Pub Date : 2024-07-01DOI: 10.1038/s41582-024-00981-9
Cecile C. de Vos, Kaare Meier
Spinal cord stimulation is an invasive therapy for chronic neuropathic pain, usually used as a last-resort treatment when all other treatments have been tried and failed. The clinical value of the therapy has been much debated in recent years; here, we summarize the therapy and discuss the core controversies. Spinal cord stimulation is seen as a last-resort therapy for the treatment of chronic pain. Controversies surrounding the treatment might be addressed through collaborative efforts to conduct innovative clinical trials and reach consensus on treatment guidelines.
{"title":"Spinal cord stimulation for the treatment of chronic pain","authors":"Cecile C. de Vos, Kaare Meier","doi":"10.1038/s41582-024-00981-9","DOIUrl":"10.1038/s41582-024-00981-9","url":null,"abstract":"Spinal cord stimulation is an invasive therapy for chronic neuropathic pain, usually used as a last-resort treatment when all other treatments have been tried and failed. The clinical value of the therapy has been much debated in recent years; here, we summarize the therapy and discuss the core controversies. Spinal cord stimulation is seen as a last-resort therapy for the treatment of chronic pain. Controversies surrounding the treatment might be addressed through collaborative efforts to conduct innovative clinical trials and reach consensus on treatment guidelines.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 8","pages":"447-448"},"PeriodicalIF":28.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141475336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1038/s41582-024-00975-7
Raúl Martínez-Fernández
Similar to any innovation that disrupts the status quo, the advent of magnetic resonance-guided focused ultrasound in neurology was accompanied by controversy and debate. However, evidence suggests that this therapeutic tool, which is already widely used to treat tremor and Parkinson disease, is gaining acceptance and will become a viable therapeutic option for various other neurological conditions in the near future.
{"title":"Focused ultrasound brain therapy is a new tool in the box","authors":"Raúl Martínez-Fernández","doi":"10.1038/s41582-024-00975-7","DOIUrl":"10.1038/s41582-024-00975-7","url":null,"abstract":"Similar to any innovation that disrupts the status quo, the advent of magnetic resonance-guided focused ultrasound in neurology was accompanied by controversy and debate. However, evidence suggests that this therapeutic tool, which is already widely used to treat tremor and Parkinson disease, is gaining acceptance and will become a viable therapeutic option for various other neurological conditions in the near future.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 8","pages":"443-444"},"PeriodicalIF":28.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141475156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-30DOI: 10.1038/s41582-024-00987-3
Nebojša Malešević, Christian Antfolk
Advanced sensory feedback from upper limb prostheses would provide multiple benefits to people with upper limb amputations, but achieving functional and natural-feeling sensation is technologically challenging. Advances are being made with invasive and non-invasive stimulation approaches, but considerable challenges need to be addressed with technological innovation.
{"title":"Sensory feedback in upper limb prosthetics: advances and challenges","authors":"Nebojša Malešević, Christian Antfolk","doi":"10.1038/s41582-024-00987-3","DOIUrl":"10.1038/s41582-024-00987-3","url":null,"abstract":"Advanced sensory feedback from upper limb prostheses would provide multiple benefits to people with upper limb amputations, but achieving functional and natural-feeling sensation is technologically challenging. Advances are being made with invasive and non-invasive stimulation approaches, but considerable challenges need to be addressed with technological innovation.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 8","pages":"449-450"},"PeriodicalIF":28.2,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141463915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-30DOI: 10.1038/s41582-024-00980-w
Aurore Thibaut, Géraldine Martens
Neuromodulation represents a promising approach for promoting neural plasticity following a brain injury, especially for non-communicative patients with prolonged disorders of consciousness. However, so far, the outcomes have been limited and inconsistent, driving researchers to explore alternative strategies to improve the efficacy of brain stimulation techniques.
