ACCURACY OF CLINICAL OPERATIONAL DIAGNOSTIC-CRITERIA FOR ALZHEIMERS-DISEASE IN RELATION TO DIFFERENT PATHOLOGICAL DIAGNOSTIC PROTOCOLS

In this study we analysed the accuracy of two sets of clinical diagnos tic criteria, the NINCDS/ADRDA and DSM-III-R, in relation to the curre ntly used pathological diagnostic criteria for Alzheimer's disease (AD ), the Khachaturian criteria, the Tierney A3 criteria and the CERAD pr otocol. The sensitivity of the individual clinical diagnostic criteria , NINCDS/ADRDA and DSM-III-R, is poor (34-58%) irrespective of the pat hological diagnostic criteria applied for the definite diagnosis of AD . The combination of the NINCDS/ADRDA 'possible' and 'probable dementi a of the Alzheimer type' (DAT) categories has a high sensitivity (91-9 8%). However the combination resulted in very poor specificity (40-61% ). Thus, none of the clinical diagnostic criteria is satisfactory. We found similar results when we analysed the predictive value of these c linical diagnostic criteria. The positive predictive value of NINCDS ' probable DAT' category and that of the DAT diagnosis by DSM-III-R is v ery high (89-100%). This makes the use of these categories suitable fo r research purposes. However, the negative predictive value of both di agnoses is poor (33-63%), making these criteria unsuitable for diagnos tic purposes in clinical practice.