Alzheimer's disease diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Akshun Kalia M.B.B.S.[3]


The diagnosis of Alzheimer's disease (AD) is made on the basis of clinical criteria described by either the National Institute on Aging and the Alzheimer's Association (NIA-AA) or DSM-V (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). Histopathologic examination for diagnosis of Alzheimer's disease is rarely done. Elderly patients presenting with progressive decline in memory and other cognitive impairments such as aphasia, agnosia or apraxia should be suspected for Alzheimer's disease. In these patients, mental status examination (MSE) and neuropsychological testing should be performed to further evaluate the status of cognitive abilities. Laboratory investigation are not required to diagnose Alzheimer's and are done to exclude other conditions which may present with similar symptoms as seen in Alzheimer's disease (such as vit B12 deficiency, syphilis, or tuberculosis). Patients with atypical clinical presentation may also be tested for biomarkers such as and total and phosphorylated tau protein.

Diagnostic Criteria

The diagnosis of Alzheimer's disease (AD) can be made either on the basis of:[1][2][3][4][5][6]

National Institute on Aging and the Alzheimer's Association (NIA-AA)

National Institute on Aging and the Alzheimer's Association (NIA-AA) describes Alzheimer's disease as either probable Alzheimer's disease or possible Alzheimer's disease.

  • Possible Alzheimer's disease (AD): The possible Alzheimer's disease differs from probable Alzheimer's disease in terms of onset, course over time and underlying disorder. Possible Alzheimer's disease is diagnosed in the presence of either one of the following:

The The NIA-AA criteria differ from prior DSM criteria in the following way:

  • NIA-AA recommends patients with positive biomarkers (such as and total and phosphorylated Tau protein) be diagnosed with Alzheimer's disease even in the absence of symptoms.
  • NIA-AA defines three distinct stages of Alzheimer's disease:
    • Preclinical Alzheimer's disease: No symptoms but measurable biologic evidence of Alzheimer's disease pathology.
    • Mild cognitive impairment (MCI): Mild memory loss but no functional impairment.
    • Alzheimer's disease leading to dementia.

DSM V (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) criteria

Alzheimer's disease is the most common cause of dementia. In DSM V, dementia has been renamed as major neurocognitive disorder and minor neurocognitive disorder. The DSM-V diagnostic criteria for major or mild neurocognitive disorder due to Alzheimer’s disease includes the following:

  • Insidious onset with gradual decline in one or more cognitive abilities (for major neurocognitive disorder, at least two domains must be impaired).
  • Criteria are met for major or mild neurocognitive disorder due to probable or possible Alzheimer’s disease as follows:

For major neurocognitive disorder:

Probable Alzheimer’s disease is diagnosed if either of the following is present; otherwise, possible Alzheimer’s disease should be diagnosed.

For mild neurocognitive disorder:


  1. Braak H, Braak E (1991). "Neuropathological stageing of Alzheimer-related changes". Acta Neuropathol. 82 (4): 239–59. PMID 1759558.
  2. "Consensus recommendations for the postmortem diagnosis of Alzheimer's disease. The National Institute on Aging, and Reagan Institute Working Group on Diagnostic Criteria for the Neuropathological Assessment of Alzheimer's Disease". Neurobiol. Aging. 18 (4 Suppl): S1–2. 1997. PMID 9330978.
  3. Khachaturian ZS (1985). "Diagnosis of Alzheimer's disease". Arch. Neurol. 42 (11): 1097–105. PMID 2864910.
  4. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR, Kawas CH, Klunk WE, Koroshetz WJ, Manly JJ, Mayeux R, Mohs RC, Morris JC, Rossor MN, Scheltens P, Carrillo MC, Thies B, Weintraub S, Phelps CH (2011). "The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease". Alzheimers Dement. 7 (3): 263–9. doi:10.1016/j.jalz.2011.03.005. PMC 3312024. PMID 21514250.
  5. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984). "Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease". Neurology. 34 (7): 939–44. PMID 6610841.
  6. Vahia, VihangN (2013). "Diagnostic and statistical manual of mental disorders 5: A quick glance". Indian Journal of Psychiatry. 55 (3): 220. doi:10.4103/0019-5545.117131. ISSN 0019-5545.
  7. Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.