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

doi:10.1001/archneur.1994.00540240042014

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Vol. 51 No. 12, December 1994

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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.

Abstract

Objective
To assess interrater reliability and validity of NINCDS-ADRDA(National Institute of Neurological and Communicative Diseasesand Stroke/Alzheimer's Disease and Related Disorders Association)criteria for Alzheimer's disease (AD).

Design
A multisite reliability and validity study in which cliniciansfrom each site diagnosed 60 case summaries yielding a preconsensusestimate of reliability and validity. A consensus conferencewas conducted for each disagreement, leading to a postconsensusestimate of validity. The criterion standard was a diagnosisof AD by autopsy.

Setting
Three academic medical centers.

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

Main Outcome Measures
The ${kappa}$ coefficient, sensitivity, and specificity.

Results
The ${kappa}$ coefficient for preconsensus agreement on a diagnosis ofprobable or possible AD vs non-AD was 0.51; the sensitivityof a diagnosis of probable or possible AD for a pathologicaldiagnosis of AD was 0.81, and the specificity was 0.73. Thepostconsensus sensitivity was 0.83, and the specificity was0.84.

Conclusions
The results support the reliability and validity of NINCDS-ADRDAcriteria and show that the consensus process may improve diagnosticaccuracy. The cases are reviewed with a focus on the sourcesof diagnostic disagreements and errors and possible changesthat 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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