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       The National Alzheimers Coordinating Center
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 1. Center:               


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 2. Source:               


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 3. Gender:               


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 4. Race:                 


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 5. Hispanic:             


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 6. Language:             


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 7. Education:            

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 8. Multiple Birth:       


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 9. Marital Status:       


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10. Residence:            


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11. Rel with Dementia:    


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12. Number Affected Rel: 

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13. CSF-Antemortem:       


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14. DNA Done:             


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15. Serum Done:           


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16. APOE Done:            


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17. CT Scan Done:         


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18. PET Done:             


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19. SPECT Done:           


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20. MRI Done:             


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21. Biopsy Done:          


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22. Age at Death:        

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23. Age Devel Dementia   

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24. Age at First Eval:   

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25. Lewy Bodies Crit:     


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26. First MMSE:          

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27. Last MMSE:           

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28. Clinical Dementia:    


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29. Dx if no Dementia:    


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30. Etiology:             


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31. Stroke:               


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32. Parkinsons:           


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33. Depression:           


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34. Primary Clin DX:      


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35. Delirium:             


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36. Vital Status          


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37. Autopsy:              


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38. Primary NP DX:        


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39. Secondary NP DX:      


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40. Frozen Brain Sample   


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41. Formalin Brain Sample 


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42. Paraffin Brain Sample 


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43. CSF - Postmortem:     


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 Page updated March 29, 2000




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