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From the Alzheimer’s Disease Research Center (Drs. Lopez, Becker, Klunk, Saxton, Hamilton, Kaufer, Sweet, Wisniewski, Kamboh, and DeKosky) and the Departments of Psychiatry (Drs. Lopez, Becker, Klunk, Saxton, Kaufer, Sweet, and DeKosky), Neurology (Drs. Lopez, Becker, Kaufer, and DeKosky), Pathology (Neuropathology) (Dr. Hamilton), Radiology (Dr. Meltzer), Epidemiology (Dr. Wisniewski), and Genetics (Dr. Kamboh), University of Pittsburgh School of Medicine, PA.
Address correspondence and reprint requests to Dr. Oscar L. Lopez, Neuropsychology Research Program, Oxford Building, 3501 Forbes Avenue, Suite 830, Pittsburgh, PA 15213.
OBJECTIVE: To describe the experience of a research clinic diagnosing possible AD during the last two decades.
BACKGROUND: The National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders Association criteria for possible AD are generally used to indicate that a patient has AD in association with another disease process that could by itself cause dementia. There are no studies describing how these criteria should be applied, and there are no descriptions of functional and cognitive progression or survival in possible AD.
METHODS: The authors examined the clinical characteristics of 267 patients diagnosed with possible AD at the AD Research Center of Pittsburgh from 1983 to 2000 and the likelihood of arriving at four endpoints: Mini-Mental State Examination score of 
9, Blessed Dementia Rating Scale for activities of daily living score of 
12, nursing home admission, and death.
RESULTS: The possible AD classification has been simplified in six categories: possible AD with cerebrovascular disease (CVD) (69%), with history of alcohol abuse (15%), with history of depression (7%), with thyroid disease (4%), with history of head trauma (6%), with vitamin B12 deficiency (6%), and with other disease process that may have affected the clinical presentation of AD (4%). The presence of CVD, history of alcohol abuse, and history of depression concomitant with the onset of dementia were associated with time to death. Neither thyroid disease, history of head trauma, nor vitamin B12 deficiency were associated with any of the four endpoints.
CONCLUSION: This cohort showed that comorbid conditions that can affect cognition delineate clearly defined subgroups in AD. The presence of environmental or other brain disorders sufficient to produce dementia appears to affect physical survival in patients with AD, but not functional and cognitive decline or institutionalization.
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  M. D. Ikonomovic, W. E. Klunk, E. E. Abrahamson, C. A. Mathis, J. C. Price, N. D. Tsopelas, B. J. Lopresti, S. Ziolko, W. Bi, W. R. Paljug, et al. Post-mortem correlates of in vivo PiB-PET amyloid imaging in a typical case of Alzheimer's disease Brain, June 1, 2008; 131(6): 1630 - 1645. [Abstract] [Full Text] [PDF]
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O. L. Lopez, J. T. Becker, R. A. Sweet, F. J. Martin-Sanchez, and R. L. Hamilton Lewy bodies in the amygdala increase risk for major depression in subjects with Alzheimer disease. Neurology, August 22, 2006; 67(4): 660 - 665. [Abstract] [Full Text] [PDF]
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 P. A. Wilkosz, S. Miyahara, O. L. Lopez, S. T. DeKosky, and R. A. Sweet Prediction of Psychosis Onset in Alzheimer Disease: The Role of Cognitive Impairment, Depressive Symptoms, and Further Evidence for Psychosis Subtypes Am J Geriatr Psychiatry, April 1, 2006; 14(4): 352 - 360. [Abstract] [Full Text] [PDF]
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 J. T. Becker, S. W. Davis, K. M. Hayashi, C. C. Meltzer, A. W. Toga, O. L. Lopez, P. M. Thompson, and for the Imaging Methods and Analysis in Geriatrics Three-dimensional Patterns of Hippocampal Atrophy in Mild Cognitive Impairment Arch Neurol, January 1, 2006; 63(1): 97 - 101. [Abstract] [Full Text] [PDF]
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 G B Frisoni, P h Scheltens, S Galluzzi, F M Nobili, N C Fox, P H Robert, H Soininen, L-O Wahlund, G Waldemar, and E Salmon Neuroimaging tools to rate regional atrophy, subcortical cerebrovascular disease, and regional cerebral blood flow and metabolism: consensus paper of the EADC J. Neurol. Neurosurg. Psychiatry, October 1, 2003; 74(10): 1371 - 1381. [Abstract] [Full Text] [PDF]
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D. T. Villareal, E. Grant, J. P. Miller, M. Storandt, D. W. McKeel, and J. C. Morris Clinical outcomes of possible versus probable Alzheimer's disease Neurology, September 9, 2003; 61(5): 661 - 667. [Abstract] [Full Text] [PDF]
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O L Lopez, J T Becker, S Wisniewski, J Saxton, D I Kaufer, and S T DeKosky Cholinesterase inhibitor treatment alters the natural history of Alzheimer's disease J. Neurol. Neurosurg. Psychiatry, March 1, 2002; 72(3): 310 - 314. [Abstract] [Full Text] [PDF]
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O. L. Lopez, J. T. Becker, D. I. Kaufer, R. L. Hamilton, R. A. Sweet, W. Klunk, and S. T. DeKosky Research Evaluation and Prospective Diagnosis of Dementia With Lewy Bodies Arch Neurol, January 1, 2002; 59(1): 43 - 46. [Abstract] [Full Text] [PDF]
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 T. Fritsch, M. J. McClendon, K. A. Smyth, A. J. Lerner, C. H. Chen, G. J. Petot, S. M. Debanne, A. Soas, and R. P. Friedland Effects of educational attainment on the clinical expression of Alzheimer's disease: Results from a research registry American Journal of Alzheimer's Disease and Other Dementias, November 1, 2001; 16(6): 369 - 376. [Abstract] [PDF]
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D. L. Sukonick, B. G. Pollock, R. A. Sweet, B. H. Mulsant, J. Rosen, W. E. Klunk, K. B. Kastango, S. T. DeKosky, and R. E. Ferrell The 5-HTTPR*S/*L Polymorphism and Aggressive Behavior in Alzheimer Disease Arch Neurol, September 1, 2001; 58(9): 1425 - 1428. [Abstract] [Full Text] [PDF]
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O.L. Lopez, J.T. Becker, W. Klunk, J. Saxton, R.L. Hamilton, D.I. Kaufer, R.A. Sweet, C. Cidis Meltzer, S. Wisniewski, M.I. Kamboh, et al. Research evaluation and diagnosis of probable Alzheimer's disease over the last two decades: I Neurology, December 26, 2000; 55(12): 1854 - 1862. [Abstract] [Full Text] [PDF]
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