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.