Tuesday, March 30, 2010

NINCDS-ADRDA Criteria for Diagnosis of AD

Summary of NINCDS-ADRDA Criteria for Diagnosis of AD

Probable AD
Deficits in two or more domains of cognition
Progressive decline of memory and other cognitive functions
Preserved consciousness
Onset between ages 40 and 90
Absence of systemic or other brain disease that could account for symptoms
Possible AD
Atypical onset, presentation, or clinical course of dementia
Presence of another illness capable of producing dementia
Definite AD
Clinical criteria for probable AD
Tissue diagnosis by autopsy or biopsy

NINCDS-ADRDA Criteria for the Diagnosis of Alzheimer's Disease *

I. Clinical Diagnosis of Probable Alzheimer's Disease
  1. Dementia established by clinical examination and mental status testing and confirmed by neuropsychological testing
  2. Deficits in at least two cognitive domains
  3. Progressive cognitive decline, including memory
  4. Normal level of consciousness
  5. Onset between ages 40 and 90 (most common after 65) years
  6. No other possible medical or neurological explanation
II. Probable Alzheimer's Disease Diagnosis Supported by
  1. Progressive aphasia, apraxia, and agnosia
  2. Impaired activities of daily living
  3. Family history of similar disorder
  4. Brain atrophy on CT/MRI, especially if progressive
  5. Normal CSF, EEG (or nonspecifically abnormal)
III. Other Clinical Features Consistent with Probable Alzheimer's Disease
  1. Plateau in course
  2. Associated symptoms: depression; insomnia; incontinence; illusions; hallucinations; catastrophic verbal, emotional, or physical outbursts; sexual disorders; weight loss; during more advanced stages increased muscle tone, myoclonus, and abnormal gait
  3. Seizures in advanced disease
  4. CT normal for age
IV. Features That Make Alzheimer's Disease Uncertain or Unlikely
  1. Acute onset
  2. Focal sensorimotor signs
  3. Seizures or gait disorder early in course
V. Clinical Diagnosis of Possible Alzheimer's Disease
  1. Dementia with atypical onset or course in the absence of another medical/neuropsychiatric explanation
  2. Dementia with another disease not felt otherwise to be the cause of dementia
  3. For research purposes, a progressive focal cognitive deficit
VI. Definite Alzheimer's Disease
  1. Meets clinical criteria for probable Alzheimer's disease
  2. Tissue confirmation (autopsy or brain biopsy)
VII. Research Classification of Alzheimer's disease should specify
  1. Familial?
  2. Early onset (before age 65)?
  3. Down's syndrome (trisomy 21)?
  4. Coexistent other neurodegenerative disease (e.g., Parkinson's disease)?

McKhann G, Drachman D, Folstein M, et al: 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 1984;34:939–944

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