title: Autopsy consent, brain collection, and standardized neuropathologic assessment of ADNI participants: the essential role of the neuropathology core.
abstract: BACKGROUND
  Our objectives are to facilitate autopsy consent, brain collection, and perform standardized neuropathologic assessments of all Alzheimer's Disease Neuroimaging Initiative (ADNI) participants who come to autopsy at the 58 ADNI sites in the USA and Canada.
  
  
  METHODS
  Building on the expertise and resources of the existing Alzheimer's Disease Research Center (ADRC) at Washington University School of Medicine, St. Louis, MO, a Neuropathology Core (NPC) to serve ADNI was established with one new highly motivated research coordinator. The ADNI-NPC coordinator provides training materials and protocols to assist clinicians at ADNI sites in obtaining voluntary consent for brain autopsy in ADNI participants. Secondly, the ADNI-NPC maintains a central laboratory to provide uniform neuropathologic assessments using the operational criteria for the classification of AD and other pathologies defined by the National Alzheimer Coordinating Center (NACC). Thirdly, the ADNI-NPC maintains a state-of-the-art brain bank of ADNI-derived brain tissue to promote biomarker and multi-disciplinary clinicopathologic studies.
  
  
  RESULTS
  During the initial year of funding of the ADNI Neuropathology Core, there was notable improvement in the autopsy rate to 44.4%. In the most recent year of funding (September 1(st), 2008 to August 31(st) 2009), our autopsy rate improved to 71.5%. Although the overall numbers to date are small, these data demonstrate that the Neuropathology Core has established the administrative organization with the participating sites to harvest brains from ADNI participants who come to autopsy.
  
  
  CONCLUSIONS
  Within two years of operation, the Neuropathology Core has: (1) implemented a protocol to solicit permission for brain autopsy in ADNI participants at all 58 sites who die and (2) to send appropriate brain tissue from the decedents to the Neuropathology Core for a standardized, uniform, and state-of-the-art neuropathologic assessment. The benefit to ADNI of the implementation of the NPC is very clear. Prior to the establishment of the NPC in September 2007, there were 6 deaths but no autopsies in ADNI participants. Subsequent to the establishment of the Core there have been 17 deaths of ADNI participants and 10 autopsies. Hence, the autopsy rate has gone from 0% to 59%. The third major accomplishment is the detection of co-existent pathologies with AD in the autopsied cases. It is possible that these co-morbidities may contribute to any variance in ADNI data.
authors.affiliation: Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO 63110, USA. cairns@wustl.edu
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Cairns
authors.forename: Lisa
authors.initials: L
authors.lastname: Taylor-Reinwald
authors.forename: John C
authors.initials: JC
authors.lastname: Morris
mesh_terms: D000544:Alzheimer Disease / Q000473:pathology*; D001344:Autopsy; D001921:Brain / Q000473:pathology*; D002170:Canada; D003072:Cognition Disorders / Q000235:genetics / Q000473:pathology; D004268:DNA-Binding Proteins / Q000378:metabolism; D003952:Diagnostic Imaging; D006801:Humans; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D014015:Tissue Banks / Q000706:statistics & numerical data; D014481:United States
chemical_list: D004268:DNA-Binding Proteins
references.citation: Neurology. 1991 Apr;41(4):479-86
references.pmid: 2011243
references.citation: Arch Neurol. 1999 Jan;56(1):33-9
references.pmid: 9923759
references.citation: Am J Pathol. 2007 Jul;171(1):227-40
references.pmid: 17591968
references.citation: Ann Neurol. 2007 May;61(5):435-45
references.pmid: 17469117
references.citation: Acta Neuropathol. 2006 Oct;112(4):389-404
references.pmid: 16906426
references.citation: Acta Neuropathol. 2007 Jul;114(1):5-22
references.pmid: 17579875
references.citation: Neurology. 2005 Dec 27;65(12):1863-72
references.pmid: 16237129
references.citation: J Neuropathol Exp Neurol. 2006 Aug;65(8):740-57
references.pmid: 16896308
references.citation: Neuropathol Appl Neurobiol. 1989 Jan-Feb;15(1):13-26
references.pmid: 2471109
references.citation: J Neuropathol Exp Neurol. 1994 May;53(3):303-15
references.pmid: 8176413
references.citation: Arch Neurol. 1985 Nov;42(11):1097-105
references.pmid: 2864910
references.citation: Acta Neuropathol. 1991;82(4):239-59
references.pmid: 1759558
references.citation: Cell Tissue Res. 2004 Oct;318(1):121-34
references.pmid: 15338272
references.citation: Neurobiol Aging. 1997 Jul-Aug;18(4 Suppl):S1-2
references.pmid: 9330978
references.citation: J Neuropathol Exp Neurol. 2002 Jun;61(6):547-56
references.pmid: 12071638
references.citation: Brain. 2009 Nov;132(Pt 11):2922-31
references.pmid: 19674978
references.citation: Neurology. 1993 Feb;43(2):250-60
references.pmid: 8094895
references.citation: Acta Neuropathol. 2009 Jan;117(1):15-8
references.pmid: 19015862
references.citation: Neurology. 1996 Nov;47(5):1113-24
references.pmid: 8909416
references.citation: Neurosci Lett. 1987 Apr 23;76(1):124-7
references.pmid: 2438598
references.citation: Arch Neurol. 2009 Dec;66(12):1557-62
references.pmid: 20008664
references.citation: Lancet. 2008 Jul 19;372(9634):216-23
references.pmid: 18640458
references.citation: Acta Neuropathol. 2009 Nov;118(5):605-16
references.pmid: 19669651