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J Neuropathol Exp Neurol. 2020 Mar 18. pii: nlaa014. doi: 10.1093/jnen/nlaa014. [Epub ahead of print]

Concordance of Clinical Alzheimer Diagnosis and Neuropathological Features at Autopsy.

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Department of Epidemiology, National Alzheimer's Coordinating Center, University of Washington, Seattle, Washington.
Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, Maryland.
School of Urban and Regional Planning, Institute for Human Health and Disease Intervention, Florida Atlantic University, Boca Raton, Florida.
Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, California (WDB); Department of Statistics.
Department of Pathology, University of Washington, Seattle, Washington.


It remains unclear what clinical features inform the accuracy of a clinical diagnosis of Alzheimer disease (AD). Data were obtained from the National Alzheimer's Coordinating Center to compare clinical and neuropathologic features among participants who did or did not have Alzheimer disease neuropathologic changes (ADNC) at autopsy. Participants (1854) had a clinical Alzheimer dementia diagnosis and ADNC at autopsy (Confirmed-AD), 204 participants had an AD diagnosis and no ADNC (AD-Mimics), and 253 participants had no AD diagnosis and ADNC (Unidentified-AD). Compared to Confirmed-AD participants, AD-Mimics had less severe cognitive impairment, while Unidentified-AD participants displayed more parkinsonian signs, depression, and behavioral problems. This study highlights the importance of developing a complete panel of biomarkers as a tool to inform clinical diagnoses, as clinical phenotypes that are typically associated with diseases other than AD may result in inaccurate diagnoses.


Alzheimer disease; Diagnosis; Neuropathology


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