CiteWeb id: 19840000001

CiteWeb score: 27377

DOI: 10.1212/WNL.34.7.939

Alzheimer’s disease is a brain disorder characterized by a progressive dementia that occurs in middle or late life. The pathologic characteristics are degeneration of specific nerve cells, presence of neuritic plaques, and neurofibrillary tangles. Alterations in transmitter-specific markers include forebrain cholinergic systems, and, in some cases, noradrenergic and somatostatinergic systems that innervate the telencephalon. A Work Group on the Diagnosis of Alzheimer’s Disease was established by the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and the Alzheimer’s Disease and Related Disorders Association (ADRDA). The group intended to establish and to describe clinical criteria for the diagnosis of Alzheimer’s disease of particular importance for research protocols and to describe approaches that would be useful for assessing the natural history of the disease. The need to refine clinical diagnostic criteria has been emphasized because 20% or more of cases with the clinical diagnosis of Alzheimer’s disease are found at autopsy to have other conditions and not Alzheimer’s disease. Moreover, therapeutic trials can be meaningfully compared only if uniform criteria are used for diagnosis and response to treatment. The need for this report was suggested by the National Advisory Council of the NINCDS. The report has been reviewed by workshop participants, representatives of the National Advisory Neurological and Communicative Disorders and Stroke Council, representatives of the ADRDA, and designated reviewers representing professional societies concerned with the diagnosis of Alzheimer’s disease. (For list of professional societies and designated reviewers, see page 943.) The report was developed by subgroups that addressed medical history, clinical examination, neuropsychological testing, and laboratory assessments; the report was then discussed in plenary session. Based on a consensus of the participants, criteria were developed to serve as a clinical basis for diagnosis. These criteria should be useful also for comparative studies of patients in different kinds of investigations, including case control studies, therapeutic trials, evaluation of new diagnostic laboratory tests, and clinicopathologic correlations. The criteria are not yet fully operational because of insufficient knowledge about the disease. The criteria are compatible with definitions in the current Diagnostic and Statistical Manual of Mental Disorders (DSM 111) and in the International Classification of Diseases. These criteria must be regarded as tentative and subject to change. Additional longitudinal studies, confirmed by autopsy, are necessary to establish the validity of these criteria in com