Cerebrospinal fluid neurofilament light predicts longitudinal diagnostic change in patients with psychiatric and neurodegenerative disorders.

IF 3.8 4区医学 Q1 Medicine Acta Neuropsychiatrica Pub Date : 2024-02-01 Epub Date: 2023-04-28 DOI:10.1017/neu.2023.25

Matthew J Y Kang, Dhamidhu Eratne, Hannah Dobson, Charles B Malpas, Michael Keem, Courtney Lewis, Jasleen Grewal, Vivian Tsoukra, Christa Dang, Ramon Mocellin, Tomas Kalincik, Alexander F Santillo, Henrik Zetterberg, Kaj Blennow, Christiane Stehmann, Shiji Varghese, Qiao-Xin Li, Colin L Masters, Steven Collins, Samuel F Berkovic, Andrew Evans, Wendy Kelso, Sarah Farrand, Samantha M Loi, Mark Walterfang, Dennis Velakoulis

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Abstract

Objective: People with neuropsychiatric symptoms often experience delay in accurate diagnosis. Although cerebrospinal fluid neurofilament light (CSF NfL) shows promise in distinguishing neurodegenerative disorders (ND) from psychiatric disorders (PSY), its accuracy in a diagnostically challenging cohort longitudinally is unknown.

Methods: We collected longitudinal diagnostic information (mean = 36 months) from patients assessed at a neuropsychiatry service, categorising diagnoses as ND/mild cognitive impairment/other neurological disorders (ND/MCI/other) and PSY. We pre-specified NfL > 582 pg/mL as indicative of ND/MCI/other.

Results: Diagnostic category changed from initial to final diagnosis for 23% (49/212) of patients. NfL predicted the final diagnostic category for 92% (22/24) of these and predicted final diagnostic category overall (ND/MCI/other vs. PSY) in 88% (187/212), compared to 77% (163/212) with clinical assessment alone.

Conclusions: CSF NfL improved diagnostic accuracy, with potential to have led to earlier, accurate diagnosis in a real-world setting using a pre-specified cut-off, adding weight to translation of NfL into clinical practice.

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脑脊液神经丝光可预测精神病和神经退行性疾病患者的纵向诊断变化。

目的：有神经精神症状的人往往迟迟得不到准确诊断。虽然脑脊液神经丝光（CSF NfL）有望区分神经退行性疾病（ND）和精神疾病（PSY），但其在具有诊断难度的人群中的纵向诊断准确性尚不清楚：我们收集了在神经精神科接受评估的患者的纵向诊断信息（平均值 = 36 个月），并将诊断结果分为神经退行性疾病/轻度认知障碍/其他神经系统疾病（ND/MCI/其他）和 PSY。我们预先设定 NfL > 582 pg/mL 为 ND/MCI/other 的指标：结果：23%的患者（49/212）的诊断类别从初步诊断变为最终诊断。NfL预测了其中92%（22/24）患者的最终诊断类别，并预测了88%（187/212）患者的最终诊断类别（ND/MCI/其他与PSY），而仅通过临床评估预测最终诊断类别的比例为77%（163/212）：CSF NfL提高了诊断的准确性，有可能在实际环境中使用预先指定的临界值更早、更准确地做出诊断，为将NfL应用于临床实践增添了砝码。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta Neuropsychiatrica 医学-精神病学

CiteScore

8.50

自引率

5.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Acta Neuropsychiatrica is an international journal focussing on translational neuropsychiatry. It publishes high-quality original research papers and reviews. The Journal''s scope specifically highlights the pathway from discovery to clinical applications, healthcare and global health that can be viewed broadly as the spectrum of work that marks the pathway from discovery to global health.