{"title":"Neuromodulation for severe brain injury: time for a paradigm shift?","authors":"Aurore Thibaut, Géraldine Martens","doi":"10.1038/s41582-024-00980-w","DOIUrl":"10.1038/s41582-024-00980-w","url":null,"abstract":"Neuromodulation represents a promising approach for promoting neural plasticity following a brain injury, especially for non-communicative patients with prolonged disorders of consciousness. However, so far, the outcomes have been limited and inconsistent, driving researchers to explore alternative strategies to improve the efficacy of brain stimulation techniques.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 8","pages":"441-442"},"PeriodicalIF":28.2,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141463931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-29DOI: 10.1038/s41582-024-00990-8
Friedhelm C. Hummel, Maximilian J. Wessel
Recently developed non-invasive deep brain stimulation methods have sufficient focal specificity to target deep brain structures. These techniques show particular promise as treatment strategies for neuropsychiatric disorders in which deep brain structures have critical roles in pathophysiology or in mediating recovery. A non-invasive technique using transcranial electrical stimulation offers an improvement in focality over other non-invasive techniques, presenting an opportunity to target deep brain structures for the treatment of neurological disorders.
{"title":"Non-invasive deep brain stimulation: interventional targeting of deep brain areas in neurological disorders","authors":"Friedhelm C. Hummel, Maximilian J. Wessel","doi":"10.1038/s41582-024-00990-8","DOIUrl":"10.1038/s41582-024-00990-8","url":null,"abstract":"Recently developed non-invasive deep brain stimulation methods have sufficient focal specificity to target deep brain structures. These techniques show particular promise as treatment strategies for neuropsychiatric disorders in which deep brain structures have critical roles in pathophysiology or in mediating recovery. A non-invasive technique using transcranial electrical stimulation offers an improvement in focality over other non-invasive techniques, presenting an opportunity to target deep brain structures for the treatment of neurological disorders.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 8","pages":"451-452"},"PeriodicalIF":28.2,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141462687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-29DOI: 10.1038/s41582-024-00976-6
Irena Rektorová
Some device-based non-invasive brain stimulation methods have been recommended as probably effective for cognitive treatment in Alzheimer disease. New targets and novel transcranial electrical stimulation techniques enable physiology-inspired modulation of oscillatory activity and precise targeting of deep brain structures. The use of non-invasive brain stimulation techniques to treat mild cognitive impairment and dementia in Alzheimer disease is expanding. Trials have produced varying results depending on the differing stimulation techniques, targeted brain regions and degrees of cognitive impairment among the treated cohorts.
{"title":"Non-invasive stimulation for treating cognitive impairment in Alzheimer disease","authors":"Irena Rektorová","doi":"10.1038/s41582-024-00976-6","DOIUrl":"10.1038/s41582-024-00976-6","url":null,"abstract":"Some device-based non-invasive brain stimulation methods have been recommended as probably effective for cognitive treatment in Alzheimer disease. New targets and novel transcranial electrical stimulation techniques enable physiology-inspired modulation of oscillatory activity and precise targeting of deep brain structures. The use of non-invasive brain stimulation techniques to treat mild cognitive impairment and dementia in Alzheimer disease is expanding. Trials have produced varying results depending on the differing stimulation techniques, targeted brain regions and degrees of cognitive impairment among the treated cohorts.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 8","pages":"445-446"},"PeriodicalIF":28.2,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141462718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-21DOI: 10.1038/s41582-024-00988-2
Rosemary J. Jackson, Bradley T. Hyman, Alberto Serrano-Pozo
For the past three decades, apolipoprotein E (APOE) has been known as the single greatest genetic modulator of sporadic Alzheimer disease (AD) risk, influencing both the average age of onset and the lifetime risk of developing AD. The APOEε4 allele significantly increases AD risk, whereas the ε2 allele is protective relative to the most common ε3 allele. However, large differences in effect size exist across ethnoracial groups that are likely to depend on both global genetic ancestry and local genetic ancestry, as well as gene–environment interactions. Although early studies linked APOE to amyloid-β — one of the two culprit aggregation-prone proteins that define AD — in the past decade, mounting work has associated APOE with other neurodegenerative proteinopathies and broader ageing-related brain changes, such as neuroinflammation, energy metabolism failure, loss of myelin integrity and increased blood–brain barrier permeability, with potential implications for longevity and resilience to pathological protein aggregates. Novel mouse models and other technological advances have also enabled a number of therapeutic approaches aimed at either attenuating the APOEε4-linked increased AD risk or enhancing the APOEε2-linked AD protection. This Review summarizes this progress and highlights areas for future research towards the development of APOE-directed therapeutics. Apolipoprotein E (APOE) is the greatest genetic modulator of sporadic Alzheimer disease risk. This Review provides a comprehensive update on our current knowledge of the genetics of APOE and its role in Alzheimer and other neurodegenerative diseases, and summarizes emerging APOE-targeted therapies designed to prevent or slow down Alzheimer disease.
