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Reliability and Validity of NINCDS-ADRDA Criteria for Alzheimer's Disease:  The National Institute of Mental Health Genetics Initiative

Deborah Blacker, MD, ScD; Marilyn S. Albert, PhD; Susan S. Bassett, PhD; Rodney C. P. Go, PhD; Lindy E. Harrell, MD, PhD; Marshai F. Folstein, MD
Arch Neurol. 1994;51(12):1198-1204. doi:10.1001/archneur.1994.00540240042014.
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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).

Design:  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.

Setting:  Three academic medical centers.

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

Main Outcome Measures:  The κ coefficient, sensitivity, and specificity.

Results:  The κ 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.

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