Although clinical diagnostic inaccuracy rates in dementia have been reduced in recent years because of increased understanding of dementing disorders, autopsy remains the definitive means for diagnosis of Alzheimer's disease (AD). However, barriers to obtaining autopsy still exist. We report here the voluntary autopsy consent protocol developed by Washington University's Memory and Aging Project. Suggestions by staff and participants over the years have been implemented to develop a protocol that insures a successful autopsy program. From a wallet-sized card of instructions for family reference, to 24-hour availability of staff families and institutions are provided a smooth transition from place of death to autopsy. The rate of voluntary autopsy consent for Memory and Aging Project participants (70 percent) reflects the effectiveness of this program.
Get full access to this article
View all access options for this article.
References
1.
1. Lundberg GD: Attitudes toward autopsy and organ donation in Sweden and the United States. JAMA. 1994; 271 (4), p. 317-317.
2.
2. Boers M: The prospects of Autopsy: Mortui Vivos Docuerunt? (“Have the dead taught the living?”)The American Journal of Medicine. 1989; 86, pp. 322-324.
3.
3. Gross JS, Neufeld RR, Libow L, Cierber I, Rodstein M: Autopsy study of the elderly institutionalized patient. Review of 234 autopsies. Archives of Internal Medicine. 1988; 148, pp. 173-176.
4.
4. Landefeld CS, Chren MM, Myers A, Geller R, Robbins S, Goldman L: Diagnostic yield of the autopsy in a university hospital and a community hospital. New England Journal of Medicine. 1988; 318, pp. 1249-1254.
5.
5. Council on Scientific Affairs. Autopsy: A comprehensive review of current issues. JAMA. 1987; 258(3), pp. 364-369.
6.
6. Sanner M: A comparison of public attitudes toward autopsy, organ donation, and anatomic dissection: A Swedish survey. Journal of the American Medical Association. 1994; 271(4), pp 284-288.
7.
7. Brumback R, Leech R, Corella D, Miner G; Dementia: The importance of clinical evaluation, autopsy confirmation, and research. The Journal of the Oklahoma State Medical Association. 1990; 83(3), pp. 109-118.
8.
8. Anderson RE, Hill RB, Key CR: The Sensitivity and Specificity of clinical diagnostics during five decades: Toward an understanding of necessary fallibility, JAMA. 1989; 261(11). pp. 1610-1617.
9.
9. Webster J, Derman D, Kopin J, Glassruth I, Patterson R: Obtaining permission for an autopsy: Its importance for patients and physicians. The American Journal of Medicine. 1986; 86, pp. 325-326.
10.
10. Goldman L: Autopsy: Seventy-five years after Cabot. Journal of the American Geriatric Society. 1986; 34. pp. 897-898.
11.
11. Schmidt S: Consent for autopsies. JAMA. 1983; 250 (9), pp. 1161-1164.
12.
12. Connell CM, Avey H, Holmes S: Attitudes About Autopsy: Implications for educational interventions. The Gerontologist. 1994; 34 (5), pp. 665-673.
13.
13. Homer AC, Honavar M, Lantos PL, Hastie IR, Kellett JM, Millard PH: Diagnosing dementia: do we get it right?British Medical Journal, 1988; 297(6653), pp. 894-896.
14.
14. Alafuzoff I, Igbal K, Friden H, Adolfsson R, Winblad B: Histopathological criteria for progressive dementia disorders: clinicalpathological correlation and classification by multivariate data analysis. Acta Neuropathology, 1987; 74(3). pp. 209-225.
15.
15. Joachim CL, Morris JH, Seldoe DJ: Clinically diagnosed Alzheimer's disease: Autopsy results in 150 cases. Ann Neurology. 1988; 24(1). pp. 50-56.
16.
16. Mirra SS, Heymon A, McKeel D, Sumi SM, Crain BJ, Brownlee LM, Vogel FS, Hughes JHP, VanBelle G, & Berg L: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part II. Standardization of the neuropathologic assessment of Alzheimer's disease. Neurology. 1991; 41(4). pp. 479-486.
18. Becker JT, Boller F, Lopez OL, Saxton J, & McGonigle KL: The natural history of Alzheimer's disease. Description of study cohort and accuracy of diagnosis. Arch Neurol. 1994; 51(6). pp. 585-594.
19.
19. Boller F, Lopez OL, & Moossy J: Diagnosis of dementia: Clinicopathologic correlations. Neurology. 1989; 39(1). pp. 76-79.
20.
20. Morris JC, McKeel DW, Fulling K, Torack RM & Berg L: Validation of clinical diagnostic criteria for Alzheimer's disease. Annals of Neurology. 1988; 24(l). pp. 17-22.
21.
21. Morris JC, McKeel DW, Storandt M, Rubin EH, Price JL, Grant EA, Ball MJ & Berg L: Very mild Alzheimer's disease: Informantbased clinical psychometric and pathologic distinction from normal aging. Neurology. 1991; 41, pp. 469-478.
22.
22. Price JL, Davis PB, Morris JC & White DL: The distribution of tangles, plaques and related immunohistochemical markers in healthy aging and Alzheimer's disease. Neurobiology of Aging. 1991; 12, pp. 295-312.
23.
23. Berg L, McKeel DW, Miller P, Baty J & Mums JC: Neuropathological indexes of Alzheimer's disease in demented and nondemented persons aged 80 years and older. Archives of Neurology. 1993; 50(4), pp. 349-358.
24.
24. McKeel D, Ball M, Price J, Smith D, Miller J, Berg L, Morris J: Histopathologic assessment of Alzheimer neuropathology: Different methodologists yield comparable diagnostic results. Alzheimer Disease and Associated Disorders. 1993; 7(3), pp. 136-151.
25.
25. Green J, Morris JC, Sandson J, McKeel DW & Miller JW: Progressive aphasia: A precursor of global dementia?Neurology. 1990; 40, pp. 423-429.
26.
26. Morris JC, Drazner M, Fulling K, Grant EA & Goldring J: Clinical and pathological aspects of Parkinsonism in Alzheimer's disease: A role for extranigral factors?Archives of Neurology. 1989; 46(6), pp. 651-657.
27.
27. Torack RM & Morris JC: The association of ventral tegmental area histopathology with adult dementia. Archives of Neurology. 1988; 45, pp. 497-501.
