Assessment of a Plasma Amyloid Probability Score to Estimate Amyloid Positron Emission Tomography Findings Among Adults With Cognitive Impairment

作者：Yan Hu, Kristopher M. Kirmess, Matthew R. Meyer, Gil D. Rabinovici, Constantine Gatsonis, Barry A. Siegel, Rachel A. Whitmer, Charles Apgar, Lucy Hanna, Michio Kanekiyo, June Kaplow, Akihiko Koyama, David Verbel, Mary S. Holubasch, S Knapik, Jason Connor, John H. Contois, Erin N. Jackson, Scott E. Harpstrite, Randall J. Bateman, David M. Holtzman, Philip B. Verghese, I. Fogelman, Joel B. Braunstein, Kevin E. Yarasheski, Tim West · 发表于：JAMA Network Open · 年份：2022 · DOI：10.1001/jamanetworkopen.2022.8392 · 被引用次数：138 · 研究领域：Dementia and Cognitive Impairment Research、Amyloidosis: Diagnosis, Treatment, Outcomes、Intracerebral and Subarachnoid Hemorrhage Research

Importance: The diagnostic evaluation for Alzheimer disease may be improved by a blood-based diagnostic test identifying presence of brain amyloid plaque pathology. Objective: To determine the clinical performance associated with a diagnostic algorithm incorporating plasma amyloid-β (Aβ) 42:40 ratio, patient age, and apoE proteotype to identify brain amyloid status. Design, Setting, and Participants: This cohort study includes analysis from 2 independent cross-sectional cohort studies: the discovery cohort of the Plasma Test for Amyloidosis Risk Screening (PARIS) study, a prospective add-on to the Imaging Dementia-Evidence for Amyloid Scanning study, including 249 patients from 2018 to 2019, and MissionAD, a dataset of 437 biobanked patient samples obtained at screenings during 2016 to 2019. Data were analyzed from May to November 2020. Exposures: Amyloid detected in blood and by positron emission tomography (PET) imaging. Main Outcomes and Measures: The main outcome was the diagnostic performance of plasma Aβ42:40 ratio, together with apoE proteotype and age, for identifying amyloid PET status, assessed by accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Results: All 686 participants (mean [SD] age 73.2 [6.3] years; 368 [53.6%] men; 378 participants [55.1%] with amyloid PET findings) had symptoms of mild cognitive impairment or mild dementia. The AUC of plasma Aβ42:40 ratio for PARIS was 0.79 (95% CI, 0.73-0.85) and 0.86 (...