M Boccardi1,2, V Nicolosi1, C Festari1,3, A Bianchetti4,5, S Cappa1,6,7, D Chiasserini8,9, A Falini10,11,12, U P Guerra13,14, F Nobili14,15,16, A Padovani7,17, G Sancesario9,18, S Morbelli15,16, L Parnetti19, P Tiraboschi20, C Muscio20, D Perani10,11, F B Pizzini21, A Beltramello21,22, G Salvini Porro23, M Ciaccio9,24, O Schillaci25,26, M Trabucchi5,25, F Tagliavini20, G B Frisoni1,2. 1. IRCCS Istituto Centro 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), Brescia, Italy. 6. University Institute of Higher Studies, Pavia, Italy. 7. Italian Society of Neurology for the Study of the Dementias (SINdem), Milan, Italy. 8. University of Perugia, Perugia, Italy. 9. Italian Society of Clinical Biochemistry and Clinical Molecular Biology - Laboratory Medicine (SIBioC), Rimini, Italy. 10. IRCCS San Raffaele Scientific Institute, Milan, Italy. 11. Vita-Salute San Raffaele University, Milan, Italy. 12. Italian Association of Neuroradiology (AINR), Milan, Italy. 13. Poliambulanza Foundation, Brescia, Italy. 14. Italian Association of Nuclear Medicine (AIMN), Bari, Italy. 15. University of Genoa, Genoa, Italy. 16. IRCCS Ospedale Policlinico San Martino, Genova, Italy. 17. Brescia University Hospital, Brescia, Italy. 18. IRCCS Santa Lucia Foundation, Neuroimmunology Unit Via Ardeatina 354, Rome, Italy. 19. Ospedale S. Maria della Misericordia, University of Perugia, 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, Milan, Italy. 24. University of Palermo, Palermo, Italy. 25. University Tor Vergata, Rome, Italy. 26. IRCCS-Neuromed, Pozzilli, Italy.
Abstract
BACKGROUND AND PURPOSE: Biomarkers support the aetiological diagnosis of neurocognitive disorders in vivo. Incomplete evidence is available to drive clinical decisions; available diagnostic algorithms are generic and not very helpful in clinical practice. The aim was to develop a biomarker-based diagnostic algorithm for mild cognitive impairment 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 - Società Italiana di Neurologia per le Demenze; neuroradiology - Associazione Italiana di Neuroradiologia; biochemistry - Società Italiana di Biochimica Clinica; psychogeriatrics - Associazione Italiana di Psicogeriatria; nuclear medicine - Associazione Italiana di Medicina Nucleare) defined the theoretical framework, relevant literature, the diagnostic issues to be addressed and the diagnostic algorithm. An N-1 majority defined consensus achievement. RESULTS: The panellists chose the 2011 National Institute on Aging and Alzheimer's Association diagnostic criteria as the reference theoretical framework and defined the algorithm in seven Delphi rounds. The algorithm includes baseline clinical and cognitive assessment, blood examination, and magnetic resonance imaging with exclusionary and inclusionary roles; dopamine transporter single-photon emission computed tomography (if no/unclear parkinsonism) or metaiodobenzylguanidine cardiac scintigraphy for suspected dementia with Lewy bodies with clear parkinsonism (round VII, votes (yes-no-abstained): 3-1-1); 18 F-fluorodeoxyglucose positron emission tomography for suspected frontotemporal lobar degeneration and low diagnostic confidence of Alzheimer's disease (round VII, 4-0-1); cerebrospinal fluid for suspected Alzheimer's disease (round IV, 4-1-0); and amyloid positron emission tomography if cerebrospinal fluid was not possible/accepted (round V, 4-1-0) or inconclusive (round VI, 5-0-0). CONCLUSIONS: These consensus recommendations can guide clinicians in the biomarker-based aetiological diagnosis of mild cognitive impairment, whilst guidelines cannot be defined with evidence-to-decision procedures due to incomplete evidence.
BACKGROUND AND PURPOSE: Biomarkers support the aetiological diagnosis of neurocognitive disorders in vivo. Incomplete evidence is available to drive clinical decisions; available diagnostic algorithms are generic and not very helpful in clinical practice. The aim was to develop a biomarker-based diagnostic algorithm for mild cognitive impairment 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 - Società Italiana di Neurologia per le Demenze; neuroradiology - Associazione Italiana di Neuroradiologia; biochemistry - Società Italiana di Biochimica Clinica; psychogeriatrics - Associazione Italiana di Psicogeriatria; nuclear medicine - Associazione Italiana di Medicina Nucleare) defined the theoretical framework, relevant literature, the diagnostic issues to be addressed and the diagnostic algorithm. An N-1 majority defined consensus achievement. RESULTS: The panellists chose the 2011 National Institute on Aging and Alzheimer's Association diagnostic criteria as the reference theoretical framework and defined the algorithm in seven Delphi rounds. The algorithm includes baseline clinical and cognitive assessment, blood examination, and magnetic resonance imaging with exclusionary and inclusionary roles; dopamine transporter single-photon emission computed tomography (if no/unclear parkinsonism) or metaiodobenzylguanidine cardiac scintigraphy for suspected dementia with Lewy bodies with clear parkinsonism (round VII, votes (yes-no-abstained): 3-1-1); 18 F-fluorodeoxyglucose positron emission tomography for suspected frontotemporal lobar degeneration and low diagnostic confidence of Alzheimer's disease (round VII, 4-0-1); cerebrospinal fluid for suspected Alzheimer's disease (round IV, 4-1-0); and amyloid positron emission tomography if cerebrospinal fluid was not possible/accepted (round V, 4-1-0) or inconclusive (round VI, 5-0-0). CONCLUSIONS: These consensus recommendations can guide clinicians in the biomarker-based aetiological diagnosis of mild cognitive impairment, whilst guidelines cannot be defined with evidence-to-decision procedures due to incomplete evidence.
Authors: Giulia Fusi; Elena Ferrari; Marina Zanetti; Maura Crepaldi; Carol Bersanini; Anna Paladino; Laura Colautti; Luca Rozzini; Alessandro Antonietti; Maria Luisa Rusconi Journal: Front Psychol Date: 2020-04-30
Authors: Giulia Fusi; Massimiliano Palmiero; Sara Lavolpe; Laura Colautti; Maura Crepaldi; Alessandro Antonietti; Alberto Di Domenico; Barbara Colombo; Adolfo Di Crosta; Pasquale La Malva; Luca Rozzini; Maria Luisa Rusconi Journal: Healthcare (Basel) Date: 2022-08-05
Authors: Marina Boccardi; Alessandra Dodich; Emiliano Albanese; Angèle Gayet-Ageron; Cristina Festari; Nicholas J Ashton; Gérard N Bischof; Konstantinos Chiotis; Antoine Leuzy; Emma E Wolters; Martin A Walter; Gil D Rabinovici; Maria Carrillo; Alexander Drzezga; Oskar Hansson; Agneta Nordberg; Rik Ossenkoppele; Victor L Villemagne; Bengt Winblad; Giovanni B Frisoni; Valentina Garibotto Journal: Eur J Nucl Med Mol Imaging Date: 2021-03-10 Impact factor: 9.236