P4‐095: COMPARISON OF FOUR NEW CONSENSUS CRITERIA AGAINST THE 1984 NINCDS‐ARDRA CRITERIA FOR ALZHEIMER'S DISEASE

Diagnosis of Alzheimer's disease (AD) has undergone significant revision, largely in response to advances in biomarker research and the understanding of AD's syndromic complexity. The new criteria include: (1) International Working Group (IWG; Dubois 2007 and 2010), (2) International Classification of Disease (ICD-10; WHO 2010), (3) National Institute on Aging - Alzheimer's Association (NIA-AA; McKhann 2011), and (4) DSM-5 (APA 2013). These differ in requirements for memory impairment, functional decline, biomarkers, and allowance for disease subtypes and mixed pathologies (Visser 2012). Comprehensive, systematic comparison in a group of well-characterized AD subjects remains to be done. Clinical history and imaging for 101 individuals from the Sunnybrook Dementia Study who met the 1984 NINCDS-ARDRA criteria (McKhann 1984), for probable AD were reviewed, applying the new criteria. Tc 99 -SPECT was used instead of FDG-PET for the NIA-AA and IWG criteria. The NIA-AA and NINCDS-ARDRA criteria had excellent agreement, with 90% (n=91) of those meeting the original 1984 McKhann criteria also satisfying the revised NIA-AA criteria. Among those that did not, 7 had insufficient functional decline to fulfill dementia criteria, and would be classified as MCI. By contrast, 47% (n=47) of those meeting the 1984 McKhann criteria failed to meet the IWG criteria, similar to the results from a prior study comparing it to the ICD-10/DSMIV(Oksengard 2010). This may reflect the IWG's strict requirement for biomarkers and predominantly amnestic course, and disallowance of co-pathology. Indeed, all atypical individuals from our cohort and those with mild-to-moderate white matter disease were rejected. Similarly, only 44% (n=44) of those meeting the 1984 McKhann criteria met the ICD-10 criteria, likely reflecting construct differences , namely, ICD-10's unique requirements for functional impairment and behavioural symptoms. 85% (n=86) of those meeting the 1984 McKhann also met the DSM-V. Both allow for non-amnestic presentations and are largely based on a similar combination of cognitive and functional factors. Differences in syndrome construct (including functional decline), biomarker use, and allowance for co-pathology within criteria significantly affect the diagnostic classification of individuals with dementia. Going forward, such differences merit careful validation to ensure that criteria accurately and meaningfully reflect disease.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.