title: Performance of a Condensed Protocol That Reduces Effort and Cost of NIA-AA Guidelines for Neuropathologic Assessment of Alzheimer Disease.
abstract: Concerns regarding resource expenditures have been expressed about the 2012 NIA-AA Sponsored Guidelines for neuropathologic assessment of Alzheimer disease (AD) and related dementias. Here, we investigated a cost-reducing Condensed Protocol and its effectiveness in maintaining the diagnostic performance of Guidelines in assessing AD, Lewy body disease (LBD), microvascular brain injury, hippocampal sclerosis (HS), and congophilic amyloid angiopathy (CAA). The Condensed Protocol consolidates the same 20 regions into 5 tissue cassettes at ∼75% lower cost. A 28 autopsy brain-retrospective cohort was selected for varying levels of neuropathologic features in the Guidelines (Original Protocol), as well as an 18 consecutive autopsy brain prospective cohort. Three neuropathologists at 2 sites performed blinded evaluations of these cases. Lesion specificity was similar between Original and Condensed Protocols. Sensitivities for AD neuropathologic change, LBD, HS, and CAA were not substantially impacted by the Condensed Protocol, whereas sensitivity for microvascular lesions (MVLs) was decreased. Specificity for CAA was decreased using the Condensed Protocol when compared with the Original Protocol. Our results show that the Condensed Protocol is a viable alternative to the NIA-AA guidelines for AD neuropathologic change, LBD, and HS, but not MVLs or CAA, and may be a practical alternative in some practice settings.
authors.affiliation: Department of Pathology, Stanford University, Stanford, CA, USA.
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Flanagan
authors.affiliation: Department of Pathology, University of Washington, Seattle, WA, USA.
authors.forename: Desiree A
authors.initials: DA
authors.lastname: Marshall
authors.affiliation: Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA.
authors.forename: Jane B
authors.initials: JB
authors.lastname: Shofer
authors.affiliation: Department of Pathology, Stanford University, Stanford, CA, USA.
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Montine
authors.affiliation: Department of Pathology, University of Kentucky, Lexington, KY, USA.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Nelson
authors.affiliation: Department of Pathology, Stanford University, Stanford, CA, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Montine
authors.affiliation: Department of Pathology, University of Washington, Seattle, WA, USA.
authors.forename: C Dirk
authors.initials: CD
authors.lastname: Keene
mesh_terms: D000544:Alzheimer Disease / Q000191:economics* / Q000473:pathology*; D001921:Brain / Q000473:pathology; D015331:Cohort Studies; D017046:Cost Savings / Q000379:methods / Q000592:standards*; D006801:Humans; D054561:National Institute on Aging (U.S.) / Q000191:economics* / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012189:Retrospective Studies; D016037:Single-Blind Method; D014481:United States
keywords: Alzheimer disease; Cost and congophilic amyloid angiopathy; Hippocampal sclerosis; Lewy body disease; Microvascular brain injury