Alzheimer's disease classification: Difference between revisions
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{{Alzheimer's disease}} | {{Alzheimer's disease}} | ||
{{CMG}}; {{AE}} {{ | {{CMG}}; {{AE}} {{HK}}, {{ARK}}, {{HW}} | ||
== Overview == | ==Overview== | ||
Alzheimer's disease may be classified according to severity into mild, moderate and severe dementia. It may also be classified based on age of onset into early onset and late onset Alzheimer's disease. Another method of classification of Alzheimer's disease is based on the course of disease into pre-dementia, early dementia, moderate dementia and advanced dementia. | Alzheimer's disease may be classified according to severity into mild, moderate and severe [[dementia]]. It may also be classified based on age of onset into early onset and late onset Alzheimer's disease. Another method of classification of Alzheimer's disease is based on the course of [[disease]] into pre-[[dementia]], early [[dementia]], moderate [[dementia]] and advanced [[dementia]]. | ||
==Classification== | ==Classification== | ||
=== Classification based on severity === | ===Classification based on severity=== | ||
Alzheimer's disease may be classified based on the clinical dementia rating criteria into minimal, | Alzheimer's disease may be classified based on the clinical [[dementia]] rating criteria into minimal, intermediate, mild, moderate and severe:<ref name="pmid9447441">{{cite journal |vauthors=Morris JC |title=Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type |journal=Int Psychogeriatr |volume=9 Suppl 1 |issue= |pages=173–6; discussion 177–8 |year=1997 |pmid=9447441 |doi= |url=}}</ref><ref name="pmid3249765">{{cite journal |vauthors=Berg L |title=Clinical Dementia Rating (CDR) |journal=Psychopharmacol Bull |volume=24 |issue=4 |pages=637–9 |year=1988 |pmid=3249765 |doi= |url=}}</ref><ref name="pmid18695059">{{cite journal |vauthors=O'Bryant SE, Waring SC, Cullum CM, Hall J, Lacritz L, Massman PJ, Lupo PJ, Reisch JS, Doody R |title=Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: a Texas Alzheimer's research consortium study |journal=Arch. Neurol. |volume=65 |issue=8 |pages=1091–5 |year=2008 |pmid=18695059 |pmc=3409562 |doi=10.1001/archneur.65.8.1091 |url=}}</ref><ref name="pmid8232972">{{cite journal |vauthors=Morris JC |title=The Clinical Dementia Rating (CDR): current version and scoring rules |journal=Neurology |volume=43 |issue=11 |pages=2412–4 |year=1993 |pmid=8232972 |doi= |url=}}</ref><ref name="pmid9191756">{{cite journal |vauthors=Morris JC, Ernesto C, Schafer K, Coats M, Leon S, Sano M, Thal LJ, Woodbury P |title=Clinical dementia rating training and reliability in multicenter studies: the Alzheimer's Disease Cooperative Study experience |journal=Neurology |volume=48 |issue=6 |pages=1508–10 |year=1997 |pmid=9191756 |doi= |url=}}</ref> | ||
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | {| style="border: 0px; font-size: 90%; margin: 3px;" align="center" | ||
| colspan="6" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Clinical Dementia Rating'''}} | | colspan="6" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Clinical Dementia Rating'''}} | ||
|- | |- | ||
| colspan="6" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Based on the severity of Impairment'''}} | | colspan="6" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|'''Based on the severity of Impairment'''}} | ||
|+ | |+ | ||
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Criteria}} | ! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Criteria}} | ||
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Minimal}} | ! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Minimal}} | ||
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Indeterminate}} | ! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Indeterminate}} | ||
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Mild}} | ! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Mild}} | ||
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Moderate}} | ! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Moderate}} | ||
! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Severe}} | ! colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Severe}} | ||
|- | |- | ||
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Memory}} | | colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Memory}} | ||
| style="padding: 5px 5px; background: #F5F5F5;" | No memory loss or slight [[forgetfulness]] | | style="padding: 5px 5px; background: #F5F5F5;" |No [[memory loss]] or slight [[forgetfulness]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Minimal forgetfulness; partial recollection of events; “benign” forgetfulness | | style="padding: 5px 5px; background: #F5F5F5;" |Minimal [[forgetfulness]]; partial recollection of events; “benign” [[forgetfulness]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Moderate memory loss; more marked for recent events; defect interferes with everyday activities | | style="padding: 5px 5px; background: #F5F5F5;" |Moderate [[memory loss]]; more marked for recent events; defect interferes with everyday activities | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Severe memory loss; only highly learned material retained; new material rapidly lost | | style="padding: 5px 5px; background: #F5F5F5;" |Severe [[memory loss]]; only highly learned material retained; new material rapidly lost | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Severe memory loss; only fragments remain | | style="padding: 5px 5px; background: #F5F5F5;" |Severe [[memory loss]]; only fragments remain | ||
