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The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part II. Standardization of the neuropathologic assessment of Alzheimer's disease.
Literature Information
| DOI | 10.1212/wnl.41.4.479 |
|---|---|
| PMID | 2011243 |
| Journal | Neurology |
| Impact Factor | 8.5 |
| JCR Quartile | Q1 |
| Publication Year | 1991 |
| Times Cited | 1976 |
| Keywords | Alzheimer's Disease, Neuropathology, Standardized Protocol, Diagnostic Criteria |
| Literature Type | Journal Article, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S. |
| ISSN | 0028-3878 |
| Pages | 479-86 |
| Issue | 41(4) |
| Authors | S S Mirra, A Heyman, D McKeel, S M Sumi, B J Crain, L M Brownlee, F S Vogel, J P Hughes, G van Belle, L Berg |
TL;DR
The Neuropathology Task Force of the CERAD has established a standardized protocol for postmortem assessment of dementia, which defines diagnostic categories like "definite Alzheimer's disease" to enhance diagnostic accuracy and consistency. In a pretest involving 142 clinically diagnosed probable AD patients, 84% met the CERAD criteria for definite AD, indicating that this protocol will improve the understanding of Alzheimer's disease and its early subclinical changes as more cases are studied.
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Alzheimer's Disease · Neuropathology · Standardized Protocol · Diagnostic Criteria
Abstract
The Neuropathology Task Force of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) has developed a practical and standardized neuropathology protocol for the postmortem assessment of dementia and control subjects. The protocol provides neuropathologic definitions of such terms as "definite Alzheimer's disease" (AD), "probable AD," "possible AD," and "normal brain" to indicate levels of diagnostic certainty, reduce subjective interpretation, and assure common language. To pretest the protocol, neuropathologists from 15 participating centers entered information on autopsy brains from 142 demented patients clinically diagnosed as probable AD and on eight nondemented patients. Eighty-four percent of the dementia cases fulfilled CERAD neuropathologic criteria for definite AD. As increasingly large numbers of prospectively studied dementia and control subjects are autopsied, the CERAD neuropathology protocol will help to refine diagnostic criteria, assess overlapping pathology, and lead to a better understanding of early subclinical changes of AD and normal aging.
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Primary Questions Addressed
- How does the CERAD neuropathology protocol compare to other existing protocols for assessing Alzheimer's disease?
- What are the implications of the standardized definitions provided by CERAD for clinical practice in diagnosing Alzheimer's disease?
- In what ways can the findings from the CERAD protocol influence future research on Alzheimer's disease and its early subclinical changes?
- How does the participation of multiple centers enhance the reliability and validity of the CERAD neuropathology assessment?
- What challenges might arise in implementing the CERAD protocol across diverse clinical settings, and how can they be addressed?
Key Findings
Key Insights
Research Background and Purpose: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) was formed to enhance the understanding and diagnosis of Alzheimer's Disease (AD). Despite the clinical approaches to diagnosing AD, there was a lack of standardized neuropathological protocols that could effectively differentiate between varying levels of dementia, including definite, probable, and possible AD. The primary aim of this study was to develop and standardize a neuropathology assessment protocol that would facilitate consistent postmortem evaluations of dementia and control subjects. This initiative sought to provide clarity in diagnostic criteria and enhance communication among researchers and clinicians in the field of Alzheimer’s research.
Main Methods and Findings: The Neuropathology Task Force of CERAD created a comprehensive neuropathologic protocol that defined critical terms associated with Alzheimer's diagnosis, such as "definite AD," "probable AD," "possible AD," and "normal brain." This standardized language aimed to minimize subjective interpretations by neuropathologists. The protocol was pretested by engaging neuropathologists from 15 participating centers, who reviewed autopsy data from 142 patients clinically diagnosed with probable AD and eight nondemented individuals. The results indicated that 84% of the dementia cases met the CERAD criteria for definite AD, showcasing the protocol's effectiveness in accurately classifying the disease.
Core Conclusions: The findings from the pretesting of the CERAD neuropathology protocol highlight its potential to enhance the diagnostic accuracy of Alzheimer's Disease postmortem assessments. The high percentage of cases classified as definite AD emphasizes the protocol's reliability and its role in reducing diagnostic ambiguity. Furthermore, the standardized definitions will aid in the refinement of diagnostic criteria, allowing for improved recognition of overlapping pathologies and early subclinical changes associated with AD.
Research Significance and Impact: The implementation of the CERAD neuropathology protocol represents a significant advancement in Alzheimer’s research, providing a critical tool for researchers and clinicians. By establishing a common language and standardized criteria, this protocol enhances comparability across studies, which is essential for advancing our understanding of AD and its pathophysiology. As more dementia and control subjects undergo autopsy using this standardized approach, it will facilitate the investigation of early biomarkers of AD, contribute to the identification of risk factors, and ultimately inform the development of therapeutic strategies. The study underscores the importance of rigorous neuropathological assessment in the pursuit of effective Alzheimer's diagnosis and treatment.
Literatures Citing This Work
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... (1966 more literatures)
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