Diagnostic criteria for Dementia of the Alzheimer's Type
( cautionary statement )
A. The development of multiple cognitive deficits manifested by both (1) memory impairment (impaired ability to learn new information or to recall previously learned information) (2) one (or more) of the following cognitive disturbances:
(a) aphasia (language disturbance)
(b) apraxia (impaired ability to carry out motor activities despite intact motor function)
(c) agnosia (failure to recognize or identify objects despite intact sensory function)
(d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)
B. The cognitive deficits in Criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.
C. The course is characterized by gradual onset and continuing cognitive decline.
D. The cognitive deficits in Criteria A1 and A2 are not due to any of the following:
(1) other central nervous system conditions that cause progressive deficits in memory and cognition (e.g., cerebrovascular disease, Parkinson's disease , Huntington's disease , subdural hematoma, normal-pressure hydrocephalus, brain tumor)
(2) systemic conditions that are known to cause dementia (e.g., hypothyroidism, vitamin B or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection)
(3) substance -induced conditions
E. The deficits do not occur exclusively during the course of a delirium .
F. The disturbance is not better accounted for by another Axis I disorder (e.g., Major Depressive Episode , Schizophrenia ).
Code based on presence or absence of a clinically significant behavioral disturbance:
294.10 Without Behavioral Disturbance: if the cognitive disturbance is not accompanied by any clinically significant behavioral disturbance.
294.11 With Behavioral Disturbance: if the cognitive disturbance is accompanied by a clinically significant behavioral disturbance. (e.g., wandering, agitation )
Specify subtype:
With Early Onset: if onset is at age 65 years or below
With Late Onset: if onset is after age 65 years
Coding note: Also code 331.0 Alzheimer's disease on Axis III . Indicate other prominent clinical features related to the Alzheimer's disease on Axis I (e.g., 293.83 Mood Disorder Due to Alzheimer's Disease, With Depressive Features, and 310.1 Personality Change Due to Alzheimer's Disease, Aggressive Type).
Associated Features:
Learning Problem
Dysarthria or Involuntary Movement
Hypoactivity
Psychosis
Depressed Mood
Somatic or Sexual Dysfunction
Hyperactivity
Addiction
Sexually Deviant Behavior
Odd or Eccentric or Suspicious Personality
Anxious or Fearful or Dependent Personality
Dramatic or Erratic or Antisocial Personality
Differential Diagnosis:
Some disorders have similar or even overlapping symptoms. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.
Normal Process of Ageing;
Delirium;
Schizophrenia;
Major Depressive Episode;
Factitious Disorder with Psychological Symptoms.
Cause:
Alzheimer's Disease is defined by the National Institute on Ageing as progressive, irreversible declines in memory, performance of routine tasks, time and space orientation, language and communication skills, abstract thinking, and the ability to learn and carry out mathematical calculations. Other symptoms include personality changes and impaired judgment. Although a direct cause of Alzheimer's is not known certain common factors are found in the clinical picture of suffers. These include; prior personality organisation of the individual and stressfulness of their life situation.
Treatment:
Although there is no cure for Alzheimer's, and various psychotherapies appear to be ineffective, there are ways to treat some of the symptoms of the disease:
Use of medications to treat cognitive decline and memory loss.
Appropriate activities such as exercise, recreation, and adult day care services appear to assist in the management of the patient.
Caregiving:
At times, a person may display behavior problems such as wandering, paranoia, suspiciousness, combativeness or resistance to maintaining personal hygiene. These behavioral problems can seem overwhelming to the caregiver. Suggest strategies to assist in daily care giving tasks can consist of:
Enrolment in the Alzheimer's Association's Safe Return Program, an identification program for memory impaired adults.
Modifying the person's environment in order to reduce confusion caused by over stimulation such as reducing noise and bright lights.
Explaining a task before you do it by such as saying, "I am going to help you put on your shirt."
Providing a predictable routine at home with structured time for meals, bathing, exercise, and bedtime.
Providing reassurance to the confused patient without challenging their accusations or misperceptions and by redirecting their attention
If it appears that the above situational strategies are not successful a combination of situational activities combine with drug therapy to manage symptoms of depression, restlessness, hallucinations, hostility and agitation may be required
Pharmacotherapy:
Cognex (tacrine hydrochloride)
Aricept (donepexil hydrochloride)
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