|- | |- | ||
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Orientation}} | | colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Orientation}} | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Fully oriented | | style="padding: 5px 5px; background: #F5F5F5;" |Fully oriented | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Fully oriented except for slight difficulty with time perception | | style="padding: 5px 5px; background: #F5F5F5;" |Fully oriented except for slight difficulty with time [[perception]] | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Moderate difficulty with time perception; oriented for place at examination; may be disoriented to place | | style="padding: 5px 5px; background: #F5F5F5;" |Moderate difficulty with time perception; oriented for place at examination; may be disoriented to place | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Severe difficulty with time relationships; usually disoriented to time, often to place | | style="padding: 5px 5px; background: #F5F5F5;" |Severe difficulty with time relationships; usually [[Disorientation|disoriented]] to time, often to place | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Oriented to person only | | style="padding: 5px 5px; background: #F5F5F5;" |Oriented to person only | ||
|- | |- | ||
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Judgment and problem solving}} | | colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Judgment and problem solving}} | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Able to handle daily life activities (including financial issues); judgment good in relation to past performance | | style="padding: 5px 5px; background: #F5F5F5;" |Able to handle daily life activities (including financial issues); judgment good in relation to past performance | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Mild impairment in solving problems, determining similarities and differences | | style="padding: 5px 5px; background: #F5F5F5;" |Mild impairment in solving problems, determining similarities and differences | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Moderate difficulty in solving problems, difficulty in distinguishing things; social judgment usually maintained | | style="padding: 5px 5px; background: #F5F5F5;" |Moderate difficulty in solving problems, difficulty in distinguishing things; social judgment usually maintained | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Severely impaired in solving problems, determining similarities and differences; social judgment usually impaired | | style="padding: 5px 5px; background: #F5F5F5;" |Severely impaired in solving problems, determining similarities and differences; social judgment usually impaired | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Unable to make judgments or solve problems | | style="padding: 5px 5px; background: #F5F5F5;" |Unable to make judgments or solve problems | ||
|- | |- | ||
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Social functioning}} | | colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Social functioning}} | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Functions independently and performs daily tasks such as shopping, and volunteer and social groups | | style="padding: 5px 5px; background: #F5F5F5;" |Functions independently and performs daily tasks such as shopping, and volunteer and social groups | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Slight impairment in performing social activities | | style="padding: 5px 5px; background: #F5F5F5;" |Slight impairment in performing social activities | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Unable to perform social activities, although may still be engaged in some; appears normal on casual observation | | style="padding: 5px 5px; background: #F5F5F5;" |Unable to perform social activities, although may still be engaged in some; appears normal on casual observation | ||
| style="padding: 5px 5px; background: #F5F5F5;" | No pretense of independent function outside of home; appears well enough to be taken to functions outside a family home | | style="padding: 5px 5px; background: #F5F5F5;" |No pretense of independent function outside of home; appears well enough to be taken to functions outside a family home | ||
| style="padding: 5px 5px; background: #F5F5F5;" | No pretense of independent function outside of home; appears too ill to be taken to functions outside a family home | | style="padding: 5px 5px; background: #F5F5F5;" |No pretense of independent function outside of home; appears too ill to be taken to functions outside a family home | ||
|- | |- | ||