{"title":"Multifaceted roles of APOE in Alzheimer disease","authors":"Rosemary J. Jackson, Bradley T. Hyman, Alberto Serrano-Pozo","doi":"10.1038/s41582-024-00988-2","DOIUrl":"10.1038/s41582-024-00988-2","url":null,"abstract":"For the past three decades, apolipoprotein E (APOE) has been known as the single greatest genetic modulator of sporadic Alzheimer disease (AD) risk, influencing both the average age of onset and the lifetime risk of developing AD. The APOEε4 allele significantly increases AD risk, whereas the ε2 allele is protective relative to the most common ε3 allele. However, large differences in effect size exist across ethnoracial groups that are likely to depend on both global genetic ancestry and local genetic ancestry, as well as gene–environment interactions. Although early studies linked APOE to amyloid-β — one of the two culprit aggregation-prone proteins that define AD — in the past decade, mounting work has associated APOE with other neurodegenerative proteinopathies and broader ageing-related brain changes, such as neuroinflammation, energy metabolism failure, loss of myelin integrity and increased blood–brain barrier permeability, with potential implications for longevity and resilience to pathological protein aggregates. Novel mouse models and other technological advances have also enabled a number of therapeutic approaches aimed at either attenuating the APOEε4-linked increased AD risk or enhancing the APOEε2-linked AD protection. This Review summarizes this progress and highlights areas for future research towards the development of APOE-directed therapeutics. Apolipoprotein E (APOE) is the greatest genetic modulator of sporadic Alzheimer disease risk. This Review provides a comprehensive update on our current knowledge of the genetics of APOE and its role in Alzheimer and other neurodegenerative diseases, and summarizes emerging APOE-targeted therapies designed to prevent or slow down Alzheimer disease.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 8","pages":"457-474"},"PeriodicalIF":28.2,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141435860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-21DOI: 10.1038/s41582-024-00982-8
Heather Wood
The 10th Congress of the European Academy of Neurology is being held in Helsinki, Finland from 29 June to 2 July 2024, and Nature Reviews Neurology is publishing a series of Comments on the overarching theme, neuromodulation. We asked Programme Committee Chairs Ulf Kallweit and Reetta Kälviäinen about their roles and their expectations for the congress.
{"title":"Neurology under the midnight sun: EAN Congress 2024 comes to Helsinki","authors":"Heather Wood","doi":"10.1038/s41582-024-00982-8","DOIUrl":"10.1038/s41582-024-00982-8","url":null,"abstract":"The 10th Congress of the European Academy of Neurology is being held in Helsinki, Finland from 29 June to 2 July 2024, and Nature Reviews Neurology is publishing a series of Comments on the overarching theme, neuromodulation. We asked Programme Committee Chairs Ulf Kallweit and Reetta Kälviäinen about their roles and their expectations for the congress.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 8","pages":"453-454"},"PeriodicalIF":28.2,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-17DOI: 10.1038/s41582-024-00973-9
Gerben van Hameren, Refat Aboghazleh, Ellen Parker, Jens P. Dreier, Daniela Kaufer, Alon Friedman
Considerable strides in medical interventions during the acute phase of traumatic brain injury (TBI) have brought improved overall survival rates. However, following TBI, people often face ongoing, persistent and debilitating long-term complications. Here, we review the recent literature to propose possible mechanisms that lead from TBI to long-term complications, focusing particularly on the involvement of a compromised blood–brain barrier (BBB). We discuss evidence for the role of spreading depolarization as a key pathological mechanism associated with microvascular dysfunction and the transformation of astrocytes to an inflammatory phenotype. Finally, we summarize new predictive and diagnostic biomarkers and explore potential therapeutic targets for treating long-term complications of TBI. Overall survival rates for traumatic brain injury have improved, but affected individuals often experience persistent and debilitating long-term complications. In this Review, the authors discuss recent evidence for the role of spreading depolarization in the initiation of long-term pathology in traumatic brain injury, including effects on blood–brain barrier dysfunction and neuroinflammation.
