Dementia of the Alzheimer Type
Dementia of the Alzheimer Type
American Description
Diagnostic Criteria
The development of multiple cognitive deficits manifested by both:
Memory impairment (impaired ability to learn new information or to recall previously learned information)
One (or more) of the following cognitive disturbances:
Aphasia (language disturbance)
Apraxia (impaired ability to carry out motor activities despite intact motor function)
Agnosia (failure to recognize or identify objects despite intact sensory function)
Disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)
The cognitive deficits (above) cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning
The course is characterized by gradual onset and continuing cognitive decline.
The cognitive deficits are not due to any of the following:
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)
Systemic conditions that are known to cause dementia (e.g., hypothyroidism, vitamin B12 or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection)
Substance-induced conditions
The cognitive deficits do not occur exclusively during the course of a delirium.
The disturbance is not better accounted for by another Axis I disorder (e.g., Major Depressive Disorder, Schizophrenia)
Problem Areas (When Initially Diagnosed)
Socio-Economic:
Moderately impaired homemaking
Moderately impaired money management
Requires voluntary institutional care (placement in supervised residence or nursing home)
Depression:
Significant loss of interest and motivation
Significant irritability or hostility
Significant problem with concentration
Intellectual Impairment:
Significant problem with memory or learning
Significant decrease in speech and movement
Significant problem with grooming and hygiene
Significant confusion as to date, place, or person
Onset and Course
Late onset (after age 65 years) is much more common than early onset.
At age 65, 0.6% of males and 0.8% of females have Alzheimer's Dementia.
At age 90, 21% of males and 25% of females have Alzheimer's Dementia.
In the first years of illness, few motor and sensory signs are associated with Alzheimer's Dementia. Later in the course, myoclonus and gait disorder may appear.
Usually the onset is insidious, with early deficits in recent memory followed by the development of aphasia, apraxia, and agnosia after several years.
Some individuals may show personality changes or increased irritability in the early stages. In the later stages of the disease, individuals may develop gait and motor disturbances and eventually become mute and bedridden.
On average, death occurs 8-10 years from onset of symptoms.
Differential Diagnosis
Delirium
Amnestic Disorder
Vascular (Multi-Infarct) Dementia
Alcoholic Dementia, or other Substance-Induced Persisting Dementia
Substance Intoxication, or Substance Withdrawal
Dementia Due to Other General Medical Conditions:
Brain Tumor
Creutzfeldt-Jakob Disease
HIV Infection
Huntington's Disease
Hypercalcemia
Hypothyroidism
Neurosyphilis
Normal-Pressure Hydrocephalus
Parkinson's Disease
Pick's Disease
Subdural Hematoma
Traumatic Brain Injury
Vitamin B12 Deficiency, Folic Acid Deficiency, Niacin Deficiency
Mental Retardation
Schizophrenia
Major Depressive Disorder
Malingering and Factitious Disorder
Age-Related Cognitive Decline
Internet Mental Health (www.mentalhealth.com) copyright © 1995-2000 by Phillip W. Long, M.D.
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