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Home and hobbies}} | | colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Home and hobbies}} | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Able to carry out daily life activities, hobbies, and intellectual interests well maintained | | style="padding: 5px 5px; background: #F5F5F5;" |Able to carry out daily life activities, hobbies, and intellectual interests well maintained | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Daily life tasks, hobbies, and intellect slightly impaired | | style="padding: 5px 5px; background: #F5F5F5;" |Daily life tasks, hobbies, and intellect slightly impaired | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Mild but definite impairment of function in performing daily life tasks; more difficult chores abandoned; more complicated hobbies and interests abandoned | | style="padding: 5px 5px; background: #F5F5F5;" |Mild but definite impairment of function in performing daily life tasks; more difficult chores abandoned; more complicated hobbies and interests abandoned | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Only simple chores preserved; interests very restricted and poorly maintained | | style="padding: 5px 5px; background: #F5F5F5;" |Only simple chores preserved; interests very restricted and poorly maintained | ||
| style="padding: 5px 5px; background: #F5F5F5;" | No significant function in home | | style="padding: 5px 5px; background: #F5F5F5;" |No significant function in home | ||
|- | |- | ||
| colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Personal care}} | | colspan="1" rowspan="1" style="background: #4479BA; padding: 5px 5px;" |{{fontcolor|#FFFFFF|Personal care}} | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Able to take care of self | | style="padding: 5px 5px; background: #F5F5F5;" |Able to take care of self | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Fully functional | | style="padding: 5px 5px; background: #F5F5F5;" |Fully functional | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Needs reminders | | style="padding: 5px 5px; background: #F5F5F5;" |Needs reminders | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Requires assistance in dressing, hygiene, keeping of personal effects | | style="padding: 5px 5px; background: #F5F5F5;" |Requires assistance in dressing, hygiene, keeping of personal effects | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Requires much help with personal care; frequent incontinence | | style="padding: 5px 5px; background: #F5F5F5;" |Requires much help with personal care; frequent [[incontinence]] | ||
|} | |} | ||
=== Classification based on age of onset === | ===Classification based on age of onset=== | ||
Alzheimer's disease may be classified into early onset and late onset based on age of onset:<ref name="urlAlzheimer Disease Overview - GeneReviews® - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK1161/ |title=Alzheimer Disease Overview - GeneReviews® - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid16966510">{{cite journal |vauthors=Brickell KL, Steinbart EJ, Rumbaugh M, Payami H, Schellenberg GD, Van Deerlin V, Yuan W, Bird TD |title=Early-onset Alzheimer disease in families with late-onset Alzheimer disease: a potential important subtype of familial Alzheimer disease |journal=Arch. Neurol. |volume=63 |issue=9 |pages=1307–11 |year=2006 |pmid=16966510 |doi=10.1001/archneur.63.9.1307 |url=}}</ref><ref name="pmid10441572">{{cite journal |vauthors=Campion D, Dumanchin C, Hannequin D, Dubois B, Belliard S, Puel M, Thomas-Anterion C, Michon A, Martin C, Charbonnier F, Raux G, Camuzat A, Penet C, Mesnage V, Martinez M, Clerget-Darpoux F, Brice A, Frebourg T |title=Early-onset autosomal dominant Alzheimer disease: prevalence, genetic heterogeneity, and mutation spectrum |journal=Am. J. Hum. Genet. |volume=65 |issue=3 |pages=664–70 |year=1999 |pmid=10441572 |pmc=1377972 |doi=10.1086/302553 |url=}}</ref><ref name="pmid11216203">{{cite journal |vauthors=Munoz DG, Feldman H |title=Causes of Alzheimer's disease |journal=CMAJ |volume=162 |issue=1 |pages=65–72 |year=2000 |pmid=11216203 |pmc=1232234 |doi= |url=}}</ref><ref name="pmid9848086">{{cite journal |vauthors=Hölscher C |title=Possible causes of Alzheimer's disease: amyloid fragments, free radicals, and calcium homeostasis |journal=Neurobiol. Dis. |volume=5 |issue=3 |pages=129–41 |year=1998 |pmid=9848086 |doi=10.1006/nbdi.1998.0193 |url=}}</ref> | Alzheimer's disease may be classified into early onset and late onset based on age of onset:<ref name="urlAlzheimer Disease Overview - GeneReviews® - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK1161/ |title=Alzheimer Disease Overview - GeneReviews® - NCBI Bookshelf |format= |work= |accessdate=}}</ref><ref name="pmid16966510">{{cite journal |vauthors=Brickell KL, Steinbart EJ, Rumbaugh M, Payami H, Schellenberg GD, Van Deerlin V, Yuan W, Bird TD |title=Early-onset Alzheimer disease in families with late-onset Alzheimer disease: a potential important subtype of familial Alzheimer disease |journal=Arch. Neurol. |volume=63 |issue=9 |pages=1307–11 |year=2006 |pmid=16966510 |doi=10.1001/archneur.63.9.1307 |url=}}</ref><ref name="pmid10441572">{{cite journal |vauthors=Campion D, Dumanchin C, Hannequin D, Dubois B, Belliard S, Puel M, Thomas-Anterion C, Michon A, Martin C, Charbonnier F, Raux G, Camuzat A, Penet C, Mesnage V, Martinez M, Clerget-Darpoux F, Brice A, Frebourg T |title=Early-onset autosomal dominant Alzheimer disease: prevalence, genetic heterogeneity, and mutation spectrum |journal=Am. J. Hum. Genet. |volume=65 |issue=3 |pages=664–70 |year=1999 |pmid=10441572 |pmc=1377972 |doi=10.1086/302553 |url=}}</ref><ref name="pmid11216203">{{cite journal |vauthors=Munoz DG, Feldman H |title=Causes of Alzheimer's disease |journal=CMAJ |volume=162 |issue=1 |pages=65–72 |year=2000 |pmid=11216203 |pmc=1232234 |doi= |url=}}</ref><ref name="pmid9848086">{{cite journal |vauthors=Hölscher C |title=Possible causes of Alzheimer's disease: amyloid fragments, free radicals, and calcium homeostasis |journal=Neurobiol. Dis. |volume=5 |issue=3 |pages=129–41 |year=1998 |pmid=9848086 |doi=10.1006/nbdi.1998.0193 |url=}}</ref> | ||