{"title":"From spreading depolarization to blood–brain barrier dysfunction: navigating traumatic brain injury for novel diagnosis and therapy","authors":"Gerben van Hameren, Refat Aboghazleh, Ellen Parker, Jens P. Dreier, Daniela Kaufer, Alon Friedman","doi":"10.1038/s41582-024-00973-9","DOIUrl":"10.1038/s41582-024-00973-9","url":null,"abstract":"Considerable strides in medical interventions during the acute phase of traumatic brain injury (TBI) have brought improved overall survival rates. However, following TBI, people often face ongoing, persistent and debilitating long-term complications. Here, we review the recent literature to propose possible mechanisms that lead from TBI to long-term complications, focusing particularly on the involvement of a compromised blood–brain barrier (BBB). We discuss evidence for the role of spreading depolarization as a key pathological mechanism associated with microvascular dysfunction and the transformation of astrocytes to an inflammatory phenotype. Finally, we summarize new predictive and diagnostic biomarkers and explore potential therapeutic targets for treating long-term complications of TBI. Overall survival rates for traumatic brain injury have improved, but affected individuals often experience persistent and debilitating long-term complications. In this Review, the authors discuss recent evidence for the role of spreading depolarization in the initiation of long-term pathology in traumatic brain injury, including effects on blood–brain barrier dysfunction and neuroinflammation.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 7","pages":"408-425"},"PeriodicalIF":28.2,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141333717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-12DOI: 10.1038/s41582-024-00977-5
Suzanne E. Schindler, Douglas Galasko, Ana C. Pereira, Gil D. Rabinovici, Stephen Salloway, Marc Suárez-Calvet, Ara S. Khachaturian, Michelle M. Mielke, Chi Udeh-Momoh, Joan Weiss, Richard Batrla, Sasha Bozeat, John R. Dwyer, Drew Holzapfel, Daryl Rhys Jones, James F. Murray, Katherine A. Partrick, Emily Scholler, George Vradenburg, Dylan Young, Alicia Algeciras-Schimnich, Jiri Aubrecht, Joel B. Braunstein, James Hendrix, Yan Helen Hu, Soeren Mattke, Mark Monane, David Reilly, Elizabeth Somers, Charlotte E. Teunissen, Eli Shobin, Hugo Vanderstichele, Michael W. Weiner, David Wilson, Oskar Hansson
Anti-amyloid treatments for early symptomatic Alzheimer disease have recently become clinically available in some countries, which has greatly increased the need for biomarker confirmation of amyloid pathology. Blood biomarker (BBM) tests for amyloid pathology are more acceptable, accessible and scalable than amyloid PET or cerebrospinal fluid (CSF) tests, but have highly variable levels of performance. The Global CEO Initiative on Alzheimer’s Disease convened a BBM Workgroup to consider the minimum acceptable performance of BBM tests for clinical use. Amyloid PET status was identified as the reference standard. For use as a triaging test before subsequent confirmatory tests such as amyloid PET or CSF tests, the BBM Workgroup recommends that a BBM test has a sensitivity of ≥90% with a specificity of ≥85% in primary care and ≥75–85% in secondary care depending on the availability of follow-up testing. For use as a confirmatory test without follow-up tests, a BBM test should have performance equivalent to that of CSF tests — a sensitivity and specificity of ~90%. Importantly, the predictive values of all biomarker tests vary according to the pre-test probability of amyloid pathology and must be interpreted in the complete clinical context. Use of BBM tests that meet these performance standards could enable more people to receive an accurate and timely Alzheimer disease diagnosis and potentially benefit from new treatments. Anti-amyloid treatments for early symptomatic Alzheimer disease have greatly increased the need for biomarker confirmation of amyloid pathology and blood biomarker tests offer an accessible and scalable biomarker test. This Consensus Statement provides recommendations for the minimum acceptable performance of blood biomarker tests for clinical use.
