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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.

Abstract
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 coefficient, sensitivity, and specificity.

Results
The 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.

Author Affiliations
From the Departments of Psychiatry (Drs Blacker and Albert) and Neurology (Dr Albert), Massachusetts General Hospital and Harvard Medical School, Boston; the Department of Psychiatry, The Johns Hopkins University Medical institutions, Baltimore, Md (Drs Bassett and Folstein); the Department of Epidemiology, School of Public Health (Dr Go), the Department of Neurology, School of Medicine (Dr Harrell), and the Alzheimer's Disease Research Center (Drs Go and Harrell), University of Alabama at Birmingham. Dr Folstein is now with the Department of Psychiatry, Tufts University School of Medicine, Boston.

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