Alzheimer's disease classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]; 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, questionable, mild, moderate and severe in the following chart:

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 relationships; oriented for place at examination; may have geographic disorientation elsewhere 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, determining similarities and differences; 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 function independently at these activities, although may still be engaged in some; appears normal to casual inspection 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 at home; 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 prompting 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:

Sub-class Genetics Prevalence
Late-onset familial (AD2)
  • APOE gene:
    • Locus: AD2
    • Protein: Apolipoprotein E
  • TREM2 gene:
    • Variant: p.Arg47His allelic variant
  • PLD3 gene
  • UNC5C gene
  • AKAP9 gene:
    • In African-Americans only
 15%-25% of familial cases
Early-onset familial AD (AD1, AD3, AD4)
  • PSEN1 gene:
    • Locus: AD3
    • Proportion: 20-70 % of early onset AD cases
    • Protein: Presenilin-1
  • PSEN2 gene:
    • Locus: AD4
    • Proportion: Rare
    • Protein: Presenilin-2
  • APP gene:
    • Locus: AD1
    • Proportion: 10-15 % of early onset AD cases
    • Protein: Amyloid precursor protein (APP)
 <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:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][9][17][18][19][20][21][22][23][24][25]

Stage of Alzheime's disease Major deficits
Predementia
Early dementia
Moderate dementia
  • Speech disturbance (paraphasia)
  • Reading and writing skills affected
  • Long-term memory, which was previously intact, becomes impaired
  • Common neuropsychiatric manifestations include:
    • Wandering
    • Sundowning (the onset of confusion and agitation each day around sundown)
    • Irritability
    • Labile affect, which can lead to crying, outbursts of unpremeditated aggression, or resistance to caregiving
    • 30% of patients also develop illusionary misidentifications and other delusional symptoms
    • Urinary incontinence
Advanced dementia
  • Language is reduced to simple phrases or even single words, eventually leading to complete loss of speech
  • Extreme apathy
  • Exhaustion
  • Completely dependent on caregivers for daily tasks
  • Decreased muscle mass, eventually becomes bedridden
In 1994 United States ex-president R. Reagan informed the country of his AD diagnosis via a hand-written letter.

References

  1. ↑ Volicer L, Harper DG, Manning BC, Goldstein R, Satlin A (2001). "Sundowning and circadian rhythms in Alzheimer's disease". Am J Psychiatry. 158 (5): 704–11. PMID 11329390. Retrieved 2008-08-27. Unknown parameter |month= ignored (help)
  2. ↑ 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)
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.
  8. ↑ 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.
  9. ↑ 9.0 9.1 Förstl H, Kurz A (1999). "Clinical features of Alzheimer's disease". European Archives of Psychiatry and Clinical Neuroscience. 249 (6): 288–290. PMID 10653284.
  10. ↑ Small BJ, Gagnon E, Robinson B (2007). "Early identification of cognitive deficits: preclinical Alzheimer's disease and mild cognitive impairment". Geriatrics. 62 (4): 19–23. PMID 17408315. Unknown parameter |month= ignored (help)
  11. ↑ Petersen RC (2007). "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. Unknown parameter |month= ignored (help)
  12. ↑ Frank EM (1994). "Effect of Alzheimer's disease on communication function". J S C Med Assoc. 90 (9): 417–23. PMID 7967534. Unknown parameter |month= ignored (help)
  13. ↑ 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.
  14. ↑ Becker JT, Overman AA (2002). "[The semantic memory deficit in Alzheimer's disease]". Rev Neurol (in Spanish; Castilian). 35 (8): 777–83. PMID 12402233.
  15. ↑ Hodges JR, Patterson K (1995). "Is semantic memory consistently impaired early in the course of Alzheimer's disease? Neuroanatomical and diagnostic implications". Neuropsychologia. 33 (4): 441–59. PMID 7617154. Unknown parameter |month= ignored (help)
  16. ↑ Benke T (1993). "Two forms of apraxia in Alzheimer's disease". Cortex. 29 (4): 715–25. PMID 8124945. Unknown parameter |month= ignored (help)
  17. ↑ Forbes KE, Shanks MF, Venneri A (2004). "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. Unknown parameter |month= ignored (help)
  18. ↑ 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.
  19. ↑ Neuropsychiatric symptoms:
    • Scarmeas N, Brandt J, Blacker D; et al. (2007). "Disruptive behavior as a predictor in Alzheimer disease". Arch. Neurol. 64 (12): 1755–61. doi:10.1001/archneur.64.12.1755. PMID 18071039. Unknown parameter |month= ignored (help)
    • Tatsch MF, Bottino CM, Azevedo D; et al. (2006). "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. Unknown parameter |month= ignored (help)
    • Volicer L, Bass EA, Luther SL (2007). "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. Unknown parameter |month= ignored (help)
  20. ↑ Honig LS, Mayeux R (2001). "Natural history of Alzheimer's disease". Aging (Milano). 13 (3): 171–82. PMID 11442300. Unknown parameter |month= ignored (help)
  21. ↑ Gold DP, Reis MF, Markiewicz D, Andres D (1995). "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. Unknown parameter |month= ignored (help)
  22. ↑ Souren LE, Franssen EH, Reisberg B (1995). "Contractures and loss of function in patients with Alzheimer's disease". J Am Geriatr Soc. 43 (6): 650–5. PMID 7775724. Unknown parameter |month= ignored (help)
  23. ↑ Wada H, Nakajoh K, Satoh-Nakagawa T; et al. (2001). "Risk factors of aspiration pneumonia in Alzheimer's disease patients". Gerontology. 47 (5): 271–6. PMID 11490146.
  24. ↑ Berkhout AM, Cools HJ, van Houwelingen HC (1998). "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. Unknown parameter |month= ignored (help)
  25. ↑ Gambassi G, Landi F, Lapane KL, Sgadari A, Mor V, Bernabei R (1999). "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. Unknown parameter |month= ignored (help)

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