抗淀粉样蛋白治疗早期无症状阿尔茨海默病的方法最近已在一些国家投入临床使用，这大大增加了对淀粉样蛋白病理学生物标志物确认的需求。与淀粉样蛋白 PET 或脑脊液 (CSF) 检测相比，淀粉样蛋白病理学的血液生物标志物 (BBM) 检测更容易接受、更方便、更可扩展，但其性能水平差异很大。阿尔茨海默病全球首席执行官倡议 "召集了一个 BBM 工作组，审议临床使用的 BBM 检测的最低可接受性能。淀粉样蛋白 PET 状态被确定为参考标准。作为淀粉样蛋白 PET 或 CSF 等后续确证检验前的分流检验，BBM 工作组建议 BBM 检验的灵敏度≥90%，特异性≥85%（初级医疗），≥75%-85%（二级医疗），具体取决于后续检验的可用性。如果不进行后续检测，而将 BBM 检测作为确诊检测使用，则其性能应与 CSF 检测相当--灵敏度和特异度约为 90%。重要的是，所有生物标记物检测的预测值都会因检测前淀粉样蛋白病理概率的不同而不同，因此必须在完整的临床背景下进行解释。使用符合这些性能标准的生物标志物检测可使更多人得到准确及时的阿尔茨海默病诊断，并有可能从新疗法中获益。
{"title":"Acceptable performance of blood biomarker tests of amyloid pathology — recommendations from the Global CEO Initiative on Alzheimer’s Disease","authors":"Suzanne E. Schindler, Douglas Galasko, Ana C. Pereira, Gil D. Rabinovici, Stephen Salloway, Marc Suárez-Calvet, Ara S. Khachaturian, Michelle M. Mielke, Chi Udeh-Momoh, Joan Weiss, Richard Batrla, Sasha Bozeat, John R. Dwyer, Drew Holzapfel, Daryl Rhys Jones, James F. Murray, Katherine A. Partrick, Emily Scholler, George Vradenburg, Dylan Young, Alicia Algeciras-Schimnich, Jiri Aubrecht, Joel B. Braunstein, James Hendrix, Yan Helen Hu, Soeren Mattke, Mark Monane, David Reilly, Elizabeth Somers, Charlotte E. Teunissen, Eli Shobin, Hugo Vanderstichele, Michael W. Weiner, David Wilson, Oskar Hansson","doi":"10.1038/s41582-024-00977-5","DOIUrl":"10.1038/s41582-024-00977-5","url":null,"abstract":"Anti-amyloid treatments for early symptomatic Alzheimer disease have recently become clinically available in some countries, which has greatly increased the need for biomarker confirmation of amyloid pathology. Blood biomarker (BBM) tests for amyloid pathology are more acceptable, accessible and scalable than amyloid PET or cerebrospinal fluid (CSF) tests, but have highly variable levels of performance. The Global CEO Initiative on Alzheimer’s Disease convened a BBM Workgroup to consider the minimum acceptable performance of BBM tests for clinical use. Amyloid PET status was identified as the reference standard. For use as a triaging test before subsequent confirmatory tests such as amyloid PET or CSF tests, the BBM Workgroup recommends that a BBM test has a sensitivity of ≥90% with a specificity of ≥85% in primary care and ≥75–85% in secondary care depending on the availability of follow-up testing. For use as a confirmatory test without follow-up tests, a BBM test should have performance equivalent to that of CSF tests — a sensitivity and specificity of ~90%. Importantly, the predictive values of all biomarker tests vary according to the pre-test probability of amyloid pathology and must be interpreted in the complete clinical context. Use of BBM tests that meet these performance standards could enable more people to receive an accurate and timely Alzheimer disease diagnosis and potentially benefit from new treatments. Anti-amyloid treatments for early symptomatic Alzheimer disease have greatly increased the need for biomarker confirmation of amyloid pathology and blood biomarker tests offer an accessible and scalable biomarker test. This Consensus Statement provides recommendations for the minimum acceptable performance of blood biomarker tests for clinical use.","PeriodicalId":19085,"journal":{"name":"Nature Reviews Neurology","volume":"20 7","pages":"426-439"},"PeriodicalIF":28.2,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41582-024-00977-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141309022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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