| Line 74: | Line 74: | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Prevalence''' | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Prevalence''' | ||
|- | |- | ||
| colspan="1" rowspan="1" |'''Late-onset familial (AD2)''' | | colspan="1" rowspan="1" |'''Late-onset familial (>60 years, AD2)''' | ||
| | | | ||
* [[APOE]] [[gene]]: | *[[APOE]] [[gene]]: | ||
** [[Locus]]: AD2 | **[[Locus]]: AD2 | ||
** [[Protein]]: Apolipoprotein E | **[[Protein]]: [[Apolipoprotein E]] | ||
* TREM2 [[gene]]: | *TREM2 [[gene]]: | ||
** Variant: p.Arg47His [[Allele|allelic]] variant | **Variant: p.Arg47His [[Allele|allelic]] variant | ||
* PLD3 [[gene]] | *PLD3 [[gene]] | ||
* UNC5C [[gene]] | *UNC5C [[gene]] | ||
* [[AKAP9]] [[gene]]: | *[[AKAP9]] [[gene]]: | ||
** In African-Americans only | **In African-Americans only | ||
| colspan="1" rowspan="1" |15%-25% of [[familial]] cases | | colspan="1" rowspan="1" |15%-25% of [[familial]] cases | ||
|- | |- | ||
| colspan="1" rowspan="1" |'''Early-onset familial AD (AD1, AD3, AD4)''' | | colspan="1" rowspan="1" |'''Early-onset familial AD (<60 years, AD1, AD3, AD4)''' | ||
| | | | ||
* [[PSEN1]] [[gene]]: | *[[PSEN1]] [[gene]]: | ||
** [[Locus (genetics)|Locus]]: AD3 | **[[Locus (genetics)|Locus]]: AD3 | ||
** Proportion: 20-70 % of early onset AD cases | **Proportion: 20-70 % of early onset AD cases | ||
** [[Protein]]: [[Presenilin 1|Presenilin-1]] | **[[Protein]]: [[Presenilin 1|Presenilin-1]] | ||
* [[PSEN2]] [[gene]]: | *[[PSEN2]] [[gene]]: | ||
** [[Locus (genetics)|Locus]]: AD4 | **[[Locus (genetics)|Locus]]: AD4 | ||
** Proportion: Rare | **Proportion: Rare | ||
** Protein: [[Presenilin|Presenilin-2]] | **Protein: [[Presenilin|Presenilin-2]] | ||
* [[Amyloid precursor protein|APP]] [[gene]]: | *[[Amyloid precursor protein|APP]] [[gene]]: | ||
** [[Locus]]: AD1 | **[[Locus]]: AD1 | ||
** Proportion: 10-15 % of early onset AD cases | **Proportion: 10-15 % of early onset AD cases | ||
** [[Protein]]: [[Amyloid precursor protein]] ([[Amyloid precursor protein|APP]]) | **[[Protein]]: [[Amyloid precursor protein]] ([[Amyloid precursor protein|APP]]) | ||
| colspan="1" rowspan="1" |<2% of [[familial]] cases | | colspan="1" rowspan="1" |<2% of [[familial]] cases | ||
|} | |} | ||
=== Classification based on course of disease === | ===Classification based on course of disease=== | ||
Alzheimer's disease may be classified into the following stages based on course of disease:<ref>{{cite journal | Alzheimer's disease may be classified into the following stages based on course of disease:<ref>{{cite journal | ||
|author=Volicer L, Harper DG, Manning BC, Goldstein R, Satlin A | |author=Volicer L, Harper DG, Manning BC, Goldstein R, Satlin A | ||
| Line 112: | Line 112: | ||
|issue=5 | |issue=5 | ||
|pages=704–11 | |pages=704–11 | ||
|pmid=11329390 | |pmid=11329390 | ||
|url=http://ajp.psychiatryonline.org/cgi/content/full/158/5/704 | |url=http://ajp.psychiatryonline.org/cgi/content/full/158/5/704 | ||
| Line 205: | Line 203: | ||
|issue=4 | |issue=4 | ||
|pages=19–23 | |pages=19–23 | ||
|pmid=17408315 | |pmid=17408315 | ||
}}</ref><ref name="pmid17279076">{{cite journal | }}</ref><ref name="pmid17279076">{{cite journal | ||
| Line 215: | Line 211: | ||
|issue=2 | |issue=2 | ||
|pages=60–1 | |pages=60–1 | ||
|pmid=17279076 | |pmid=17279076 | ||
|doi=10.1038/ncpneuro0402 | |doi=10.1038/ncpneuro0402 | ||
| Line 226: | Line 220: | ||
|issue=9 | |issue=9 | ||
|pages=417–23 | |pages=417–23 | ||
|pmid=7967534 | |pmid=7967534 | ||
}}</ref><ref name="pmid8821346">{{cite journal | }}</ref><ref name="pmid8821346">{{cite journal | ||
| Line 256: | Line 248: | ||
|issue=4 | |issue=4 | ||
|pages=441–59 | |pages=441–59 | ||
|pmid=7617154 | |pmid=7617154 | ||
}}</ref><ref name="pmid8124945">{{cite journal | }}</ref><ref name="pmid8124945">{{cite journal | ||
| Line 266: | Line 256: | ||
|issue=4 | |issue=4 | ||
|pages=715–25 | |pages=715–25 | ||
|pmid=8124945 | |pmid=8124945 | ||
}}</ref><ref name="pmid10653284" /><ref name="pmid15121235">{{cite journal | }}</ref><ref name="pmid10653284" /><ref name="pmid15121235">{{cite journal | ||
| Line 276: | Line 264: | ||
|issue=1 | |issue=1 | ||
|pages=19–24 | |pages=19–24 | ||
|pmid=15121235 | |pmid=15121235 | ||
|doi=10.1016/j.brainresbull.2003.11.005 | |doi=10.1016/j.brainresbull.2003.11.005 | ||
| Line 290: | Line 276: | ||
|pmid=16209425 | |pmid=16209425 | ||
}}</ref><ref>Neuropsychiatric symptoms: | }}</ref><ref>Neuropsychiatric symptoms: | ||
*{{cite journal | *{{cite journal | ||
|author=Scarmeas N, Brandt J, Blacker D, ''et al'' | |author=Scarmeas N, Brandt J, Blacker D, ''et al'' | ||
| Line 297: | Line 284: | ||
|issue=12 | |issue=12 | ||
|pages=1755–61 | |pages=1755–61 | ||
