COMPARISON OF NEUROPATHOLOGIC CRITERIA FOR THE DIAGNOSIS OF ALZHEIMERS-DISEASE

The National Institute on Aging and Reagan Institute (NIA-RI) criteria -and other neuropathologic criteria for Alzheimer's disease (AD), were compared with the clinical diagnosis of dementia in a well defined po pulation of Catholic sisters. The 47 participant subset examined in th is study were college educated and lacked complicating conditions such as brain infarcts or diffuse Lewy body disease. Sixteen participants had a clinical diagnosis of dementia. The NIA-RI criteria imply a perf ect correlation between neuritic plaque (NP) density and neurofibrilla ry tangle distribution. However, NP density often did not coincide wit h tangle distribution. As a result, it was not possible to categorize many of the participants using the NIA-RI guidelines. The 'high likeli hood' category of the NIA-RI criteria for AD research settings (neocor tical Braak stage and frequent neocortical NP) had relatively high spe cificity (90% of nondemented participants did not meet this criteria). However, only half cf the demented participants were in this category . Neuropathologic criteria requiring the presence of. neocortical tang les (rather than neocortical E-rank stage) had relatively high sensiti vity, accounting for 87-94% of participants with dementia, but also in cluded 32-35% of nondemented participants. Criteria based on neocortic al NP or senile plaques had 100% sensitivity, but a majority of nondem ented participants also met these criteria. The results support consid eration of both tangles and NP for the neuropathologic diagnosis of AD , but indicate that refinement of the NIA-RI criteria is necessary. A possible refinement is suggested for further consideration. (C) 1997 E lsevier Science Tnc.