Diagnostic imaging devices in Alzheimer’s disease

Sensitivity and specificity of diagnostic accuracy in Alzheimer's disease: a synthesis of existing evidence

PURPOSE OF THE STUDY

This report synthesizes existing evidence to compare the accuracy of various Alzheimer's disease (AD) diagnostic approaches.

DESIGN AND METHODS

Meta-analyses and reviews of diagnostic accuracy of AD were identified through a search of the PubMed and Cochrane Library databases using the keyword combinations of "sensitivity specificity Alzheimer's disease diagnosis" and "accuracy of Alzheimer's disease diagnosis."

RESULTS

From 507 abstracts initially identified, 41 systematic reviews or meta-analyses were selected. Cerebrospinal fluid-tau demonstrated variable sensitivity (range 73.3%-100%) and specificity (range 70.0%-92.4%) in diagnosing AD when compared to neuropathological verification of clinical criteria for AD. Various positron emission tomography approaches showed a similar range of sensitivity (range 80.0%-100%) and specificity (range 62.0%-90%) as diagnostic protocols.

IMPLICATIONS

Issues that remain in the study of AD diagnosis include the need to determine the comparative effectiveness of diagnostic approaches. Variations in study quality make empirically derived conclusions about the diagnostic accuracy of existing approaches tenuous.

Rapid and reliable quantitation of amino acids and myo-inositol in mouse brain by high performance liquid chromatography and tandem mass spectrometry

Amino acids and myo-inositol have long been proposed as putative biomarkers for neurodegenerative diseases. Accurate measures and stability have precluded their selective use. To this end, a sensitive liquid chromatography tandem mass spectrometry (LC-MS/MS) method based on multiple reaction monitoring was developed to simultaneously quantify glutamine, glutamate, γ-aminobutyric acid (GABA), aspartic acid, N-acetyl aspartic acid, taurine, choline, creatine, phosphocholine and myo-inositol in mouse brain by methanol extractions. Chromatography was performed using a hydrophilic interaction chromatography silica column within in a total run time of 15 min. The validated method is selective, sensitive, accurate, and precise. The method has a limit of quantification ranging from 2.5 to 20 ng/ml for a range of analytes and a dynamic range from 2.5-20 to 500-4000 ng/ml. This LC-MS/MS method was validated for biomarker discovery in models of human neurological disorders.

Cognitive phenotypes, brain morphometry and the detection of cognitive decline in preclinical AD

Identifying a preclinical phase of Alzheimer’s Disease (PCAD) that is distinct from cognitive changes in healthy aging continues to be a major research focus. Combining neuropsychological and neuroimaging methodologies should improve our ability to differentiate healthy from pathological aging, although studies that utilize both methods often result in equivocal findings, possibly due to variability in cognitive test performance that may be capturing distinct phenotypes. One method of capturing this cognitive variability is to utilize contrasting neuropsychological tests to identify subgroups representative of distinct cognitive phenotypes, and determine whether differences in brain morphometry support these classifications. We review several approaches to defining cognitive subgroups, and we consider the possibility that cognitive asymmetry might provide one means of identifying both functional and structural changes associated with aging and dementia.