Reliability and validity of NINCDS-ADRDA criteria for Alzheimer's disease. The National Institute of Mental Health Genetics Initiative.
OBJECTIVE
To assess interrater reliability and validity of NINCDS-ADRDA (National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association) criteria for Alzheimer's disease (AD).


METHODS
A multisite reliability and validity study in which clinicians from each site diagnosed 60 case summaries yielding a preconsensus estimate of reliability and validity. A consensus conference was conducted for each disagreement, leading to a postconsensus estimate of validity. The criterion standard was a diagnosis of AD by autopsy.


METHODS
Three academic medical centers.


METHODS
A convenience sample of 60 detailed case summaries, 40 with AD and 20 with other dementing disorders.


METHODS
The kappa coefficient, sensitivity, and specificity.


RESULTS
The kappa coefficient for preconsensus agreement on a diagnosis of probable or possible AD vs non-AD was 0.51; the sensitivity of a diagnosis of probable or possible AD for a pathological diagnosis of AD was 0.81, and the specificity was 0.73. The postconsensus sensitivity was 0.83, and the specificity was 0.84.


CONCLUSIONS
The results support the reliability and validity of NINCDS-ADRDA criteria and show that the consensus process may improve diagnostic accuracy. The cases are reviewed with a focus on the sources of diagnostic disagreements and errors and possible changes that might improve the accuracy of the criteria.
Blacker
D
D
Department of Psychiatry, Massachusetts General Hospital, Boston.
Albert
M S
MS
Bassett
S S
SS
Go
R C
RC
Harrell
L E
LE
Folstein
M F
MF
D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D015203:Reproducibility of Results; D014481:United States