Reliability of NINCDS-ADRDA clinical criteria for the diagnosis of Alzheimer's disease

Lopez, O. L. MD
Swihart, A. A. PhD
Becker, J. T. PhD
Reinmuth, O. M. MD
Reynolds, C. F. III MD
Rezek, D. L. PhD, MD
Daly, F. L. III MD

From the Ahheimer Disease -arch Center (Drs. Lopez, Becker, Reinmuth, Rezek, and Daly), and the Departments of Neurology (Drs. Lopez, Swihart, Becker, Reinmuth, and Rezek) and Psychiatry (Drs. Swihart, Becker, Reynolds, and Daly), University of Pittsburgh School of Medicine, Pittsburgh, PA.

Address correspondence and reprint requests to Dr. Oscar L. Lopez, Alzheimer Disease Research Center, Suite 400, Iroquois Building, 3600 Forbes Avenue, Pittsburgh, PA 15213.

Supported by NIH grants AG05133 and AG0370bt.

Presented in part at the 42nd annual meeting of the American Academy of Neurology, Miami Beach, FL, April 1990.

Received December 30, 1989. Accepted for publication in final form April 2, 1990.

Neurology 40(10):p 1517-1522, October 1990.

Article abstract

Although the NINCDS-ADRDA Work Group has recently developed uniform clinical criteria for the diagnosis of Alzheimer's disease (AD), inter-rater reliability studies of these criteria are few. We report a study in which 2 neurologists and 2 psychiatrists independently reviewed clinical data abstracted from the records of 30 demented subjects and 10 nondemented control subjects participating in a longitudinal study of AD at the University of Pittsburgh. We recorded the clinical data on a standardized form; the subjects' identity and clinical and pathologic diagnoses were omitted. Each physician diagnosed each case according to the NINCDS-ADRDA criteria. We calculated the inter-rater agreement for all possible 2-way combinations of clinicians with the Kappa statistic, which ranged from 0.36 (fair agreement) to 0.65 (substantial agreement). We conclude that current NINCDS-ADRDA criteria enable moderate levels of agreement among clinicians in general.