Kapaki 2005.
| Study characteristics | |||
| Patient Sampling | A total of 103 subjects were included in the study: 33 patients with AD, 20 patients with ARCD and 50 controls (healthy elderly). ARCD patients were recruited during a two‐year period from a larger pool of 82 detoxified alcoholic subjects. No further details about sampling procedure. Separate data were available for the performance of biomarkers in distinguishing between AD from ACRD. We did not include data on performance of the index test to discriminate AD participants from controls. Exclusion criteria not reported. |
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| Patient characteristics and setting | The sample considered in the review comprised of 53 participants: were included in the review: 33 with AD and 20 with ARCD, which completed a detoxification program. AD patients were subjected to a detailed evaluation (medical history, physical and neurological examination, computed tomography and/or magnetic resonance imaging and blood tests to exclude metabolic causes of dementia). There was no history of alcohol use or abuse and all had a sufficient follow‐up (for at least two years) to ensure diagnosis. No one of the patients was under any medication for dementia at the time of lumbar puncture. Evaluation of alcohol abuse was made by the Pattern of Abuse tool (Hughes 1980), the section on alcoholism of Composite International Diagnostic Interview (WHO 1990) and the Diagnostic Interview Schedule (Wells 1994). The mean duration of alcohol consumption was 29 years (range 6–40 years). Only 23 of the 83 subjects met the DSM‐IV criteria of alcohol‐induced persisting dementia. Three out of the 23 patients were under the age of 40 years (out of the range of AD patients), and were not included in the study. Sex: 14 M, 19 F AD; 18 M, 2 F ACRD Age: 63±11 years AD; 60±12 ACRD MMSE: 23 (15‐27) AD; 25 (15‐28) ACRD Resources of recruitment: i) in‐patients: Drug and Alcohol Addiction Clinic, Department of Psychiatry, Athens National University, Greece; ii) not reported for AD participants |
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| Index tests | Patients gave CSF samples. The samples were collected in polypropylene tubes, centrifuged, aliquoted, and stored at ‐70°C and analysed. Abeta42 was measured using enzyme‐linked immunosorbent assays, obtained from Innogenetics NV, Gent, Belgium. Threshold: 562 pg/ml; not prespecified; Cut‐offs were determined by ROC analysis. Were the index test results reported without knowledge of the reference standard? [Not reported] |
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| Target condition and reference standard(s) |
Target condition: Alzheimer's disease dementia (differential diagnosis of AD dementia from ARCD) Reference standard: NINCDS‐ADRDA criteria Clinical diagnostic criteria for ARCD: the Pattern of Abuse tool (Hughes 980), the section on alcoholism of Composite International Diagnostic Interview (WHO 1990) and the Diagnostic Interview Schedule (Wells 1994). The reference standard was performed before applying the index test. |
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| Flow and timing | The interval between established clinical diagnosis and CSF sample collection was not reported.However, it appears that CSF samples were collected short after neuropsychological examination that was performed two months after detoxification for alcohol‐induced dementia. Sample included in the analysis: 33 AD; 20 ARCD AD vs ACRD (53) TP=28; FP=4; FN=5; TN=16 (Fig 1B, p402) Sensitivity=85%; Specificity=80% (Abstract) |
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| Comparative | |||
| Notes | |||
| Methodological quality | |||
| Item | Authors' judgement | Risk of bias | Applicability concerns |
| DOMAIN 1: Patient Selection | |||
| Was a consecutive or random sample of patients enrolled? | Unclear | ||
| Was a case‐control design avoided? | No | ||
| Did the study avoid inappropriate exclusions? | Unclear | ||
| Could the selection of patients have introduced bias? | High risk | ||
| Are there concerns that the included patients and setting do not match the review question? | Low concern | ||
| DOMAIN 3: Reference Standard | |||
| Is the reference standards likely to correctly classify the target condition? | Yes | ||
| Were the reference standard results interpreted without knowledge of the results of the index tests? | Yes | ||
| Could the reference standard, its conduct, or its interpretation have introduced bias? | Low risk | ||
| Are there concerns that the target condition as defined by the reference standard does not match the question? | Low concern | ||
| DOMAIN 4: Flow and Timing | |||
| Was there an appropriate interval between index test and reference standard? | Yes | ||
| Were all patients included in the analysis? | Yes | ||
| Could the patient flow have introduced bias? | Low risk | ||