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Mary Sano, PhD; D. P. Devanand, MD; Marcus Richards, PhD; Lisa W. Miller; Karen Marder, MD; Karen Bell, MD; George Dooneief, MD; Frederick W. Bylsma, PhD; Ginette Lafleche, PhD; Marilyn Albert, PhD; Marshal Folstein, MD; Yaakov Stern, PhD

Arch Neurol. 1995;52(10):961-966.

Abstract
Objectives
To develop an informant-based semistructured interview to determine the onset and duration of symptoms of Alzheimer's disease, and to use this instrument with informants to characterize a cohort of mildly impaired patients with Alzheimer's disease.

Design
In study 1, interrater and interinformant reliability was examined for the date of onset and the order of appearance for specific symptoms that were elicited by the semistructured onset interview. In study 2, the instrument was used to characterize disease onset in a cohort of patients with Alzheimer's disease who were participating in a large multicenter study.

Subjects
Informants of patients with Alzheimer's disease.

Results
In study 1, interrater reliability for duration of illness was excellent (intraclass correlation coefficient=.99, P<.001), and interinformant reliability was good (intraclass correlation coefficient=.86, P<.001). Agreement for the presence of a given symptom was highest for those that were most commonly reported (eg, memory and performance difficulty). In study 2, 89% of the cohort had memory problems, and 63.9% had performance difficulties as the first or second symptom. Depression and language problems were less commonly reported. Psychosis and behavioral disturbances were rarely reported as the first problem.

Conclusion
This instrument provides a reliable procedure for standardizing the estimation of duration of illness based on retrospective report.

Author Affiliations
From the Departments of Neurology (Drs Sano, Richards, Marder, Bell, Dooneief, and Stern and Ms Miller) and Psychiatry (Drs Devanand and Stern) and the Sergievsky Center (Drs Sano, Richards, and Stern), College of Physicians & Surgeons of Columbia University, the Memory Disorders Center, New York State Psychiatric Institute (Drs Sano, Devanand, Marder, Bell, Dooneief, and Stern and Ms Miller), and the Center for Alzheimer's Disease Research (Drs Sano, Marder, Bell, Dooneief, and Stern), New York, NY; the Departments of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, Md (Drs Bylsma and Folstein); and the Departments of Psychiatry and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (Drs Lafleche and Albert).

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