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Am J Psychiatry 1995; 152:1476-1484
Copyright © 1995 by American Psychiatric Association
Multicenter clinicopathological correlation in dementia
J Victoroff, WJ Mack, SA Lyness and HC Chui
University of Southern California School of Medicine, Rancho Los Amigos Medical Center, Downey 90242, USA.
OBJECTIVE: The aim of the present study was to determine the accuracy of
clinical diagnoses of dementia in a large group of patients evaluated in a
multicenter, university-based, Alzheimer's disease diagnostic and treatment
program. METHOD: Clinical diagnoses and neuropathological results from
seven collaborating Alzheimer's disease research centers were compared for
196 cases of dementia. RESULTS: When diagnoses of probable Alzheimer's
disease, possible Alzheimer's disease, and Alzheimer's disease plus another
condition were combined, 163 (83%) of the patients were clinically regarded
as likely to have had Alzheimer's disease. Of those patients, 134 (82%)
were found to have neuropathological changes diagnostic of Alzheimer's
disease or Alzheimer's disease plus another condition. A total of 116
patients were diagnosed as having probable Alzheimer's disease; 100 (86%)
of those were found to have pathological diagnoses of Alzheimer's disease
or Alzheimer's disease plus another condition. Cerebral infarcts were found
in 17% of the patients clinically diagnosed with probable Alzheimer's
disease. Lewy bodies with variable Alzheimer's disease-type pathological
changes were found in 7% of the patients with clinical diagnoses of
probable Alzheimer's disease. Conversely, significant Alzheimer's
disease-type pathological changes were found in 55% of the patients
clinically diagnosed as having vascular dementia. CONCLUSIONS: Clinicians
accurately predict Alzheimer's disease-type neuropathological findings in a
high proportion of cases of dementia but may not predict cerebrovascular
pathology and Lewy bodies in some patients with apparent clinical
Alzheimer's disease and may often fail to predict Alzheimer's disease-type
pathological findings in patients with apparent vascular dementia. With the
emergence of effective treatments for Alzheimer's disease, there is an
increasing need to optimize methods for ante-mortem diagnosis of dementia.
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