MULTICENTER CLINICOPATHOLOGICAL CORRELATION IN DEMENTIA

Objective: The aim of the present study was to determine the accuracy of clinical diagnoses of dementia in a large group of patients evaluat ed in a multicenter, university-based, Alzheimer's disease diagnostic and treatment program. Method: Clinical diagnoses and neuropathologica l results from seven collaborating Alzheimer's disease research center s were compared for 196 cases of dementia. Results: When diagnoses of probable Alzheimer's disease, possible Alzheimer's disease, and Alzhei mer's disease plus another condition were combined, 163 (83%) of the p atients were clinically regarded as likely to have had Alzheimer's dis ease. Of those patients, 134 (82%) were found to have neuropathologica l changes diagnostic of Alzheimer's disease or Alzheimer's disease plu s another condition. A total of 116 patients were diagnosed as having probable Alzheimer's disease; 100 (86%) of those were found to have pa thological diagnoses of Alzheimer's disease or Alzheimer's disease plu s another condition. Cerebral infarcts were found in 17% of the patien ts clinically diagnosed with probable Alzheimer's disease. Lewy bodies with variable Alzheimer's disease-type pathological changes were foun d in 7% of the patients with clinical diagnoses of probable Alzheimer' s disease. Conversely, significant Alzheimer's disease-type pathologic al changes were found in 55% of the patients clinically diagnosed as h aving vascular dementia. Conclusions: Clinicians accurately predict Al zheimer's disease-type neuropathological findings in a high proportion of cases of dementia but may not predict cerebrovascular pathology an d Lewy bodies in some patients with apparent clinical Alzheimer's dise ase and may often fail to predict Alzheimer's disease type pathologica l findings in patients with apparent vascular dementia. With the emerg ence of effective treatments for Alzheimer' disease, there is an incre asing need to optimize methods for ante-mortem diagnosis of dementia.