Author's School

Graduate School of Arts & Sciences

Author's Department/Program

Psychology

Language

English (en)

Date of Award

Winter 12-1-2013

Degree Type

Thesis

Degree Name

Master of Arts (MA)

Chair and Committee

Brian D. Carpenter

Abstract

Cerebrospinal fluid: CSF) proteins correlate with pathological changes that are hallmarks of Alzheimer’s disease: AD). CSF biomarkers have been used in research settings to predict AD diagnosis and rate of cognitive decline, however their use in clinical settings is limited. Given their potential utility in identifying preclinical AD and in increasing diagnostic confidence in clinical settings, we sought to understand how clinicians use CSF biomarkers in conjunction with other clinical details to diagnose AD. Participants: N = 193) were physicians and other medical professionals who routinely evaluate older adults for neurodegenerative disease. In a within-subjects factorial design, participants were randomized and viewed normal, borderline, AD-consistent, or no CSF information along with two clinical vignettes portraying patients with borderline and mild AD symptoms. In addition, clinicians reported on their use and the utility of CSF lab results in clinical practice. Clinicians reported infrequent use and limited utility of CSF biomarkers in clinical practice, yet CSF biomarkers affected clinical decisions on two vignettes. AD-consistent CSF values made clinicians 6-12 times more likely to make an AD-related diagnosis, increased diagnostic confidence, and led clinicians to initiate treatment more often than other CSF values. Furthermore, clinicians relied on CSF evidence more heavily when AD-consistent CSF values were presented in the context of a borderline case of memory impairment. In sum, CSF biomarkers have a significant impact on clinical decisions, and show different effects depending on contextual factors. Therefore, as CSF biomarkers become more widespread in clinical practice, clinicians should consider the potentially significant effect of biomarkers on their clinical decisions.

Comments

This work is not available online per the author’s request. For access information, please contact digital@wumail.wustl.edu or visit http://digital.wustl.edu/publish/etd-search.html.

Permanent URL: http://dx.doi.org//K7KS6PQD

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