COMMENTARY ON THE CONSENSUS RECOMMENDATIONS FOR THE POST-MORTEM DIAGNOSIS OF ALZHEIMERS-DISEASE

The consensus recommendations for the post mortem diagnosis Alzheimer' s disease (AD) highlight the difficulties in establishing a pathologic al diagnosis in brains from clinically demented individuals with both certainty and uniformity. There is, however, a need fur diagnostic gui delines that are relatively simple, inexpensive, and adaptable to gene ral pathologists and different laboratories. The current Consortium to Establish a Registry for Alzheimer's disease (CERAD) criteria and the recommendations in the consensus document giving three probabilistic categories for diagnosis go a long way towards establishing a uniform approach for the diagnosis of AD. However, more uniformity could be ad opted in;he topography of sectioning to enhance diagnostic and future research comparisons. We also recommend that immunohistochemistry for beta A4 (A beta) amyloid and tau-reactive neurofibrillary changes, in addition to hematoxylin and eosin stains, should become the basis for histological diagnosis. We agree with the guidelines concerning docume ntation of all AD changes. Until a clearer understanding of the early changes of AD is established, strict observation and recording are the pathologists' best diagnostic skills. The ill-defined diagnostic area s of AD continue to prompt the need for a new method of detection of t he underlying pathologic process. (C) 1997 Elsevier Science Inc.