Guidelines for the use and interpretation of Alzheimer's disease biomarkers in clinical practice in Brazil: recommendations from the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

Adalberto Studart-Neto; Breno José Alencar Pires Barbosa; Artur Martins Coutinho; Leonardo Cruz de Souza; Lucas Porcello Schilling; Mari Nilva Maia da Silva; Raphael Machado Castilhos; Paulo Henrique Ferreira Bertolucci; Wyllians Vendramini Borelli; Hélio Rodrigues Gomes; Gustavo Bruniera Peres Fernandes; Maira Tonidandel Barbosa; Marcio Luiz Figueredo Balthazar; Norberto Anízio Ferreira Frota; Orestes Vicente Forlenza; Jerusa Smid; Sonia Maria Dozzi Brucki; Paulo Caramelli; Ricardo Nitrini; Eliasz Engelhardt; Elisa de Paula França Resende

doi:10.1590/1980-5764-DN-2024-C001

Guidelines for the use and interpretation of Alzheimer's disease biomarkers in clinical practice in Brazil: recommendations from the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

Dement Neuropsychol. 2024 Nov 11:18:e2024C001. doi: 10.1590/1980-5764-DN-2024-C001. eCollection 2024.

Authors

Adalberto Studart-Neto^{1

2}, Breno José Alencar Pires Barbosa^{1

3

4}, Artur Martins Coutinho^{5

6}, Leonardo Cruz de Souza^{1

7}, Lucas Porcello Schilling^{1

8}, Mari Nilva Maia da Silva^{1

9}, Raphael Machado Castilhos^{1

10}, Paulo Henrique Ferreira Bertolucci^{1

11}, Wyllians Vendramini Borelli^{1

12}, Hélio Rodrigues Gomes^{13

14

15}, Gustavo Bruniera Peres Fernandes¹⁶, Maira Tonidandel Barbosa⁷, Marcio Luiz Figueredo Balthazar^{1

17}, Norberto Anízio Ferreira Frota^{1

18

19}, Orestes Vicente Forlenza²⁰, Jerusa Smid^{1

2}, Sonia Maria Dozzi Brucki^{1

2}, Paulo Caramelli^{1

7}, Ricardo Nitrini^{1

2}, Eliasz Engelhardt^{1

21

22}, Elisa de Paula França Resende^{1

7}

Affiliations

¹ Academia Brasileira de Neurologia, Departamento Científico de Neurologia Cognitiva e do Envelhecimento, São Paulo SP, Brazil.
² Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.
³ Universidade Federal de Pernambuco, Hospital das Clínicas, Recife, Centro de Ciências Médicas, Recife PE, Brazil.
⁴ Universidade Federal de Pernambuco, Empresa Brasileira de Serviços Hospitalares, Hospital das Clínicas, Departamento de Neurologia, Recife PE, Brazil.
⁵ Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Radiologia, Centro de Medicina Nuclear, Laboratório de Investigação Médica (LIM 43), São Paulo SP, Brazil.
⁶ Hospital Sírio-Libanês, Medicina Nuclear e Serviço de PET-CT, São Paulo SP, Brazil.
⁷ Universidade Federal de Minas Gerais, Faculdade de Medicina, Unidade de Neurologia Cognitiva e do Comportamento, Belo Horizonte MG, Brazil.
⁸ Pontifícia Universidade do Rio Grande do Sul, Escola de Medicina, Serviço de Neurologia, Porto Alegre RS, Brazil.
⁹ Hospital Nina Rodrigues, Serviço de Neuropsiquiatria, São Luís MA, Brazil.
¹⁰ Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Centro de Neurologia Cognitiva e Comportamental, Porto Alegre RS, Brazil.
¹¹ Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
¹² Universidade Federal do Rio Grande do Sul, Instituto de Ciências Básicas da Saúde, Departamento de Ciências Morfológicas, Porto Alegre RS, Brazil.
¹³ Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Laboratório de Líquido Cefalorraquidiano, São Paulo SP, Brazil.
¹⁴ Universidade de São Paulo, Faculdade de Medicina, Laboratório de Investigação Médica (LIM 15), São Paulo SP, Brazil.
¹⁵ Departamento Científico de Líquido Cefalorraquiano, Academia Brasileira de Neurologia, São Paulo SP, Brazil.
¹⁶ Hospital Israelita Albert Einstein, Laboratório Clínico, São Paulo SP, Brazil.
¹⁷ Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brazil.
¹⁸ Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza CE, Brazil.
¹⁹ Universidade de Fortaleza, Fortaleza, CE, Brazil.
²⁰ Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Psiquiatria, Laboratório de Neurociências, São Paulo SP, Brazil.
²¹ Universidade Federal do Rio de Janeiro, Instituto de Neurologia Deolindo Couto, Rio de Janeiro RJ, Brazil.
²² Universidade Federal do Rio de Janeiro, Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil.

