AUTOPSY DIAGNOSES OF ALZHEIMER-DISEASE - INDEPENDENT REVIEWS AND CLINICAL IMPLICATIONS

At present, the neuropathologic examination is universally regarded as essential for the final diagnosis of Alzheimer disease (AD). However, there is absence of agreement on what areas to examine, what stains t o use, which lesions to report, and how to interpret other neuropathol ogic findings. In this study, we describe the results of reviewing the neuropathologic findings in probands from a family study of AD who ha d received a clinical diagnosis of 'probable AD' (N = 33). A neuropath ologic diagnosis of AD was received for 88% of the probands, a proport ion entirely in agreement with that reported in the literature. An ind ependent review of the autopsy reports found variability in whether th e neuropathologic diagnosis was based on the presence of plaques or ta ngles or both. Further, when a subset of histologic slides was reviewe d by two researchers working in the field of AD, there were substantia l diagnostic discrepancies. These findings indicate the need for stand ardized protocols, but suggest that even they have limitations. These limitations are of particular concern when estimating vulnerability to AD of first-degree relatives. Thus, while neuropathologic examination continues to provide invaluable information about the causes of demen tia, it cannot be regarded as a gold standard for diagnosis of individ ual cases.