Diagnosis of Alzheimer's Disease in Developed and Developing Countries: Systematic Review and Meta-Analysis of Diagnostic Test Accuracy

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Castaneda-Via, Jose
Champi, Ana
Delgado, Leyla
Guillen, Ronald
Landauro, Carlos, V
Montalvo, Fred
Moya, Marie-Jose
Pena-Rodriguez, Victor
Quispe-Marcatoma, Justiniano
Rumiche, Francisco
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Background: The present systematic review and meta-analysis of diagnostic test accuracy summarizes the last three decades in advances on diagnosis of Alzheimer's disease (AD) in developed and developing countries. Objective: To determine the accuracy of biomarkers in diagnostic tools in AD, for example, cerebrospinal fluid, positron emission tomography (PET), and magnetic resonance imaging (MRI), etc. Methods: The authors searched PubMed for published studies from 1990 to April 2020 on AD diagnostic biomarkers. 84 published studies were pooled and analyzed in this meta-analysis and diagnostic accuracywas compared by summary receiver operating characteristic statistics. Results: Overall, 84 studies met the criteria and were included in a meta-analysis. For EEG, the sensitivity ranged from 67 to 98%, with a median of 80%, 95%CI [75, 91], tau-PET diagnosis sensitivity ranged from 76 to 97%, with a median of 94%, 95%CI [76, 97]; and MRI sensitivity ranged from 41 to 99%, with a median of 84%, 95%CI [81, 87]. Our results showed that tau-PET diagnosis had higher performance as compared to other diagnostic methods in this meta-analysis. Conclusion: Our findings showed an important discrepancy in diagnostic data for AD between developed and developing countries, which can impact global prevalence estimation and management of AD. Also, our analysis found a better performance for the tau-PET diagnostic over other methods to diagnose AD patients, but the expense of tau-PET scan seems to be the limiting factor in the diagnosis of AD in developing countries such as those found in Asia, Africa, and Latin America.
This study was supported by the Consejo Nacional de Ciencia, Tecnologia e Innovacion y Tecnologia (CONCYTEC) and the Fondo Nacional de Desarrollo Cientifico, Tecnologico y de Innovacion Tecnologica de Peru (FONDECYT). Contract Nr. 24-2019. We would like to thank Dr. Maximo Rondon and Dra Karina Rosas and theVicerrectorado de investigacion for providing substantial support to the Laboratory of Genomics and Neurovascular Diseases to carry out this work.
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systematic review