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Diagnostic Criteria for Alzheimer's Disease (AD)

 

NINDS-ADRDA Diagnostic criteria for Alzheimer's Disease (AD)

Probable AD: A plus one or more supportive features B, C, D, or E

Core diagnostic criteria

A. Presence of an early and significant episodic memory impairment that includes the following features:

  1. Gradual and progressive change in memory function reported by patients or informants over more than 6 months

  2. Objective evidence of significantly impaired episodic memory on testing: this generally consists of recall deficit that does not improve significantly or does not normalise with cueing or recognition testing and after effective encoding of information has been previously controlled

  3. The episodic memory impairment can be isolated or associated with other cognitive changes at the onset of AD or as AD advances

Supportive features

B. Presence of medial temporal lobe atrophy

  • Volume loss of hippocampi, entorhinal cortex, amygdala evidenced on MRI with qualitative ratings using visual scoring (referenced to well characterised population with age norms) or quantitative volumetry of regions of interest (referenced to well characterised population with age norms)

C. Abnormal cerebrospinal fluid biomarker

  • Low amyloid β142 concentrations, increased total tau concentrations, or increased phospho-tau concentrations, or combinations of the three

  • Other well validated markers to be discovered in the future

D. Specific pattern on functional neuroimaging with PET

  • Reduced glucose metabolism in bilateral temporal parietal regions

  • Other well validated ligands, including those that foreseeably will emerge such as Pittsburg compound B or FDDNP

E. Proven AD autosomal dominant mutation within the immediate family

Exclusion criteria

History

  • Sudden onset

  • Early occurrence of the following symptoms: gait disturbances, seizures, behavioural changes

Clinical features

  • Focal neurological features including hemiparesis, sensory loss, visual field deficits

  • Early extrapyramidal signs

Other medical disorders severe enough to account for memory and related symptoms

  • Non-AD dementia

  • Major depression

  • Cerebrovascular disease

  • Toxic and metabolic abnormalities, all of which may require specific investigations

  • MRI FLAIR or T2 signal abnormalities in the medial temporal lobe that are consistent with infectious or vascular insults

Criteria for definite AD

AD is considered definite if the following are present:

  • Both clinical and histopathological (brain biopsy or autopsy) evidence of the disease, as required by the NIA-Reagan criteria for the post-mortem diagnosis of AD; criteria must both be present

  • Both clinical and genetic evidence (mutation on chromosome 1, 14, or 21) of AD; criteria must both be present

 

DSM-IV-TR Diagnostic criteria for Alzheimer's Disease (AD)

A. The development of multiple cognitive deficits manifested by both memory impairment and one or more of the following

  • Aphasia

  • Apraxia

  • Agnosia

  • and disturbances in executive functioning

B. The cognitive deficits represent as decline from previous functioning and cause significant impairment in social or occupational functioning

C. The course is characterized by gradual onset and continuing decline

D. The cognitive deficits are not due to other central nervous system, systemic, or substance-induced conditions that cause progressive deficits in memory and cognition

E. The disturbance is not better accounted for by another psychiatric disorder.

 

 

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References:

  1. Reisberg B. Diagnostic criteria in dementia: a comparison of current criteria, research challenges, and implications for DSM-V. J Geriatr Psychiatry Neurol. 2006 Sep;19(3):137-46. [Medline]

  2. Dubois B, Feldman HH, Jacova C, Dekosky ST, Barberger-Gateau P, Cummings J, Delacourte A, Galasko D, Gauthier S, Jicha G, Meguro K, O'brien J, Pasquier F, Robert P, Rossor M, Salloway S, Stern Y, Visser PJ, Scheltens P. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS-ADRDA criteria. Lancet Neurol. 2007 Aug;6(8):734-46. [Medline]

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Created: Oct 07, 2007
Last Modified: 10/23/2010

 
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