RELIABILITY AND VALIDITY OF NINCDS-ADRDA CRITERIA FOR ALZHEIMERS-DISEASE - THE NATIONAL-INSTITUTE-OF-MENTAL-HEALTH GENETIC INITIATIVE

Objective: To assess interrater reliability and validity of NINCDS-ADR DA (National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association) criteria for Alzheimer's disease (AD). Design: A multisite reliability and val idity study in which clinicians from each site diagnosed 60 case summa ries yielding a preconsensus estimate of reliability and validity. A c onsensus conference was conducted for each disagreement, leading to a postconsensus estimate of validity. The criterion standard was a diagn osis of AD by autopsy. Setting: Three academic medical centers. Subjec ts: A convenience sample of 60 detailed case summaries, 40 with AD and 20 with other dementing disorders. Main Outcome Measures: The K coeff icient, sensitivity, and specificity. Results: The K coefficient for p reconsensus agreement on a diagnosis of probable or possible AD vs non -AD was 0.51; the sensitivity of a diagnosis of probable or possible A D for a pathological diagnosis of AD was 0.81, and the specificity was 0.73. The postconsensus sensitivity was 0.83, and the specificity was 0.84. Conclusions: The results support the reliability and validity o f NINCDS-ADRDA criteria and show that the consensus process may improv e diagnostic accuracy. The cases are reviewed with a focus on the sour ces of diagnostic disagreements and errors and possible changes that m ight improve the accuracy of the criteria.