THE NATURAL-HISTORY OF ALZHEIMERS-DISEASE - DESCRIPTION OF STUDY COHORT AND ACCURACY OF DIAGNOSIS

Objective: We describe the sampling, initial evaluation, and final dia gnostic classification of subjects enrolled in a natural history study of Alzheimer's disease (AD). Design: Volunteer cohort study. Setting: Multidisciplinary behavioral neurology research clinic. Patients or O ther Participants: Three-hundred nineteen individuals were enrolled in the Alzheimer Research Program between March 1983 and March 1988. Of these, 204 were originally classified with AD, 102 were normal elderly control subjects, and 13 were considered special cases. Main Outcome Measures: Final consensus clinical diagnosis, final neuropathologic di agnosis, and death. Results: Of the 204 patients enrolled in the study , re-review after as many as 5 years of follow-up resulted in a final clinical classification of 188 with probable AD. Seven patients were b elieved to have a significant vascular component to the dementia, thre e were found to have developed depression, and six were excluded on ot her clinical grounds. Neuropathologic examination of 50 brains indicat ed definite AD in 43. After removing these seven misdiagnosed patients , the final group of probable/definite AD totaled 181 individuals. Acc uracy of the baseline clinical diagnosis relative to neuropathology wa s 86%, and when follow-up clinical data were considered, 91.4%. Detail ed neuropsychological testing yielded high sensitivity (0.988) and spe cificity (0.983) to dementia. Analyses of survival time from study ent ry until death revealed that older patients were significantly more li kely to die during follow-up, but neither sex, years of education, nor pattern of cognitive impairment were related to survival. Conclusions : These data provide the descriptive basis for future studies of this cohort. They indicate that longitudinal follow-up of demented cases in creases accuracy of diagnosis, and that detailed cognitive testing aid s in early classification.