|pmid=18071039 | |pmid=18071039 | ||
|doi=10.1001/archneur.64.12.1755 | |doi=10.1001/archneur.64.12.1755 | ||
| Line 309: | Line 294: | ||
|issue=5 | |issue=5 | ||
|pages=438–45 | |pages=438–45 | ||
|pmid=16670248 | |pmid=16670248 | ||
|doi=10.1097/01.JGP.0000218218.47279.db | |doi=10.1097/01.JGP.0000218218.47279.db | ||
| Line 321: | Line 304: | ||
|issue=8 | |issue=8 | ||
|pages=527–32 | |pages=527–32 | ||
|pmid=17931577 | |pmid=17931577 | ||
|doi=10.1016/j.jamda.2007.05.005 | |doi=10.1016/j.jamda.2007.05.005 | ||
| Line 332: | Line 313: | ||
|issue=3 | |issue=3 | ||
|pages=171–82 | |pages=171–82 | ||
|pmid=11442300 | |pmid=11442300 | ||
}}</ref><ref name="pmid7806732">{{cite journal | }}</ref><ref name="pmid7806732">{{cite journal | ||
| Line 342: | Line 321: | ||
|issue=1 | |issue=1 | ||
|pages=10–6 | |pages=10–6 | ||
|pmid=7806732 | |pmid=7806732 | ||
}}</ref><ref name="pmid7775724">{{cite journal | }}</ref><ref name="pmid7775724">{{cite journal | ||
| Line 352: | Line 329: | ||
|issue=6 | |issue=6 | ||
|pages=650–5 | |pages=650–5 | ||
|pmid=7775724 | |pmid=7775724 | ||
}}</ref><ref name="pmid11490146">{{cite journal | }}</ref><ref name="pmid11490146">{{cite journal | ||
| Line 362: | Line 337: | ||
|issue=5 | |issue=5 | ||
|pages=271–6 | |pages=271–6 | ||
|pmid=11490146 | |pmid=11490146 | ||
}}</ref><ref name="pmid12675103">{{cite journal | }}</ref><ref name="pmid12675103">{{cite journal | ||
| Line 371: | Line 345: | ||
|issue=5 | |issue=5 | ||
|pages=637–41 | |pages=637–41 | ||
|pmid=12675103 | |pmid=12675103 | ||
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! align="center" style="background:#4479BA; color: #FFFFFF;" + |Major deficits | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Major deficits | ||
|- | |- | ||
|Predementia | |'''Predementia''' | ||
| | | | ||
* Difficulty remembering recently learned facts and acquiring new information | *Difficulty remembering recently learned facts and acquiring new information | ||
* Disturbance of [[executive functions]] of [[attention|attentiveness]], [[planning]], flexibility, and [[abstraction|abstract thinking]], or impairments in [[semantic memory]] (memory of meanings, and conceptual relationships) | *Disturbance of [[executive functions]] of [[attention|attentiveness]], [[planning]], flexibility, and [[abstraction|abstract thinking]], or impairments in [[semantic memory]] (memory of meanings, and conceptual relationships) | ||
* Apathy | *[[Apathy]] | ||
* Mild cognitive impairment | *Mild [[cognitive impairment]] | ||
|- | |- | ||
|Early dementia | |'''Early dementia''' | ||
| | | | ||
* Impairment of [[learning]] and [[memory]] | *Impairment of [[learning]] and [[memory]] | ||
* Difficulties with language, [[executive functions]], [[perception]] ([[agnosia]]), or execution of movements ([[apraxia]]) are more prominent than memory problems | *Difficulties with language, [[executive functions]], [[perception]] ([[agnosia]]), or execution of movements ([[apraxia]]) are more prominent than [[memory]] problems | ||
* [[long-term memory|Older memories]] of the person's life ([[episodic memory]]), facts learned ([[semantic memory]]), and [[implicit memory]] (the memory of the body on how to do things, such as using a fork to eat) are less affected than formation of new memories | *[[long-term memory|Older memories]] of the person's life ([[episodic memory]]), facts learned ([[semantic memory]]), and [[implicit memory]] (the [[memory]] of the body on how to do things, such as using a fork to eat) are less affected than formation of new [[memories]] | ||
* Decreased word fluency | *Decreased word [[fluency]] | ||
* Cluminess when performing fine motor tasks such as writing, drawing or dressing | *Cluminess when performing fine motor tasks such as writing, drawing or dressing | ||
* Apraxia | *[[Apraxia]] | ||
* Noticeable cognitive impairment | *Noticeable [[cognitive impairment]] | ||
|- | |- | ||
|Moderate dementia | |'''Moderate dementia''' | ||
| | | | ||
* Speech disturbance (paraphasia) | *Speech disturbance ([[paraphasia]]) | ||
* Reading and writing skills affected | *Reading and writing skills affected | ||
* [[Long-term memory]], which was previously intact, becomes impaired | *[[Long-term memory]], which was previously intact, becomes impaired | ||
* Common [[neuropsychiatric]] manifestations include: | *Common [[neuropsychiatric]] manifestations include: | ||
** Wandering | **Wandering | ||
** Sundowning (the onset of confusion and agitation each day around sundown) | **Sundowning (the onset of confusion and agitation each day around sundown) | ||
** Irritability | **[[Irritability]] | ||
** Labile affect, which can lead to crying, outbursts of unpremeditated [[aggression]], or resistance to caregiving | **[[Labile affect]], which can lead to crying, outbursts of unpremeditated [[aggression]], or resistance to caregiving | ||
** 30% of patients also develop [[Delusional misidentification syndrome|illusionary misidentifications]] and other [[delusion]]al symptoms | **30% of patients also develop [[Delusional misidentification syndrome|illusionary misidentifications]] and other [[delusion]]al [[symptoms]] | ||
** Urinary incontinence | **[[Urinary incontinence]] | ||
|- | |- | ||
|Advanced dementia | |'''Advanced dementia''' | ||
| | | | ||
