Citation

Asken BM. JAMA Neurol. 2019; 76(5): 515-516.

Affiliation

Division of Clinical Psychology, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island.

Copyright

(Copyright © 2019, American Medical Association)

DOI

10.1001/jamaneurol.2019.0125

PMID

30830175

Abstract

Biomarkers are now near ubiquitous across neurologic research and increasingly influence clinical care. Advanced neuroimaging and fluid-based biomarkers (eg, cerebrospinal fluid and blood) offer unique opportunities for characterizing biologic processes. Concussion biomarker research emerged with the hope that truly objective indicators may finally help resolve the inherent complexities of a condition with heterogeneous effects and nonspecific symptoms.

“Led down the garden path” means being seduced by an illusory ideal or solution. The deceptive appeal of the biomarker garden path is the promise that an athlete suspected of sustaining a sport-related concussion or a brain trauma survivor in the emergency department could be unequivocally diagnosed without relying on subjective symptom reporting or crude clinical evaluations. A decade of research has fallen short of that promise, perhaps because there currently exists only a clinical symptom gold standard without a biologic analog. This creates a de facto situation where clinically diagnosed concussion serves as the benchmark for a biomarker’s validity. In other words, there is no scenario where a biomarker’s diagnostic accuracy will match or outperform the very criteria that classified concussed and nonconcussed cases in the first place ...

Language: en