Evaluation of the NINCDS-ADRDA criteria in the diVerentiation of Alzheimer’s disease and frontotemporal dementia

Objectives—The diagnosis of Alzheimer’s disease (AD) is now reliant on the use of NINCDS-ADRDA criteria. Other diseases causing dementia are being increasingly recognised—for example, frontotemporal dementia (FTD). Historically, these disor-ders have not been clearly demarcated from AD. This study assesses the capabil-ity of the NINCDS-ADRDA criteria to accurately distinguish AD from FTD in a series of pathologically proved cases. Methods—The case records of 56 patients (30 with AD, 26 with FTD) who had undergone neuropsychological evalua-tion, brain imaging, and ultimately post-mortem, were assessed in terms of whether at initial diagnosis the NINCDS-ADRDA criteria were successful in diag-nosing those patients who had AD and excluding those who did not. Results—(1) The overall sensitivity of the NINCDS-ADRDA criteria in diagnosing “probable ” AD from 56 patients with cor-tical dementia (AD and FTD) was 0.93. However, the specificity was only 0.23; most patients with FTD also fulfilled NINCDS-ADRDA criteria for AD. (2) Cognitive deficits in the realms of orienta-tion and praxis significantly increased the odds of a patient having AD compared with FTD, whereas deficits in problem solving significantly decreased the odds. Neuropsychological impairments in the domains of attention, language, percep-tion, and memory as defined in the NINCDS-ADRDA statement did not con-tribute to the clinical diVerentiation of AD and FTD. Conclusion—NINCDS-ADRDA criteria fail accurately to diVerentiate AD from FTD. Suggestions to improve the diagnos-tic specificity of the current criteria are made