed decreased radiality primarily in entorhinal, insula, frontal and temporal cortex as disease progress onward. Especially, radiality could delineate the difference between cognitive normal and EMCI group while other biomarkers could not. We looked into the relationship between the radiality and other biomarkers to validate its pathological evidence in AD. Overall, radiality showed high association with conventional biomarkers. Additional ROI analysis exhibit dynamics of AD related changes as stages onward. In conclusion, radiality in cortical gray matter showed AD specific changes and relevance with other conventional AD biomarkers with higher sensitivity. Besides, it could show group differences in early AD changes from EMCI which show advantage for early diagnosis than using conventional biomarkers. We provide the evidence of structure changes with cognitive impairment and suggest radiality as a sensitive biomarker for early diagnose and progress monitor AD.


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