Experts from eleven European scientific associations and organizations have joined forces to develop recommendations for the more effective and individualized use of biomarkers for the diagnosis of Alzheimer's disease. The result is a consensus that can be described as a turning point in the approaches currently used. Doctors are now focusing even more on the person affected in their diagnostic considerations – and not on the disease or a test. The development of the consensus was coordinated by a team from the University Hospital of Geneva (HUG), the University of Geneva (UNIGE) and the National Research Center for Alzheimer's Disease (IRCCS) in Brescia. Their results were published in the journal The Lancet Neurology.
Focused on the individual case
The working group, of which Prof. Dr. Lutz Frölich, Head of the Department of Geriatric Psychiatry at the CIMH, was also a member, has defined a diagnostic pathway geared towards the individual case, which makes it possible to determine the correct tests depending on the symptom profile. It is easy to use in memory clinics and enables an extremely reliable diagnosis. The diagnostic pathway was developed on the basis of scientific literature and the practical experience of experts. After a specialist has examined the complaints, performed memory tests and carried out an MRI of the brain, he/she can use these recommendations to assign the case to one of the eleven defined phenotypes (manifestations of the disease) and then search for biomarkers using the tests recommended by the international experts.
"The sequence of diagnostic examinations developed here presents a 'best practice' approach. This optimizes efficiency and effort in the differential diagnosis of cognitive disorders in old age," says Prof. Dr. Lutz Frölich. "It corresponds to the recommendations of the new S3 guideline on dementia from the DGPPN and DGN, which was recently presented for Germany."
Focus on the individual
The aim of the diagnostic pathway is to overcome the current limitations of the recommendations and guidelines for the diagnosis of Alzheimer's disease. The latter focus mainly on the disease itself or on biomarkers and less on the person affected. Indeed, most of these recommendations do not take into account the numerous diagnostic possibilities or the fact that there are several tests that can be performed simultaneously or sequentially. The diagnostic pathway developed by the experts will help clinicians to determine the most meaningful biomarker for the most common clinical cases.
Method
To reach this consensus, the experts used the participatory Delphi approach. This method makes it possible to compare the difference in effectiveness of one test compared to another in different situations. It consists of measuring the opinion of the experts on the features under investigation and only taking into account the opinions that reach a consensus of over 70 percent - and are therefore considered very likely.
By pooling expertise, it has been possible to create a reference standard that will be of use to all doctors in Europe. It is now up to the national health authorities, healthcare providers, medical managers and health insurers to implement it in their respective countries.
Publication
Frisoni Giovanni B et al.: European intersocietal recommendations for the biomarker-based diagnosis of neurocognitive disorders. The Lancet Neurology. 2024. Doi: 10.1016/S1474-4422(23)00447-7
https://doi.org/10.1016/S1474-4422(23)00447-7
Further information: www.thelancet.com/podcasts