* Language is reduced to simple phrases or even single words, eventually leading to complete loss of speech | *Language is reduced to simple phrases or even single words, eventually leading to complete loss of [[speech]] | ||
* Extreme [[apathy]] | *Extreme [[apathy]] | ||
* Exhaustion | *Exhaustion | ||
* Completely dependent on caregivers for daily tasks | *Completely dependent on caregivers for daily tasks | ||
* Decreased muscle mass, eventually becomes bedridden | *Decreased [[muscle]] mass, eventually becomes bedridden | ||
|} | |} | ||
Latest revision as of 23:25, 24 September 2020
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Alzheimer's disease Microchapters |
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Diagnosis |
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Treatment |
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Alzheimer's disease classification On the Web |
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American Roentgen Ray Society Images of Alzheimer's disease classification |
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Risk calculators and risk factors for Alzheimer's disease classification |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2], Aravind Reddy Kothagadi M.B.B.S[3], Haleigh Williams, B.S.
Overview
Alzheimer's disease may be classified according to severity into mild, moderate and severe dementia. It may also be classified based on age of onset into early onset and late onset Alzheimer's disease. Another method of classification of Alzheimer's disease is based on the course of disease into pre-dementia, early dementia, moderate dementia and advanced dementia.
Classification
Classification based on severity
Alzheimer's disease may be classified based on the clinical dementia rating criteria into minimal, intermediate, mild, moderate and severe:[1][2][3][4][5]
| Clinical Dementia Rating | |||||
| Based on the severity of Impairment | |||||
| Criteria | Minimal | Indeterminate | Mild | Moderate | Severe |
|---|---|---|---|---|---|
| Memory | No memory loss or slight forgetfulness | Minimal forgetfulness; partial recollection of events; “benign” forgetfulness | Moderate memory loss; more marked for recent events; defect interferes with everyday activities | Severe memory loss; only highly learned material retained; new material rapidly lost | Severe memory loss; only fragments remain |
| Orientation | Fully oriented | Fully oriented except for slight difficulty with time perception | Moderate difficulty with time perception; oriented for place at examination; may be disoriented to place | Severe difficulty with time relationships; usually disoriented to time, often to place | Oriented to person only |
| Judgment and problem solving | Able to handle daily life activities (including financial issues); judgment good in relation to past performance | Mild impairment in solving problems, determining similarities and differences | Moderate difficulty in solving problems, difficulty in distinguishing things; social judgment usually maintained | Severely impaired in solving problems, determining similarities and differences; social judgment usually impaired | Unable to make judgments or solve problems |
| Social functioning | Functions independently and performs daily tasks such as shopping, and volunteer and social groups | Slight impairment in performing social activities | Unable to perform social activities, although may still be engaged in some; appears normal on casual observation | No pretense of independent function outside of home; appears well enough to be taken to functions outside a family home | No pretense of independent function outside of home; appears too ill to be taken to functions outside a family home |
| Home and hobbies | Able to carry out daily life activities, hobbies, and intellectual interests well maintained | Daily life tasks, hobbies, and intellect slightly impaired | Mild but definite impairment of function in performing daily life tasks; more difficult chores abandoned; more complicated hobbies and interests abandoned | Only simple chores preserved; interests very restricted and poorly maintained | No significant function in home |
| Personal care | Able to take care of self | Fully functional | Needs reminders | Requires assistance in dressing, hygiene, keeping of personal effects | Requires much help with personal care; frequent incontinence |
Classification based on age of onset
Alzheimer's disease may be classified into early onset and late onset based on age of onset:[6][7][8][9][10]
| Sub-class | Genetics | Prevalence |
|---|---|---|
| Late-onset familial (>60 years, AD2) | 15%-25% of familial cases | |
| Early-onset familial AD (<60 years, AD1, AD3, AD4) |
|
<2% of familial cases |
Classification based on course of disease
Alzheimer's disease may be classified into the following stages based on course of disease:[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][19][27][28][29][30][31][32][33][34][35]
| Stage of Alzheime's disease | Major deficits |
|---|---|
| Predementia |
|
| Early dementia |
|
| Moderate dementia |
|
| Advanced dementia |
References
- ↑ Morris JC (1997). "Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type". Int Psychogeriatr. 9 Suppl 1: 173–6, discussion 177–8. PMID 9447441.
