Optimal diagnostic tests for sporadic Creutzfeldt-Jakob disease based on support vector machine classification of RT-QuIC data

In this work we study numerical construction of optimal clinical diagnostic tests for detecting sporadic Creutzfeldt-Jakob disease (sCJD). A cerebrospinal fluid sample (CSF) from a suspected sCJD patient is subjected to a process which initiates the aggregation of a protein present only in cases of sCJD. This aggregation is indirectly observed in real-time at regular intervals, so that a longitudinal set of data is constructed that is then analysed for evidence of this aggregation. The best existing test is based solely on the final value of this set of data, which is compared against a threshold to conclude whether or not aggregation, and thus sCJD, is present. This test criterion was decided upon by analysing data from a total of 108 sCJD and non-sCJD samples, but this was done subjectively and there is no supporting mathematical analysis declaring this criterion to be exploiting the available data optimally. This paper addresses this deficiency, seeking to validate or improve the test primarily via support vector machine (SVM) classification. Besides this, we address a number of additional issues such as i) early stopping of the measurement process, ii) the possibility of detecting the particular type of sCJD and iii) the incorporation of additional patient data such as age, sex, disease duration and timing of CSF sampling into the construction of the test.