Results Clinical diagnosis To provide a comparison for the accuracy of imaging data, and evaluate its cost-benefit characteristics, we first provide information on the accuracy of clinical diagnosis against postmortem neuropathology. Simple screening measures, such as the Mini-Mental

State Examination (MMSE), often provide good diagnostic accuracy. For example, Muller et al and Wahlund et al reported reasonable sensitivity and specificity values for the MMSE alone and in combination with a verbal recall test.12,13 More informative results were obtained with standardized clinical measures when validated against neuropathological diagnosis. In Inhibitors,research,lifescience,medical Jobst et al, 200 affected cases were compared with normal controls by standardized clinical measures, and then validated with histopathologic diagnosis.14 Using NINCDS Inhibitors,research,lifescience,medical possible or probable AD criteria, Jobst et al reported a maximum sensitivity of 96%, with associated specificity of 61 %. In the same study, the use of DSM-III-R criteria applied to

the same study groups resulted in a sensitivity of 51%, and specificity of 97%. Other authors, Inhibitors,research,lifescience,medical noted in Table I, obtained similar results.15-21 Overall, the range of sensitivity of clinical diagnosis was 39% to 98%, and the range of specificity was 33% to 100%. There was a significant negative correlation (r = -0.79, P=0.01) between sensitivity and specificity, Inhibitors,research,lifescience,medical as expected, reflecting the necessary tradeoff. Thus, for instance, to achieve

a specificity greater than 80%, four out. of five studies had to settle for sensitivity lower than 70%. This correlation is depicted in Figure 1 Figure 1. Sensitivity and specificity of clinical diagnosis against neuropathological diagnosis. Table I. Sensitivity and specificity of clinical measurements. AD, Alzheimer’s disease; CERAD, CERAD (Consortium to Establish a Registry for Alzheimer Disease) probable or definite AD (neuropathology); Other, other neuropathological review; DSM-III-R, Inhibitors,research,lifescience,medical Diagnostic … A number of studies used the criteria “NINCDS possible or probable AD” or other nonstandard clinical measures (data not shown). 14-18,20,22-27 While clinical diagnosis is often those used to validate imaging findings, and neuro-pathological diagnosis is the overall “gold standard,” and despite the existence of Selleckchem CP868596 modern standardized criteria, the application of these standards should not be considered free of ambiguity. A good example is provided by Hoffman et al.15 The clinical NINCDS criteria allow the definition of probable or possible AD, reflecting different, degrees of confidence. The Consortium to Establish a Registry for Alzheimer Disease (CERAD) pathological criteria allow the finding of “pure” AD or AD in addition to other pathology.