Consortium to Establish a Registry for Alzheimer's Disease

The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) was funded in 1986 by the National Institute on Aging to develop brief, standardized, valid, and reliable measures to assess severity in Alzheimer's disease (AD). Although well-accepted diagnostic criteria for Alzheimer's disease were available, approaches to measurement and the specific measures used varied from site to site. In consequence, aggregation of information across sites or studies was problematic, reducing the potential to carry out correlational studies (e.g., between clinical and neuropathological findings), studies of AD subgroups (e.g., early onset vs. late onset), or studies of special populations (e.g., AD patients of different races/ethnicities).

Working with all 23 initial Alzheimer Disease Research Centers, CERAD developed and evaluated [Page 118]standardized assessments for the following areas: clinical, neuropsychological, behavioral pathology, neuroimaging, and neuropathological. CERAD also developed a standardized means for determining family history and use of patient care services.

The clinical battery obtains information on demographic characteristics, clinical history (including activities of daily living [ADLs] and cognitive functioning), physical and neurological examination, clinical laboratory and neuroimaging findings, and stage of disease. It provides diagnostic criteria for determining the presence of cognitive impairment and dementia and of type of dementia.

The neuropsychological battery, which takes approximately 40 minutes to administer, assesses those areas of cognitive functioning most likely to be affected in AD. The measures currently include verbal fluency; a 15-item version of the Boston Naming Test; the Mini-Mental State Examination; word list memory, recall, and recognition tasks; and constructional praxis copy and recall. Norms and test–retest reliability are available. A 48-item Behavioral Rating Scale for Dementia (BRSD), as well as an abbreviated 17-item version, measures the presence and frequency of pathological behaviors in eight domains.

The neuroimaging assessment specifies the manner in which images should be taken and provides guidelines for reading. Intrasite agreement is good, but intersite agreement is poor. Consequently, the neuroimaging protocol is rarely used. The neuropathology protocol, with guidelines for neuropathological assessment and criteria for AD and other neuropathological disorders, including Parkinson's disease, and good interrater agreement, has been widely adopted.

The family history assessment helps to identify family members with AD, Parkinson's disease, and Down syndrome. The brief (approximately 15-minute) services assessment protocol permits identification of health and social services used by, and needed for, patients with AD and their caregivers.

The CERAD assessments have been well received in the United States and abroad. They have been translated into more than a dozen languages and used in both clinical and epidemiological studies. Publications based on CERAD data range from clinical and epidemiological studies to health economics. CERAD materials and up to 7 years of data on 204 African American AD patients, 890 White AD patients, and 463 controls, including autopsy information on 202 AD cases, are available on CD-ROM. Further information and a bibliography through 2002 are also available (http://cerad.mc.duke.edu).