Abstract
in English, Portuguese

In recent years, the diagnostic accuracy of Alzheimer's disease has been enhanced by the development of different types of biomarkers that indicate the presence of neuropathological processes. In addition to improving patient selection for clinical trials, biomarkers can assess the effects of new treatments on pathological processes. However, there is concern about the indiscriminate and poorly supported use of biomarkers, especially in asymptomatic individuals or those with subjective cognitive decline. Difficulties interpreting these tests, high costs, and unequal access make this scenario even more challenging in healthcare. This article presents the recommendations from the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology (Departamento Científico de Neurologia Cognitiva e Envelhecimento da Academia Brasileira de Neurologia) regarding the rational use and interpretation of Alzheimer's disease biomarkers in clinical practice. The clinical diagnosis of cognitive-behavioral syndrome is recommended as the initial step to guide the request for biomarkers.

Nos últimos anos, a precisão diagnóstica da doença de Alzheimer tem sido aprimorada pelo desenvolvimento de diferentes tipos de biomarcadores que indicam a presença dos processos neuropatológicos. Além de melhorar a seleção de pacientes para ensaios clínicos, os biomarcadores podem avaliar os efeitos de novos tratamentos nos processos patológicos. No entanto, há preocupação com o uso indiscriminado e mal fundamentado de biomarcadores, especialmente em indivíduos assintomáticos ou com declínio cognitivo subjetivo. As dificuldades na interpretação desses testes, os altos custos e o acesso desigual tornam esse cenário ainda mais desafiador no cuidado assistencial. Neste artigo, são apresentadas as recomendações do Departamento Científico de Neurologia Cognitiva e Envelhecimento da Academia Brasileira de Neurologia quanto ao uso racional e interpretação de biomarcadores da doença de Alzheimer na prática clínica. O diagnóstico clínico da síndrome cognitivo-comportamental é recomendado como o passo inicial para orientar a solicitação de biomarcadores.

Keywords: Alzheimer Disease; Biomarkers; Cognitive Dysfunction; Diagnosis; Neuroimaging.

Grants and funding

ASN has received honoraria for participation in advisory board for Roche. BJAP has participated as a speaker in symposiums promoted by the laboratories Sandoz, Roche, Knight Therapeutics, Novo Nordisk, and Libbs, participated in the advisory board of Roche and received financial support for participation in events from Novo Nordisk. OVF is a principal investigator in a clinical trial for Biogen (ENVISION). EPFR received support from Proneuro for the preparation of educational materials, from Novo Nordisk for conference attendance, and from Roche for participation in educational activities. PHFB has received honoraria from Neuroimmun, RMC received Alzheimer’s Association Grant (AARGD-21-846545) and is funded by CNPq, Brazil (research productivity grant). GBPF has received participation as speaker in symposium sponsored by Lilly and Roche. MLFB participates in research sponsored by Roche. NAFF has received honoraria for participation in advisory boards for Roche. LPS has received honoraria for participation in advisory boards for Biogen, Knight, Lilly, Novo Nordisk e Roche and for the development of continuing medical education material by Aché, Apsen, Biogen, Knight, Libbs, Novo Nordisk e Roche. LCS has received honoraria for participation in advisory boards for Biogen and Lilly, for the development of continuing medical education material, and participation as a speaker in a symposium sponsored by Abbott, Biogen, Knight, and Novo Nordisk; he is a principal investigator in a clinical trial for PassageBio. SMDB has received honoraria for participation in the advisory board for Biogen, Novo Nordisk, Lilly, Roche, and Adium. PC has participated in a clinical trial sponsored by Novo Nordisk, has participated in consulting activities for Aché, Danone, Eurofarma, Knight Therapeutics and Roche and has prepared continuing medical education materials and participation as speaker in symposia sponsored by Aché, Danone, Grupo Fleury, Novo Nordisk and Roche. RN and SMDB are funded by CNPq, Brazil (research productivity grant). AMC, WVB, MNMS, HRG, MTB, JS, EE have no conflicts of interest to declare.

Abstract in English, Portuguese

Grants and funding

Abstract
in English, Portuguese