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Clinical Criteria for the Diagnosis of Alzheimer Disease: Still Good After All These Years

From the Department of Psychiatry (NAR, LSH, MFW), Department of Clinical Sciences (Biostatistics) (LSH), Department of Neurology (MFW), and Department of Pathology (CLW), University of Texas Southwestern Medical Center, Dallas, TX.

Objective: To examine the impact of newer neuropathological techniques on the power of National Institute of Neurological and Communicative Disorders and Stroke–AD and Related Disorders Association criteria for Alzheimer disease (AD) to detect AD at later postmortem study.

Design: We examined clinical and postmortem diagnoses of persons evaluated postmortem with thioflavin-S staining for plaques and tangles and immunohistochemical staining techniques for alpha synuclein, uhiquitin, and tau protein. Setting: Alzheimer Disease Center.

Participants: Clinically evaluated persons for whom tissue diagnosis was available.

Results: Of 313 evaluees, 166 met criteria for probable AD. An additional 59 subjects had clinical diagnoses that included AD, e.g., possible AD, Lewy body variant of AD, AD and Parkinsonism, and mixed AD and vascular dementia. Of the 166 probable AD cases, 147 of 166 (88.6%) met pathologic criteria for AD. When all five AD groups were combined, 194 of 225 subjects (86.2%) met pathologic criteria for AD. There were five cases diagnosed pathologically as tangle-only dementia, which was considered a variant of AD. A pathologic diagnosis of Lewy body variant of AD was made in 56 (17.9%) of cases, including 44 of 313 (14.1%) cases diagnosed as probable or possible AD. Pure dementia with Lewy bodies was seen in 13 (4.2%). There were 9 (2.9%) cases of mixed AD and vascular dementia, and 37 (11.4%) cases of frontotemporal dementia.

Conclusions: McKhann et al. criteria for probable and possible AD are valid for AD but do not exclude additional Lewy body pathology.

Key Words: NINCDS/ADRDA criteria • Alzheimer disease • postmortem

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