Classification of Alzheimer's disease and frontotemporal dementia using routine clinical and cognitive measures across multicentric underrepresented samples: A cross sectional observational study
Lancet Reg Health Am. 2023 Jan;17:100387. doi: 10.1016/j.lana.2022.100387. Epub 2022 Nov 3.
ABSTRACT
BACKGROUND: Global brain health initiatives call for improving methods for the diagnosis of Alzheimer's disease (AD) and frontotemporal dementia (FTD) in underrepresented populations. However, diagnostic procedures in upper-middle-income countries (UMICs) and lower-middle income countries (LMICs), such as Latin American countries (LAC), face multiple challenges. These include the heterogeneity in diagnostic methods, lack of clinical harmonisation, and limited access to biomarkers.
METHODS: This cross-sectional observational study aimed to identify the best combination of predictors to discriminate between AD and FTD using demographic, clinical and cognitive data among 1794 participants [904 diagnosed with AD, 282 diagnosed with FTD, and 606 healthy controls (HCs)] collected in 11 clinical centres across five LAC (ReDLat cohort).
FINDINGS: A fully automated computational approach included classical statistical methods, support vector machine procedures, and machine learning techniques (random forest and sequential feature selection procedures). Results demonstrated an accurate classification of patients with AD and FTD and HCs. A machine learning model produced the best values to differentiate AD from FTD patients with an accuracy = 0.91. The top features included social cognition, neuropsychiatric symptoms, executive functioning performance, and cognitive screening; with secondary contributions from age, educational attainment, and sex.
INTERPRETATION: Results demonstrate that data-driven techniques applied in archival clinical datasets could enhance diagnostic procedures in regions with limited resources. These results also suggest specific fine-grained cognitive and behavioural measures may aid in the diagnosis of AD and FTD in LAC. Moreover, our results highlight an opportunity for harmonisation of clinical tools for dementia diagnosis in the region.
FUNDING: This work was supported by the Multi-Partner Consortium to Expand Dementia Research in Latin America (ReDLat), funded by NIA/NIH (R01AG057234), Alzheimer's Association (SG-20-725707-ReDLat), Rainwater Foundation, Takeda (CW2680521), Global Brain Health Institute; as well as CONICET; FONCYT-PICT (2017-1818, 2017-1820); PIIECC, Facultad de Humanidades, Usach; Sistema General de Regalías de Colombia (BPIN2018000100059), Universidad del Valle (CI 5316); ANID/FONDECYT Regular (1210195, 1210176, 1210176); ANID/FONDAP (15150012); ANID/PIA/ANILLOS ACT210096; and Alzheimer's Association GBHI ALZ UK-22-865742.
PMID:36583137 | PMC:PMC9794191 | DOI:10.1016/j.lana.2022.100387
Authors
![hernando santamaria](/sites/default/files/styles/image_1x1_small/public/profile/hernando_santamaria.jpg?h=1969fba6&itok=W98t-Vqb)
Hernando Santamaría-García, MD, MSc, PhD
Psychiatrist and Researcher
![Sebastian Moguilner](/sites/default/files/styles/image_1x1_small/public/profile/Sebastian%20Moguilner_0.jpg?h=a9697f3a&itok=3q-RPElI)
Sebastian Moguilner, PhD
Neuroscientist
![Kate Possin](/sites/default/files/styles/image_1x1_small/public/profile/Kate-Possin.jpg?h=b17e2d09&itok=N7EpTTfi)
Kate Possin, PhD
Professor of Neurology
![Adolfo Garcia 2023](/sites/default/files/styles/image_1x1_small/public/profile/Adolfo%20Garc%C3%ADa%20-%20Foto%2017.jpg?h=020f7c01&itok=e2SBFZEC)
Adolfo M. García, PhD
Neuroscientist
![Shireen Javandel](/sites/default/files/styles/image_1x1_small/public/profile/Shireen%20Javandel.jpg?h=8acaa938&itok=2fkqfluB)
Shireen Javandel
Assistant Director for Operations & Impact
![Bruce Miller](/sites/default/files/styles/image_1x1_small/public/profile/Bruce%20Miller.jpg?h=3334e0bf&itok=3zITuREU)
Bruce Miller, MD
Founding Director, University of California, San Francisco
![Maira Okada de Oliveira](/sites/default/files/styles/image_1x1_small/public/profile/maira_okada_de_oliveira.jpg?h=6846fd67&itok=NL4UrZlN)
Maira Okada de Oliveira, PhD
Neuropsychologist
![Stefanie Pina Escudero 2023](/sites/default/files/styles/image_1x1_small/public/profile/GBHI_2023-Conference-Photos_125%20%281%29%20%281%29.jpg?h=301bf149&itok=H795CwKR)
Stefanie Piña Escudero, MD
Geriatrician
![Andrea Slachevsky headshot](/sites/default/files/styles/image_1x1_small/public/profile/Slachevsky.jpg?h=ce9941eb&itok=cPeWICLO)
Andrea Slachevsky, MD, PhD
![Victor Valcour](/sites/default/files/styles/image_1x1_small/public/profile/Victor%20Valcour.jpg?h=88b1f798&itok=-hX5KIpa)
Victor Valcour, MD, PhD
Site Director, University of California, San Francisco
![Jennifer Yokoyama headshot](/sites/default/files/styles/image_1x1_small/public/profile/Jennifer-Yokoyama_2021_imaged.jpg?h=3a9097f1&itok=FyQqCmF-)
Jennifer Yokoyama, PhD
Associate Professor of Neurology