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==Overview== | ==Overview== | ||
The diagnosis of Alzheimer's disease 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 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 | 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 [[Diagnostic and statistical manual of mental disorders|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 test|neuropsychological testing]] should be performed to further evaluate the status of [[Cognitive|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 [[Vitamin B12 deficiecny|vit B12 deficiency]], [[syphilis]], or [[tuberculosis]]). Patients with atypical clinical presentation may also be tested for [[biomarkers]] such as [[Aβ]] and total and [[phosphorylated]] [[tau protein|tau protein.]] | ||
==Diagnostic Criteria== | ==Diagnostic Criteria== | ||
The diagnosis of Alzheimer's disease can be made either on the basis of:<ref name="pmid1759558">{{cite journal |vauthors=Braak H, Braak E |title=Neuropathological stageing of Alzheimer-related changes |journal=Acta Neuropathol. |volume=82 |issue=4 |pages=239–59 |year=1991 |pmid=1759558 |doi= |url=}}</ref><ref name="pmid9330978">{{cite journal |vauthors= |title=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 |journal=Neurobiol. Aging |volume=18 |issue=4 Suppl |pages=S1–2 |year=1997 |pmid=9330978 |doi= |url=}}</ref><ref name="pmid2864910">{{cite journal |vauthors=Khachaturian ZS |title=Diagnosis of Alzheimer's disease |journal=Arch. Neurol. |volume=42 |issue=11 |pages=1097–105 |year=1985 |pmid=2864910 |doi= |url=}}</ref><ref name="pmid21514250">{{cite journal |vauthors=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 |title=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 |journal=Alzheimers Dement |volume=7 |issue=3 |pages=263–9 |year=2011 |pmid=21514250 |pmc=3312024 |doi=10.1016/j.jalz.2011.03.005 |url=}}</ref><ref name="pmid6610841">{{cite journal |vauthors=McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM |title=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 |journal=Neurology |volume=34 |issue=7 |pages=939–44 |year=1984 |pmid=6610841 |doi= |url=}}</ref><ref name="Vahia2013">{{cite journal|last1=Vahia|first1=VihangN|title=Diagnostic and statistical manual of mental disorders 5: A quick glance|journal=Indian Journal of Psychiatry|volume=55|issue=3|year=2013|pages=220|issn=0019-5545|doi=10.4103/0019-5545.117131}}</ref> | The [[diagnosis]] of Alzheimer's disease (AD) can be made either on the basis of:<ref name="pmid1759558">{{cite journal |vauthors=Braak H, Braak E |title=Neuropathological stageing of Alzheimer-related changes |journal=Acta Neuropathol. |volume=82 |issue=4 |pages=239–59 |year=1991 |pmid=1759558 |doi= |url=}}</ref><ref name="pmid9330978">{{cite journal |vauthors= |title=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 |journal=Neurobiol. Aging |volume=18 |issue=4 Suppl |pages=S1–2 |year=1997 |pmid=9330978 |doi= |url=}}</ref><ref name="pmid2864910">{{cite journal |vauthors=Khachaturian ZS |title=Diagnosis of Alzheimer's disease |journal=Arch. Neurol. |volume=42 |issue=11 |pages=1097–105 |year=1985 |pmid=2864910 |doi= |url=}}</ref><ref name="pmid21514250">{{cite journal |vauthors=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 |title=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 |journal=Alzheimers Dement |volume=7 |issue=3 |pages=263–9 |year=2011 |pmid=21514250 |pmc=3312024 |doi=10.1016/j.jalz.2011.03.005 |url=}}</ref><ref name="pmid6610841">{{cite journal |vauthors=McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM |title=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 |journal=Neurology |volume=34 |issue=7 |pages=939–44 |year=1984 |pmid=6610841 |doi= |url=}}</ref><ref name="Vahia2013">{{cite journal|last1=Vahia|first1=VihangN|title=Diagnostic and statistical manual of mental disorders 5: A quick glance|journal=Indian Journal of Psychiatry|volume=55|issue=3|year=2013|pages=220|issn=0019-5545|doi=10.4103/0019-5545.117131}}</ref> | ||
*National Institute on Aging and the Alzheimer's Association (NIA-AA); most recently updated in 2011, or | *National Institute on Aging and the Alzheimer's Association (NIA-AA); most recently updated in 2011, or | ||
*DSM-V (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) diagnostic criteria for major or mild neurocognitive disorder due to Alzheimer’s disease<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | *[[Diagnostic and statistical manual of mental disorders|DSM]]-V ([[Diagnostic and statistical manual of mental disorders|Diagnostic and Statistical Manual of Mental Disorders]], fifth edition) diagnostic criteria for major or mild [[neurocognitive]] disorder due to Alzheimer’s disease<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
===National Institute on Aging and the Alzheimer's Association (NIA-AA)=== | ===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. | [[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. | ||
