SELECTION OF PATIENTS FOR THERAPEUTIC TRI ALS IN ALZHEIMERS-DISEASE -THE QUESTION OF DIAGNOSTIC SPECIFICITY

NINCDS-ADRDA criteria are currently used to include patients into ther apeutic trials in Alzheimer's disease (AD). However, specificity of th ese criteria is not very high (from 64 to 87 % of diagnosis accuracy). The main causes of errors are the other degenerative dementias such a s Frontal Lobe Dementias and Diffuse Lewy Body Disease. On the other h and, clinical heterogeneity of the patients fitting the criteria is la rge. To increase the power of therapeutic trials it is suggested : 1) to use specific criteria to rule out the other degenerative dementias when the efficacy of the tested drug is presumed to be specific for AD (cholinomimetics, inhibitors of beta-amyloid deposits...); 2) a bette r definition and assessment of the target symptoms when symptomatic im provement is the goal of the trial.