Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-0228 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYConsortium to Establish a Registryfor Alzheimer’s Disease (CERAD)Gerda G. Fillenbaum and Albert HeymanDuke University Medical Center, Durham, NC, USACERAD was funded by the National Institute on Aging in 1986to develop a battery of standardized instruments for theevaluation of patients with Alzheimer’s disease (AD). Until thattime clinical investigation of AD and comparison of researchfindings was hampered by the absence of standardized assessmentand uniform diagnostic criteria. The assessments developed byCERAD have been evaluated on over 1000 patients with AD andnearly 500 control subjects, seen at 24 major University medicalcenters across the USA. Because of their sensitivity to dementia,they have also been used in epidemiologic surveys of the elderly,to aid in identification and staging of those with dementia. Themeasures permit uniform identification of dementia and standardizedassessment of AD.CERAD has developed and evaluated three primary assessments.These include a clinical battery, a neuropsychologicalbattery, and a neuropathological assessment. An overview of thecontents of these assessments is given in Table 1. In addition,specialized assessments have been developed to assess familyhistory of AD, Parkinson’s disease, and Down’s syndrome;extrapyramidal dysfunction in AD; neuroimaging; behavioralpathology; and assessment of service use.Videotapes demonstrating administration of these measures areavailable. Educational brochures on memory loss, AD, theimportance of autopsy, and an autopsy resources packet to helpsites, have been prepared. Many of the CERAD assessments havebeen translated into various European and Asian languages, andare in use internationally.A brief but extensive review of CERAD, including a bibliographycovering the first 10 years, has been published 1 . Multiyeardata on CERAD patients and control subjects as well as theCERAD measures, are available on CD-ROM. This andadditional information can be obtained by writing to the PrincipalInvestigator, Dr A. Heyman, CERAD, Box 3203, Duke UniversityMedical Center, Durham, NC 27710, USA.REFERENCE1. Heyman A, Fillenbaum G, Nash F (eds). Consortium to Establish aRegistry for Alzheimer’s Disease: the CERAD experience. Neurology1997; 49(suppl 3).Table 1.Overview of the contents of the primary CERAD assessmentsClinical batteryDemographic data on subject and informantClinical history, including cognitive function, systemic disorders,cerebrovascular history, parkinsonism, depression, drug effectsBlessed Dementia Scale (ADL)Screen for Behavior Rating Scale for Dementia (BRSD)Short Blessed, Calculation, Clock, LanguageClinical examinations, including brief physical, overall neurologicalassessment, extrapyramidal dysfunctionLaboratory and imaging studiesClinical diagnosis, including CDR staging, diagnostic impression for:Possible dementia prodromeProbable and possible ADNon-AD dementiasNeuropsychological batteryVerbal fluencyModified Boston Naming TestMini-Mental State ExaminationWord list memoryConstructional praxisWord list recallWord list recognitionConstructional praxis recallThe following are used as needed:Shipley ScaleWechsler Memory Scale, Paired Association ITrail Making, A and BWechsler Memory Scale, Paired Association IINelson Adult Reading TestFinger tappingVerbal fluency (F and P words)Neuropathology AssessmentDemographic information and historyGross examinationCerebrovascular disease (gross)Microscopic findings: vascular; major non-vascular; hippocampusand neocortexNeurohistologic findingsNeuropathological diagnosesFinal assessment