* Probable | * Probable Alzheimer's disease includes all of the following criteria: | ||
** A decline from a previous level of functioning with inability or interference in carrying out usual daily activities. | ** A decline from a previous level of functioning with inability or interference in carrying out usual daily activities. | ||
** Loss of two or more cognitive abilities such as anterograde amnesia, aphasia, apraxia, agnosia, or other disturbance in executive functioning. | ** Loss of two or more [[Cognitive|cognitive abilities]] such as [[anterograde amnesia]], [[aphasia]], [[apraxia]], [[agnosia]], or other disturbance in [[executive functioning]]. | ||
** Cognitive loss documented by mental status examination (MSE) or neuropsychological tests. | ** [[Cognitive]] loss documented by [[Mental status examination|mental status examination (MSE)]] or [[Neuropsychological test|neuropsychological tests]]. | ||
** Symptoms not consistent with other cerebrovascular disease, psychiatric disorders or delirium. | ** Symptoms not consistent with other [[cerebrovascular disease]], [[psychiatric disorders]] or [[delirium]]. | ||
** Insidious onset and gradual progression of symptoms. | ** Insidious onset and gradual progression of [[symptoms]]. | ||
** Intact consciousness | ** Intact [[consciousness]] | ||
* Possible | * 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: | ||
** In possible AD cognitive impairment is sudden in onset with insufficient history or documentation of progressive decline in cognitive abilities. | ** In possible AD [[cognitive]] impairment is sudden in onset with insufficient [[History & Symptoms|history]] or documentation of progressive decline in [[cognitive]] abilities. | ||
** The patient has insidious onset of cognitive impairment with gradual progression over time but in the presence of neurologic, medical condition or medications that may have notable effect on the cognitive abilities of the patient. | ** The [[patient]] has insidious onset of [[cognitive]] impairment with gradual progression over time but in the presence of [[Neurology|neurologic]], [[medical condition]] or [[medications]] that may have notable effect on the [[cognitive]] abilities of the [[patient]]. | ||
The The NIA-AA criteria differ from prior DSM criteria in the following way: | The The [[National Institute on Aging|NIA]]-[[Alzheimer's Association|AA]] criteria differ from prior [[Diagnostic and statistical manual of mental disorders|DSM]] criteria in the following way: | ||
*NIA-AA recommends patients with positive biomarkers (such as Aβ and total and phosphorylated Tau protein) be diagnosed with | *NIA-AA recommends patients with positive [[biomarkers]] (such as [[Aβ]] 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: | *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. | **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. | **[[Mild cognitive impairment]] (MCI): Mild [[memory loss]] but no functional impairment. | ||
**Alzheimer's disease leading to dementia. | **Alzheimer's disease leading to [[dementia]]. | ||
===DSM V (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) criteria=== | ===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: | Alzheimer's disease is the most common cause of [[dementia]]. In [[Diagnostic and statistical manual of mental disorders|DSM]] V, [[dementia]] has been renamed as major neurocognitive disorder and minor neurocognitive disorder. The [[Diagnostic and statistical manual of mental disorders|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). | * 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: | * Criteria are met for major or mild neurocognitive disorder due to probable or possible Alzheimer’s disease as follows: | ||
====For major neurocognitive disorder:==== | ====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. | Probable Alzheimer’s disease is diagnosed if either of the following is present; otherwise, possible Alzheimer’s disease should be diagnosed. | ||
*Evidence of a causative Alzheimer’s disease genetic mutation from family history or genetic testing. | *[[Evidence]] of a causative Alzheimer’s disease genetic mutation from [[family history]] or [[genetic testing]]. | ||
*All three of the following are present: | *All three of the following are present: | ||
**Clear evidence of decline in memory and learning and at least one other cognitive domain (based on detailed history or serial neuropsychological testing). | **Clear evidence of decline in [[memory]] and [[learning]] and at least one other [[cognitive]] domain (based on detailed [[History & Symptoms|history]] or serial [[Neuropsychological test|neuropsychological testing]]). | ||
**Steadily progressive, gradual decline in cognition, without extended plateaus. | **Steadily progressive, gradual decline in [[cognition]], without extended plateaus. | ||
**No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline). | **No evidence of mixed etiology (i.e., absence of other [[Neurodegenerative disease|neurodegenerative]] or [[cerebrovascular disease]], or another [[Neurology|neurological]], [[mental]], or [[systemic disease]] or condition likely contributing to [[cognitive]] decline). | ||
====For mild neurocognitive disorder:==== | ====For mild neurocognitive disorder:==== | ||
