title: Accuracy of clinical criteria for AD in the Honolulu-Asia Aging Study, a population-based study.
abstract: OBJECTIVE
  To determine diagnostic accuracy for AD in a population-based study of Japanese-American men. AD is neuropathologically confirmed for more than 80% of cases at major referral centers (primarily Caucasians); however, information on diagnostic accuracy in population-based studies and studies of different ethnic groups is limited.
  
  
  METHODS
  There were 3,734 men who participated in the Honolulu-Asia Aging Study 1991 through 1993 dementia examination and 2,603 in the 1994 through 1996 examination. Diagnoses were based on published criteria. Neuropathologists blinded to clinical data quantified neurofibrillary tangles (NFT) and neuritic plaques (NP).
  
  
  RESULTS
  Of 220 autopsied subjects, clinical evaluation revealed 68 with normal cognition, 73 intermediate, and 79 with dementia: 20 AD, 27 vascular dementia, 19 AD + other, and 13 other dementia. Among 20 cases with pure AD, the median value for maximum neocortical NFT density was 6.9/mm(2) and for neocortical NP density was 8.0/mm2. Corresponding densities for other groups were <3.0/mm2. Using established neuropathologic criteria, 25% (5/20) of clinical AD cases had enough NP to meet definite AD criteria, whereas 65% (13/20) had sufficient NP to meet neuropathologic definite or probable AD criteria. Among nine AD cases with moderately severe dementia, only two (22%) had NP densities great enough to meet definite neuropathologic criteria, whereas seven (78%) met neuropathologic criteria for probable AD.
  
  
  CONCLUSIONS
  Neuropathologic confirmation and NP density among decedents with clinical AD in this population-based study were lower than reported by referral centers and similar to reports from two other community studies. Ethnic differences in propensity for amyloid deposition as well as differences in clinical severity and representativeness of cases might contribute to these findings.
authors.affiliation: Pacific Health Research Institute, Honolulu, HI 96813, USA. helen@phri.hawaii-health.com
authors.forename: H
authors.initials: H
authors.lastname: Petrovitch
authors.forename: L R
authors.initials: LR
authors.lastname: White
authors.forename: G W
authors.initials: GW
authors.lastname: Ross
authors.forename: S C
authors.initials: SC
authors.lastname: Steinhorn
authors.forename: C Y
authors.initials: CY
authors.lastname: Li
authors.forename: K H
authors.initials: KH
authors.lastname: Masaki
authors.forename: D G
authors.initials: DG
authors.lastname: Davis
authors.forename: J
authors.initials: J
authors.lastname: Nelson
authors.forename: J
authors.initials: J
authors.lastname: Hardman
authors.forename: J D
authors.initials: JD
authors.lastname: Curb
authors.forename: P L
authors.initials: PL
authors.lastname: Blanchette
authors.forename: L J
authors.initials: LJ
authors.lastname: Launer
authors.forename: K
authors.initials: K
authors.lastname: Yano
authors.forename: W R
authors.initials: WR
authors.lastname: Markesbery
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000473:pathology*; D002986:Clinical Trials as Topic; D006254:Hawaii; D006801:Humans; D008297:Male; D011159:Population Surveillance