These circumstances are discussed below. Clinical expertise An overall summary of this review is provided in Figure 2 Note that all clinical diagnoses were evaluated against histopathology, whereas some imaging findings were validated by clinical diagnosis. Nevertheless, the data suggest the following

observations. First, the specificity of clinical diagnosis Inhibitors,research,lifescience,medical may be better than its sensitivity (77±26% vs 72±18%, NS in this sample). The mean specificity of clinical diagnosis compares favorably with the values offered by neuroimaging, but mean sensitivity of clinical diagnosis is lower. More striking, however, are the differences in variance. By any measure of dispersion, clinical diagnosis Inhibitors,research,lifescience,medical accuracy is far more variable in this material than the accuracy of any imaging method. The range of sensitivity of clinical diagnosis is 34% to 95%, and the range of specificity 33% to 100%. Clearly, these values range from perfect to unacceptable. This variability of clinical diagnostic accuracy can VX-770 probably be attributed to several factors. It includes the relatively large number of studies reviewed, characteristics of patient, and control samples, limited reproducibility of clinical ratings, and perhaps even different, Inhibitors,research,lifescience,medical neuropatho logical procedures. Another source of variance may be the

result of imperfect clinical criteria. Both NINCDS and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Inhibitors,research,lifescience,medical Edition (DSM-IV)38 criteria sets contain features dependent on the skill of the clinician, as well as features requiring qualitative determination, possibly rendering the criteria subject to variable interpretation. In the NINCDS criteria, a diagnosis of “probable AD”

requires the establishment of dementia Inhibitors,research,lifescience,medical by (i) MMSE or Blessed Dementia Scale; and (ii) confirmatory neuropsychological testing. In addition, there must, be a “progressive worsening of memory and other cognitive functions.” While the former features arc for the most part objective measures, the latter feature is not. specified in detail and might be interpreted in a subjective manner. The alternative criteria delineated in DSM-IV do not require objective testing, thus permitting a diagnosis of AD solely on subjective grounds. Thus, a clinician employing Carfilzomib DSM-IV criteria might diagnose AD solely from the patient’s history without seeking confirmatory, objective testing. This approach limits the standardization of diagnosis and depends heavily on the diagnostician’s skills. Indeed, we believe that the main factor responsible for the variability in clinical diagnosis is the selleckbio individual skill, experience, and expertise of the diagnostician. Training, experience, and insight vary substantially, and probably affect accuracy. Further, the clinical assessment, of AD occurs primarily in two settings: (i) primary care screening; and (ii) consultative evaluation of memory or cognitive complaints.