* | *Probable Alzheimer’s disease is diagnosed if there is evidence of a causative Alzheimer’s disease [[genetic mutation]] from either [[genetic testing]] or [[family history]]. | ||
*Possible Alzheimer’s disease is diagnosed if there is no evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history, and all three of the following are present: | *Possible Alzheimer’s disease is diagnosed if there is no evidence of a causative Alzheimer’s disease [[genetic mutation]] from either [[genetic testing]] or [[Family history|family history,]] and all three of the following are present: | ||
**Clear evidence of decline in memory and learning. | **Clear evidence of decline in [[memory]] and [[learning]]. | ||
**Steadily progressive, gradual decline in cognition, without extended plateaus. | **Steadily progressive, gradual decline in [[cognition]], without extended plateaus. | ||
**No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological or systemic disease or condition likely contributing to cognitive decline). | **No evidence of mixed [[etiology]] (i.e., absence of other [[Neurodegenerative disease|neurodegenerative]] or [[cerebrovascular disease]], or another [[neurological]] or [[systemic disease]] or [[condition]] likely contributing to [[cognitive]] decline). | ||
==References== | ==References== | ||
Latest revision as of 15:32, 21 September 2017
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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]
Overview
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 Aβ 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); most recently updated in 2011, or
- DSM-V (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) diagnostic criteria for major or mild neurocognitive disorder due to Alzheimer’s disease[7]
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.
- Probable Alzheimer's disease includes all of the following criteria:
- A decline from a previous level of functioning with inability or interference in carrying out usual daily activities.
- Loss of two or more cognitive abilities such as anterograde amnesia, aphasia, apraxia, agnosia, or other disturbance in executive functioning.
- Cognitive loss documented by mental status examination (MSE) or neuropsychological tests.
- Symptoms not consistent with other cerebrovascular disease, psychiatric disorders or delirium.
- Insidious onset and gradual progression of symptoms.
- Intact consciousness
- 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:
- In possible AD cognitive impairment is sudden in onset with insufficient history or documentation of progressive decline in cognitive abilities.
- The patient has insidious onset of cognitive impairment with gradual progression over time but in the presence of neurologic, medical condition or medications that may have notable effect on the cognitive abilities of the patient.
The The NIA-AA criteria differ from prior DSM criteria in the following way:
- NIA-AA recommends patients with positive biomarkers (such as Aβ 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.
- Evidence of a causative Alzheimer’s disease genetic mutation from family history or genetic testing.
- All three of the following are present:
- Clear evidence of decline in memory and learning and at least one other cognitive domain (based on detailed history or serial neuropsychological testing).
- Steadily progressive, gradual decline in cognition, without extended plateaus.
- No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline).
For mild neurocognitive disorder:
- Probable Alzheimer’s disease is diagnosed if there is evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history.
- Possible Alzheimer’s disease is diagnosed if there is no evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history, and all three of the following are present:
- Clear evidence of decline in memory and learning.
- Steadily progressive, gradual decline in cognition, without extended plateaus.
- No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological or systemic disease or condition likely contributing to cognitive decline).
References
- ↑ Braak H, Braak E (1991). "Neuropathological stageing of Alzheimer-related changes". Acta Neuropathol. 82 (4): 239–59. PMID 1759558.
- ↑ "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.
- ↑ Khachaturian ZS (1985). "Diagnosis of Alzheimer's disease". Arch. Neurol. 42 (11): 1097–105. PMID 2864910.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.