Home › Research › Biomarkers
Accuracy of Biomarker Testing for Neuropathologically Defined Alzheimer Disease in Older Adults With Dementia
Fink HA, Linskens EJ, Silverman PC, McCarten JR, Hemmy LS, Ouellette JM, Greer NL, Wilt TJ et al.. Annals of internal medicine, 2020-04-28
Topic: Amyloid, tau and blood-test diagnosis
Background Biomarker accuracy for Alzheimer disease (AD) is uncertain. Purpose To summarize evidence on biomarker accuracy for classifying AD in older adults with dementia. Data sources Electronic bibliographic databases (searched from January 2012 to November 2019 for brain imaging and cerebrospinal fluid [CSF] tests and from inception to November 2019 for blood tests), ClinicalTrials.gov (to November 2019), and systematic review bibliographies. Study selection English-language studies evaluating the accuracy of brain imaging, CSF testing, or blood tests for distinguishing neuropathologically defined AD from non-AD among older adults with dementia. Studies with low or medium risk of bias were analyzed. Data extraction Two reviewers rated risk of bias. One extracted data; the other verified accuracy. Data synthesis Fifteen brain imaging studies and 9 CSF studies met analysis criteria. Median sensitivity and specificity, respectively, were 0.91 and 0.92 for amyloid positron emission tomography (PET), 0.89 and 0.74 for 18 F-labeled fluorodeoxyglucose ( 18 F-FDG) PET, 0.64 and 0.83 for single-photon emission computed tomography, and 0.91 and 0.89 for medial temporal lobe atrophy on magnetic resonance imaging (MRI). Individual CSF biomarkers and ratios had moderate sensitivity (range, 0.62 to 0.83) and specificity (range, 0.53 to 0.69); in the few direct comparisons, β-amyloid 42 (Aβ42)/phosphorylated tau (p-tau) ratio, total tau (t-tau)/Aβ42 ratio, and p-tau appeared more accurate than Aβ42 and t-tau alone. Single studies suggested that amyloid PET, 18 F-FDG PET, and CSF test combinations may add accuracy to clinical evaluation. Limitations Studies were small, biomarker cut points and neuropathologic AD were inconsistently defined, and methods with uncertain applicability to typical clinical settings were used. Few studies directly compared biomarkers, assessed test combinations, evaluated whether biomarkers improved classification accuracy when added to clinical evaluation, or reported harms. Conclusion In methodologically heterogeneous studies of uncertain applicability to typical clinical settings, amyloid PET, 18 F-FDG PET, and MRI were highly sensitive for neuropathologic AD. Amyloid PET, 18 F-FDG PET, and CSF test combinations may add accuracy to clinical evaluation. Primary funding source Agency for Healthcare Research and Quality. (PROSPERO: CRD42018117897).
Key findings
- Single studies suggested that amyloid PET, 18 F-FDG PET, and CSF test combinations may add accuracy to clinical evaluation.
Why it matters
This review of biomarker accuracy found that amyloid PET and medial temporal lobe atrophy on MRI had high sensitivity and specificity for distinguishing neuropathologically defined Alzheimer's disease from non-Alzheimer's disease in older adults with dementia, while individual CSF biomarkers had moderate sensitivity and specificity. It is about how well tests classify disease, not about treating, curing or preventing it.
New to this subject? Start with our plain-English guide: Blood tests & biomarkers →
Study details
- Study designsystematic review
- Evidence strengthHigh
How this study scored 61/100
Published in a leading specialty journal, and it is a systematic review of all the studies on the question. Scored zero for sample size, effect reported and studied in people because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Annals of internal medicine) |
| Journal's citation record | 4 / 4 | Annals of Internal Medicine: journal h-index 648 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2020 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 4 / 7 | Cited 57 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 7.1 citations a year over 8 year(s) since 2020 |
| Impact for its field and year | 3 / 6 | Cited 4.3× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 5 other studies in this library |
| Still being cited | 2 / 4 | Cited 30 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Mary Butler: h-index 12 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Minnesota: institution h-index 1,568 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 32340038) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 61 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
May need a subscription Unpaywall, Europe PMC and OpenAlex found no free copy of the full text (checked 10 Oct 2026), so the publisher may charge for it. The PubMed abstract is free.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Fink, H. A., Linskens, E. J., Silverman, P. C., McCarten, JR., Hemmy, L. S., Ouellette, J. M., et al. (2020). Accuracy of Biomarker Testing for Neuropathologically Defined Alzheimer Disease in Older Adults With Dementia. Annals of internal medicine. https://doi.org/10.7326/m19-3888
Vancouver
Fink HA, Linskens EJ, Silverman PC, McCarten JR, Hemmy LS, Ouellette JM, et al. Accuracy of Biomarker Testing for Neuropathologically Defined Alzheimer Disease in Older Adults With Dementia. Annals of internal medicine. 2020. doi:10.7326/m19-3888. PMID: 32340038.
BibTeX
@article{fink2020-32340038,
author = {Fink, H. A. and Linskens, E. J. and Silverman, P. C. and McCarten, JR. and Hemmy, L. S. and Ouellette, J. M. and Greer, N. L. and Wilt, T. J. and others},
title = {{Accuracy of Biomarker Testing for Neuropathologically Defined Alzheimer Disease in Older Adults With Dementia}},
journal = {Annals of internal medicine},
year = {2020},
doi = {10.7326/m19-3888},
pmid = {32340038},
url = {https://doi.org/10.7326/m19-3888}
}
Studies this one cites
Referenced by this study and also in the alzhub library, so you can read them here. Showing 12 of 25.
Later studies that cite this one
5 studies in the alzhub library list this one in their references.
Related studies in Biomarkers
Also tagged “biomarkers”
821 studies in the library carry the topic tag “biomarkers”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 821 tagged studies.