Alzheimer’s disease (AD) cerebrospinal fluid (CSF) biomarkers are promising tools to help identify the underlying pathology of neurocognitive disorders. In this manuscript, we report our experience with AD CSF biomarkers in 262 consecutive patients in a tertiary care memory clinic.

We retrospectively reviewed 262 consecutive patients who underwent lumbar puncture (LP) and CSF measurement of AD biomarkers (Aβ1–42, total tau or t-tau, and p-tau181). We studied the safety of the procedure and its impact on patient’s diagnosis and management.

The LP allowed to identify underlying AD pathology in 72 of the 121 patients (59%) with early onset amnestic mild cognitive impairment (aMCI) with a high probability of progression to AD; to distinguish the behavioral/dysexecutive variant of AD from the behavioral variant of frontotemporal dementia (bvFTD) in 25 of the 45 patients (55%) with an atypical neurobehavioral profile; to identify AD as the underlying pathology in 15 of the 27 patients (55%) with atypical or unclassifiable primary progressive aphasia (PPA); and to distinguish AD from other disorders in 9 of the 29 patients (31%) with psychiatric differential diagnoses and 19 of the 40 patients (47%) with lesional differential diagnoses (normal pressure hydrocephalus, encephalitis, prion disease, etc.). No major complications occurred following the LP.

Our results suggest that CSF analysis is a safe and effective diagnostic tool in select patients with neurocognitive disorders. We advocate for a wider use of this biomarker in tertiary care memory clinics in Canada.

The use of digital technologies in healthcare systems (digital health)– such as electronic health records and telehealth – can improve primary care (PC). However, integration of digital health can be constrained/impaired and/or facilitated due to several factors. We propose an integrative framework for classifying the factors that could favour or limit digital health integration in PC in order to guide the identification of strategies that could be helpful for technology promoters, managers, clinicians and researchers.

Based on a systematic review, our framework includes seven categories to classify the main opportunities and threats to digital health integration in PC: technological; individual/interpersonal; professional; organisational/institutional; ethical/legal; sociopolitical; economical. We consulted a panel of researchers, managers, clinicians, and citizens/patients in a scientific meeting regarding the main opportunities and threats to the integration of digital health in PC. We performed a content analysis of the reported factors according to the framework.

Technological factors such as maturity, interoperability and ease of use were often mentioned as key conditions for digital health integration. Individual and interpersonal factors such as depersonalisation and digital literacy were seen as threats. The impact on workload and shared responsibility were threats at the professional level, whereas silos and change management were noted as organisational threats. Current policies and social trends favored digital health. Threats regarding privacy and confidentiality were mentioned at the legal/ethical level. The possibility to reduce costs and sharing of benefits were noted as opportunities at the economic level.

Knowing these multidimensional conditions, perceived as either threats or opportunities depending on the context of each PC setting, is essential to inform decisions, from strategic planning to evaluation. Our integrative framework allows a simple classification of opportunities and threats that can guide the development and implementation of tailored strategies favouring the integration of digital health in PC.

The impact of malignant glioma resection on survival is still a matter of controversy. The lack of well-designed prospective studies as well as control of all factors in retrospective studies plays an important role in this debate. Amongst some of these uncontrolled factors, are the inclusion of different histological grades, the lack of objective methods to estimate the extent of resection and unspecified delays in post-operative imaging.

We retrospectively reviewed 126 consecutive patients with glioblastoma, operated on by the senior authors at the Centre Hospitalier Universitaire de Sherbrooke, who met the following criteria: >18 years of age, newly diagnosed glioblastoma, pre-operative magnetic resonance imaging (MRI) within 2 weeks prior to surgery, and a post-operative MRI within 72 hours after surgery. Extent of tumour resection was calculated using pre and post-operative tumour delimitation on gadolinium-enhanced T1 MRI in a volumetric analysis.

Applying stringent specific inclusion criteria, 126 patients were retained in the analysis. The median overall survival was 271 days and the median extent of resection was 65%. Patients with more than 90% of tumour resection had a significantly better outcome, improving median survival from 225 to 519 days (P=0.006). Other factors that significantly improved survival were the use of radiotherapy, the number of regimens and type of chemotherapy used.

A more aggressive approach combining maximal safe resection and use of salvage chemotherapy seems to confer a survival advantage for glioblastoma patients.