Sensitivity, Specificity and Reliability of Three Pathological Criteria for Alzheimer’s Disease (P6.223)

Objectives: To examine the sensitivity and specificity, and reliability of the 3 pathological criteria for Alzheimer’s disease (AD). Background: The pathological diagnosis of AD has been based on the Consortium to Establish a Registry for AD (CERAD), The National Institute on Aging (NIA) and the Ronald Reagan Institute (RI) Work Group on Diagnostic Criteria for the Neuropathological Assessment of AD, and the NIA-Alzheimer’s Association (NIA-AA) criteria. Methodology: We applied the 3 pathological criteria to 76 demented patients autopsied at the University of Pittsburgh. The neuropathological criteria were dichotomized based on different levels of certainty for AD: CERAD: definite, probable, possible and not AD; NIA-RI: high, moderate, low and not AD; and the NIA-AA: high, intermediate, low, and not AD. Results: The best sensitivity for the NIA-AA criteria (93[percnt]) was when we compared patients with high, intermediate and low levels of certainty versus those considered not AD, and the worst (80[percnt]) when we compared patients with high versus intermediate, low, and not AD. The best sensitivity for the CERAD criteria (93[percnt]) was when we compared definite, probable, and possible levels of certainty versus not AD, and the worst (88[percnt]) when we compared definite versus probable, possible, and not AD. The best sensitivity for the NIA-RI criteria (90[percnt]) was when we compared high, moderate, and low levels of certainty versus not AD, and the worst (78[percnt]) when we compared high versus moderate, low and not AD. The best agreement among the different pathological criteria was between the NIA-AA and CERAD criteria (kappa 0.86). Conclusion: The different diagnostic pathological criteria have similar levels of sensitivity, and there was a high level of agreement among them. The high sensitivity observed with the more “loose” use of the criteria indicated that the clinical syndrome can be expressed with low and high levels of AD pathology. Disclosure: Dr. Steinberg has nothing to disclose. Dr. Lopez has nothing to disclose. Dr. Kofler has nothing to disclose. Dr. Becker has nothing to disclose. Dr. Sweet has nothing to disclose. Dr. Berman has nothing to disclose. Dr. McDade has received personal compensation for activities with UpToDate. Dr. McDade has received personal compensation in an editorial capacity from Springer Publishing. Dr. Rodriguez has nothing to disclose. Dr. Klunk has received license fee payments from GE Healthcare.