Abstract
INTRODUCTION
Plasma phosphorylated tau (p-tau)217 is a promising biomarker for Alzheimer’s disease (AD) diagnosis, but its clinical implementation remains challenging. We propose a strategy based on Bayes’ theorem and test it in real-life memory clinics.
METHODS
Memory clinic patients were evaluated by neurocognitive specialists for prespecified diagnosis and subsequently underwent blood collection for p-tau217, cerebrospinal fluid, or amyloid positron emission tomography. Using cross-validation, the Bayesian approach (pretest probability × individualized likelihood ratio) was compared to other models for AD diagnosis.
RESULTS
The Bayesian strategy demonstrated an area under the receiver operating characteristic curve (AUC) of 0.98 (95% confidence interval [CI]: 0.96–1.0), significantly outperforming multivariable logistic regression (p-tau217, age, apolipoprotein E; AUC 0.95, p = 0.024) and p-tau217 alone (AUC = 0.94, p = 0.007). When applying the two-threshold approach, the Bayesian strategy yielded an accuracy of 0.94 (95% CI: 0.88–1.0) without requiring confirmatory tests in 62.9% of the iterations.
DISCUSSION
The Bayesian strategy offers an effective and flexible approach to address the limitations of plasma p-tau217 in clinical practice.
Highlights
Incorporating pretest probability into the interpretation of plasma phosphorylated tau (p-tau)217 improves the diagnostic performance significantly.
The strategy could obviate the need for confirmatory testing in most of the patients.
Plasma p-tau217 proves useful as a biomarker for Alzheimer’s disease in low- and middle-income country such as Thailand.
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This post is Copyright: Poosanu Thanapornsangsuth,
Kittithatch Booncharoen,
Jedsada Khieukhajee,
Watayuth Luechaipanit,
Thanaporn Haethaisong,
Adipa Chongsuksantikul,
Thirawat Supharatpariyakorn,
Chaipat Chunharas,
Yuttachai Likitjaroen,
Thiravat Hemachudha | July 17, 2024