Diagnostic
Criteria
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A. Alzheimer's
disease is characterized by progressive decline and ultimately loss of
multiple cognitive functions, including both:
- Memory impairment--impaired
ability to learn new information or to recall previously learned information.
- And at least
one of the following:
Loss of word comprehension ability, for example, inability to respond to
"Your daughter is on the phone." (aphasia);
Loss of ability to perform complex tasks involving muscle coordination,
for example, bathing or dressing (apraxia);
Loss of ability to recognize and use familiar objects, for example, clothing
(agnosia);
Loss of ability to plan, organize, and execute normal activities, for example,
going shopping.
B. The problems
in "A" represent a substantial decline from previous abilities
and cause significant problems in everyday functioning.
C. The problems in "A" begin slowly and gradually become more
severe.
D. The problems in "A" are not due to:
- Other conditions
that cause progressive cognitive decline, among them: stroke, Parkinson's
disease, Huntington's chorea, brain tumor, etc.
- Other conditions
that cause dementia, among them: hypothyroidism, HIV infection, syphilis,
and deficiencies in niacin, vitamin B12, and folic acid.
E. The problems
in "A" are not caused by episodes of delirium.
F. The problems in "A" are not caused by another mental illness:
depression, schizophrenia, etc.
NINCDS/ADRDA
Adapted from McKhann, G. et al. "Clinical Diagnosis of Alzheimer's
Disease: Report of the NINCDS/ADRDA Work Group, Dept. of HHS Task Force
on Alzheimer's Disease," Neurology (1984) 34:939.
Criteria for
Diagnosis of Probable Alzheimer's Disease:
- Dementia
established by clinical examination, and documented by a standard test
of cognitive function (e.g. Mini-Mental State Examination, Blessed Dementia
Scale, etc.), and confirmed by neuropsychological tests.
- Significant
deficiencies in two or more areas of cognition, for example, word comprehension
and task-completion ability.
- Progressive
deterioration of memory and other cognitive functions.
- No loss of
consciousness.
- Onset from
age 40 to 90, typically after 65.
- No other
diseases or disorders that could account for the loss of memory and cognition.
A Diagnosis of
Probable Alzheimer's Disease is Supported By:
- Progressive
deterioration of specific cognitive functions: language (aphasia), motor
skills (apraxia), and perception (agnosia).
- Impaired
activities of daily living and altered patterns of behavior.
- A family
history of similar problems, particularly if confirmed by neurological
testing.
- The following
laboratory results:
Normal cerebrospinal fluid (lumbar puncture test).
Normal electroencephalogram (EEG) test of brain activity.
Evidence of cerebral atrophy in a series of CT scans.
Other Features
Consistent with Alzheimer's Disease
- Plateaus
in the course of illness progression.
- CT findings
normal for the person's age.
- Associated
symptoms, including: depression, insomnia, incontinence, delusions, hallucinations,
weight loss, sex problems, and significant verbal, emotional, and physical
outbursts.
- Other neurological
abnormalities, especially in advanced disease: including: increased muscle
tone and a shuffling gait.
Features That
Decrease the Likelihood of Alzheimer's Disease:
- Sudden onset.
- Such early
symptoms as: seizures, gait problems, and loss of vision and coordination.
Criteria for
Diagnosis of Probable Alzheimer's Disease:
- Dementia
established by clinical examination, and documented by a standard test
of cognitive function (e.g. Mini-Mental State Examination, Blessed Dementia
Scale, etc.), and confirmed by neuropsychological tests.
- Significant
deficiencies in two or more areas of cognition, for example, word comprehension
and task-completion ability.
- Progressive
deterioration of memory and other cognitive functions.
- No loss of
consciousness.
- Onset from
age 40 to 90, typically after 65.
- No other
diseases or disorders that could account for the loss of memory and cognition.
A Diagnosis of
Probable Alzheimer's Disease is Supported By:
- Progressive
deterioration of specific cognitive functions: language (aphasia), motor
skills (apraxia), and perception (agnosia).
- Impaired
activities of daily living and altered patterns of behavior.
- A family
history of similar problems, particularly if confirmed by neurological
testing.
- The following
laboratory results:
Normal cerebrospinal fluid (lumbar puncture test).
Normal electroencephalogram (EEG) test of brain activity.
Evidence of cerebral atrophy in a series of CT scans. (atrophy means shrinking
so atrophy seen in a CT scan would mean shrinking in the brain)
Other Features
Consistent with Alzheimer's Disease
- Plateaus
in the course of illness progression.
- CT findings
normal for the person's age.
- Associated
symptoms, including: depression, insomnia, incontinence, delusions, hallucinations,
weight loss, sex problems, and significant verbal, emotional, and physical
outbursts.
- Other neurological
abnormalities, especially in advanced disease: including: increased muscle
tone and a shuffling gait.
Features That
Decrease the Likelihood of Alzheimer's Disease:
- Sudden onset.
- Such early
symptoms as: seizures, gait problems, and loss of vision and coordination.
NINCDS/ADRDA
Adapted from McKhann, G. et al. "Clinical Diagnosis of Alzheimer's
Disease: Report of the NINCDS/ADRDA Work Group, Dept. of HHS Task Force
on Alzheimer's Disease," Neurology (1984) 34:939.
Several sets
of criteria have been developed to diagnose Alzheimer's disease. Two sets
are the most widely used -- one from the fourth edition of the American
Psychiatric Association's Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV), the other from a joint task force of the National
Institute of Neurological and Communicative Disorders and Stroke and the
Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA). According
to neurologist Robert Friedland, M.D., chief of the laboratory of Neurogeriatrics
at Case Western Reserve University School of Medicine in Cleveland, application
of these criteria by experienced clinicians diagnoses Alzheimer's disease
with about 90 percent accuracy.
DSM-IV
Adapted from the Diagnostic and Statistical Manual of Mental Disorders,
Fourth Ed. (DSM-IV), American Psychiatric Association, Washington, D.C.,
1994.
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