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Neuropathologic criteria for diagnosing Alzheimer disease in persons with pure dementia of Alzheimer type.

Authors :
McKeel DW Jr
Price JL
Miller JP
Grant EA
Xiong C
Berg L
Morris JC
Source :
Journal of neuropathology and experimental neurology [J Neuropathol Exp Neurol] 2004 Oct; Vol. 63 (10), pp. 1028-37.
Publication Year :
2004

Abstract

Universally accepted neuropathologic criteria for differentiating Alzheimer disease (AD) from healthy brain aging do not exist. We tested the hypothesis that Bielschowsky silver stained total, cored, and neuritic senile plaques (TSPs, CSPs, and NSPs, respectively), rather than neurofibrillary tangles (NFTs), best discriminate between the 2 conditions using rigorously defined nondemented (n = 7) and AD (n = 35) subjects with no known co-morbidities. We compared lesions in 3 neocortical regions, in hippocampal CA1, and in entorhinal cortex in 19 men and 13 women between 74 and 86 years at death. The Clinical Dementia Rating (CDR) was used to assess degree of cognitive impairment within a year of demise. Neocortical TSP measures provided the highest correlation with expiration CDR: area under the curve (AUC) = 0.986 with 97.8% sensitivity at 90% specificity with an estimated cut-point of 6.0 TSP/ mm2. All SP measures yielded higher estimated AUC and sensitivity for 90% specificity compared to NFTs. Derived TSP cut-points applied to 149 persons with clinical AD regardless of their neuropathologic diagnosis yielded a sensitivity of 97% and specificity of 84% for TSPs in the 3 neocortical areas. Thus cut-points based on both diffuse and neuritic SP in neocortical regions distinguished nondemented and AD subjects with high sensitivity and specificity.

Details

Language :
English
ISSN :
0022-3069
Volume :
63
Issue :
10
Database :
MEDLINE
Journal :
Journal of neuropathology and experimental neurology
Publication Type :
Academic Journal
Accession number :
15535130
Full Text :
https://doi.org/10.1093/jnen/63.10.1028