- ↑ Berg L (1988). "Clinical Dementia Rating (CDR)". Psychopharmacol Bull. 24 (4): 637–9. PMID 3249765.
- ↑ O'Bryant SE, Waring SC, Cullum CM, Hall J, Lacritz L, Massman PJ, Lupo PJ, Reisch JS, Doody R (2008). "Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: a Texas Alzheimer's research consortium study". Arch. Neurol. 65 (8): 1091–5. doi:10.1001/archneur.65.8.1091. PMC 3409562. PMID 18695059.
- ↑ Morris JC (1993). "The Clinical Dementia Rating (CDR): current version and scoring rules". Neurology. 43 (11): 2412–4. PMID 8232972.
- ↑ Morris JC, Ernesto C, Schafer K, Coats M, Leon S, Sano M, Thal LJ, Woodbury P (1997). "Clinical dementia rating training and reliability in multicenter studies: the Alzheimer's Disease Cooperative Study experience". Neurology. 48 (6): 1508–10. PMID 9191756.
- ↑ "Alzheimer Disease Overview - GeneReviews® - NCBI Bookshelf".
- ↑ Brickell KL, Steinbart EJ, Rumbaugh M, Payami H, Schellenberg GD, Van Deerlin V, Yuan W, Bird TD (2006). "Early-onset Alzheimer disease in families with late-onset Alzheimer disease: a potential important subtype of familial Alzheimer disease". Arch. Neurol. 63 (9): 1307–11. doi:10.1001/archneur.63.9.1307. PMID 16966510.
- ↑ Campion D, Dumanchin C, Hannequin D, Dubois B, Belliard S, Puel M, Thomas-Anterion C, Michon A, Martin C, Charbonnier F, Raux G, Camuzat A, Penet C, Mesnage V, Martinez M, Clerget-Darpoux F, Brice A, Frebourg T (1999). "Early-onset autosomal dominant Alzheimer disease: prevalence, genetic heterogeneity, and mutation spectrum". Am. J. Hum. Genet. 65 (3): 664–70. doi:10.1086/302553. PMC 1377972. PMID 10441572.
- ↑ Munoz DG, Feldman H (2000). "Causes of Alzheimer's disease". CMAJ. 162 (1): 65–72. PMC 1232234. PMID 11216203.
- ↑ Hölscher C (1998). "Possible causes of Alzheimer's disease: amyloid fragments, free radicals, and calcium homeostasis". Neurobiol. Dis. 5 (3): 129–41. doi:10.1006/nbdi.1998.0193. PMID 9848086.
- ↑ Volicer L, Harper DG, Manning BC, Goldstein R, Satlin A. "Sundowning and circadian rhythms in Alzheimer's disease". Am J Psychiatry. 158 (5): 704–11. PMID 11329390. Retrieved 2008-08-27.
- ↑ Arnáiz E, Almkvist O (2003). "Neuropsychological features of mild cognitive impairment and preclinical Alzheimer's disease". Acta Neurol. Scand., Suppl. 179: 34–41. doi:10.1034/j.1600-0404.107.s179.7.x. PMID 12603249.
|access-date=requires|url=(help) - ↑ Kazui H, Matsuda A, Hirono N; et al. (2005). "Everyday memory impairment of patients with mild cognitive impairment". Dement Geriatr Cogn Disord. 19 (5–6): 331–7. doi:10.1159/000084559. PMID 15785034. Retrieved 2008-06-12.
- ↑ Rapp MA, Reischies FM (2005). "Attention and executive control predict Alzheimer disease in late life: results from the Berlin Aging Study (BASE)". American Journal of Geriatric Psychiatry. 13 (2): 134–141. doi:10.1176/appi.ajgp.13.2.134. PMID 15703322.
- ↑ Spaan PE, Raaijmakers JG, Jonker C (2003). "Alzheimer's disease versus normal ageing: a review of the efficiency of clinical and experimental memory measures". Journal of Clinical Experimental Neuropsychology. 25 (2): 216–233. PMID 12754679.
- ↑ Craig D, Mirakhur A, Hart DJ, McIlroy SP, Passmore AP (2005). "A cross-sectional study of neuropsychiatric symptoms in 435 patients with Alzheimer's disease". American Journal of Geriatric Psychiatry. 13 (6): 460–468. doi:10.1176/appi.ajgp.13.6.460. PMID 15956265.
