Clinical Utility of a Novel Test to Diagnose Alzheimer’s Disease in Patients with Suspected Dementia - Abstract
Background: Historically, Alzheimer’s Disease (AD) diagnosis has been made using non-specific tests (imaging and/or CSF biomarkers). The DISCERNTM test is novel AD test combining three biomarkers: Morphometric Imaging, Protein Kinase C ?, and AD-Index, and is validated against autopsy confirmed diagnosis (NIH gold standard for AD diagnosis) with 95% sensitivity and 95% specificity. Materials and Methods: We utilized a web-based survey to estimate treatment decisions from a sample of primary care physicians (PCPs), neurologists, and geriatricians. Computer software was used to randomly generate hypothetical patient profiles with five attributes: MRI/CT Scan results, MMSE score, Blood test results (TSH, Vitamin B12, Folate, Syphilis, Lyme disease), Age, and DISCERNTM result. Each physician viewed 7 of 27 unique profiles generated, using a least-fill methodology. For each profile, physicians indicated whether they would diagnose the patient with AD, prescribe medications indicated to treat AD symptoms, refer the patient to a neurologist (PCPs and geriatricians only), and prescribe a futuristic disease-modifying drug (Drug X). Aggregate logit models were used to assess attribute importance. Findings: 402 physicians participated in the survey (250 PCPs, 102 neurologists, and 50 geriatricians). 4% of physicians expressed satisfaction with current tests, and 90% indicated they were likely to order DISCERNTM. DISCERNTM result was the most important attribute in most physician decision-making scenarios; physicians were more likely to diagnose AD with a positive DISCERNTM result vs no test (relative attribute importance (RAI):64%; OR: 6.45; 95% CI: 5.09-8.17). A positive DISCERNTM result was associated with significantly higher odds of prescribing Drug X (RAI: 62%; OR: 4.12; 95% CI: 3.36-5.04) and prescribing treatments for AD symptoms (RAI: 54%; OR: 2.98; 95% CI: 2.40-3.68). Physicians were significantly less likely to prescribe treatments with a negative DISCERNTM result vs no test (OR: 0.58; 95% CI: 0.48-0.70). Conclusions: This study indicates that DISCERNTM test results has a significant impact on physician decision-making regarding AD diagnosis and management.