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PRE-RECORDED: DIAGNOSTIC ACCURACY OF THE ADNI CLINICAL DIAGNOSIS OF ALZHEIMER DISEASE: A CLINICOPATHOLOGICAL STUDY
Abstract
Abstract Body
Objectives: The Alzheimer Disease Neuroimaging Initiative (ADNI) aims to validate clinical diagnoses and molecular biomarkers of Alzheimer disease (AD) to inform the design of clinical trials of anti-AD investigational therapies. We examined the accuracy of these diagnoses and biomarkers for predicting the presence of neuropathological AD.
Methods: All ADNI participants who had completed neuropathological assessments through January 31, 2022, were included in the analyses. The clinical diagnosis of AD, with or without other dementing disorders, at the last ADNI assessment before death was correlated with the presence or absence of neuropathological AD, defined as “intermediate” or “high” AD Neuropathologic Change (ADNC; NIA-AA criteria). Similar correlations were examined using the last amyloid positron emission tomography (PET) results and/or amyloid-beta42, total tau, and p-tau181 measurements from the last cerebrospinal fluid (CSF) collection.
Results: In 76 ADNI participants with a clinical diagnosis of AD dementia alone (N=66) or AD dementia with other dementing disorders (N=10), intermediate or high ADNC was present in 64 (84%). AD was the sole neuropathological dementing disorder in 12 (16%) of the 76 cases. In 8 participants who were not diagnosed with AD dementia, 7 (88%) had low or absent ADNC. The predictive accuracy of amyloid PET and CSF biomarkers will be reported.
Conclusions: The ADNI clinical diagnostic accuracy of 84% for neuropathologic AD is acceptable but can be improved with the incorporation of biomarker results. Non-AD biomarkers are also needed as most neuropathologic AD cases have non-AD pathologies that could contribute to dementia and compromise anti-AD trials.