- ↑ Robert PH, Berr C, Volteau M, Bertogliati C, Benoit M, Sarazin M, Legrain S, Dubois B (2006). "Apathy in patients with mild cognitive impairment and the risk of developing dementia of Alzheimer's disease: a one-year follow-up study". Clin Neurol Neurosurg. 108 (8): 733–736. doi:10.1016/j.clineuro.2006.02.003. PMID 16567037.
- ↑ Palmer K, Berger AK, Monastero R, Winblad B, Bäckman L, Fratiglioni L (2007). "Predictors of progression from mild cognitive impairment to Alzheimer disease". Neurology. 68 (19): 1596–1602. doi:10.1212/01.wnl.0000260968.92345.3f. PMID 17485646.
- ↑ 19.0 19.1 Förstl H, Kurz A (1999). "Clinical features of Alzheimer's disease". European Archives of Psychiatry and Clinical Neuroscience. 249 (6): 288–290. PMID 10653284.
- ↑ Small BJ, Gagnon E, Robinson B. "Early identification of cognitive deficits: preclinical Alzheimer's disease and mild cognitive impairment". Geriatrics. 62 (4): 19–23. PMID 17408315.
- ↑ Petersen RC. "The current status of mild cognitive impairment—what do we tell our patients?". Nat Clin Pract Neurol. 3 (2): 60–1. doi:10.1038/ncpneuro0402. PMID 17279076.
- ↑ Frank EM. "Effect of Alzheimer's disease on communication function". J S C Med Assoc. 90 (9): 417–23. PMID 7967534.
- ↑ Jelicic M, Bonebakker AE, Bonke B (1995). "Implicit memory performance of patients with Alzheimer's disease: a brief review". International Psychogeriatrics. 7 (3): 385–392. doi:10.1017/S1041610295002134. PMID 8821346.
- ↑ Becker JT, Overman AA (2002). "[The semantic memory deficit in Alzheimer's disease]". Rev Neurol (in Spanish; Castilian). 35 (8): 777–83. PMID 12402233.
- ↑ Hodges JR, Patterson K. "Is semantic memory consistently impaired early in the course of Alzheimer's disease? Neuroanatomical and diagnostic implications". Neuropsychologia. 33 (4): 441–59. PMID 7617154.
- ↑ Benke T. "Two forms of apraxia in Alzheimer's disease". Cortex. 29 (4): 715–25. PMID 8124945.
- ↑ Forbes KE, Shanks MF, Venneri A. "The evolution of dysgraphia in Alzheimer's disease". Brain Res. Bull. 63 (1): 19–24. doi:10.1016/j.brainresbull.2003.11.005. PMID 15121235.
- ↑ Galasko D, Schmitt F, Thomas R, Jin S, Bennett D (2005). "Detailed assessment of activities of daily living in moderate to severe Alzheimer's disease". Journal of the International Neuropsychology Society. 11 (4): 446–453. PMID 16209425.
- ↑ Neuropsychiatric symptoms:
- Scarmeas N, Brandt J, Blacker D; et al. "Disruptive behavior as a predictor in Alzheimer disease". Arch. Neurol. 64 (12): 1755–61. doi:10.1001/archneur.64.12.1755. PMID 18071039.
- Tatsch MF, Bottino CM, Azevedo D; et al. "Neuropsychiatric symptoms in Alzheimer disease and cognitively impaired, nondemented elderly from a community-based sample in Brazil: prevalence and relationship with dementia severity". Am J Geriatr Psychiatry. 14 (5): 438–45. doi:10.1097/01.JGP.0000218218.47279.db. PMID 16670248.
- Volicer L, Bass EA, Luther SL. "Agitation and resistiveness to care are two separate behavioral syndromes of dementia". J Am Med Dir Assoc. 8 (8): 527–32. doi:10.1016/j.jamda.2007.05.005. PMID 17931577.
- ↑ Honig LS, Mayeux R. "Natural history of Alzheimer's disease". Aging (Milano). 13 (3): 171–82. PMID 11442300.
- ↑ Gold DP, Reis MF, Markiewicz D, Andres D. "When home caregiving ends: a longitudinal study of outcomes for caregivers of relatives with dementia". J Am Geriatr Soc. 43 (1): 10–6. PMID 7806732.
- ↑ Souren LE, Franssen EH, Reisberg B. "Contractures and loss of function in patients with Alzheimer's disease". J Am Geriatr Soc. 43 (6): 650–5. PMID 7775724.
- ↑ Wada H, Nakajoh K, Satoh-Nakagawa T; et al. "Risk factors of aspiration pneumonia in Alzheimer's disease patients". Gerontology. 47 (5): 271–6. PMID 11490146.
- ↑ Berkhout AM, Cools HJ, van Houwelingen HC. "The relationship between difficulties in feeding oneself and loss of weight in nursing-home patients with dementia". Age Ageing. 27 (5): 637–41. PMID 12675103.
- ↑ Gambassi G, Landi F, Lapane KL, Sgadari A, Mor V, Bernabei R. "Predictors of mortality in patients with Alzheimer's disease living in nursing homes". J. Neurol. Neurosurg. Psychiatr. 67 (1): 59–65. PMC 1736445. PMID 10369823.