Alzheimer dementia
Diagnostics
Clinical criteria for Alzheimer’s dementia 41 1) Probable Alzheimer’s disease dementia (core clinical criteria)
- a. Insidious onset over months to years
- b. Clear-cut history of worsening cognition by report or observation
- c. Initial and most prominent cognitive deficits on history and examination are one of the following:
- i. Amnestic presentation: impairment in learning and recall
- ii. Non-amnestic presentation
- 1. Language presentation: word-finding difficulties, deficits in other domains should be present
- 2. Visuospatial presentation: spatial cognition-object agnosia, facial recognition, simultagnosia, and alexia, deficits in other domains should be present
- 3. Executive dysfunction: impaired reasoning, judgment and problem solving, deficits in other domains should be present
- d. There is no evidence of
- i. Stroke temporally related to the onset of cognitive symptoms or presence of extensive infarcts or severe white matter hyperintensity burden
- ii. Core features of DLB other than dementia itself
- iii. Prominent features of bvFTD
- iv. Prominent features of semantic or non-fluent / agrammatic PPA
- v. Other active neurological disease, medical comorbidity, or use of medications with effects on cognition
2) Probable AD dementia with documented decline: core clinical criteria + evidence of decline on subsequent evaluation based on informants, formal neuropsychological evaluation, or standardized mental status examinations
3) Probable AD dementia in a carrier of a causative AD genetic mutation: core clinical criteria + presence of APP, PSEN1, or PSEN2 mutations
4) Probable AD dementia with evidence of AD pathophysiological process meets core clinical criteria + biomarker data
a. High probability: amyloid PET or CSF + positive CSF tau, FDG-PET, or structural MRI
b. Intermediate probability:
i. unavailable, conflicting, or indeterminate amyloid PET or CSF + positive CSF tau, FDG-PET, or structural MRI
ii. positive amyloid PET or CSF + unavailable, conflicting, or indeterminate CSF tau, FDG-PET, or structural MRI
c. Uninformative: unavailable, conflicting, or indeterminate amyloid PET or CSF + unavailable, conflicting, or indeterminate CSF tau, FDG-PET, or structural MRI
5) Possible AD:
a. Atypical: meets core clinical criteria for AD but either has a sudden onset or demonstrates insufficient historical detail or objective cognitive documentation or progressive decline
b. Etiologically mixed presentation meets criteria for AD but has evidence of
i. Stroke
ii. Features of DLB other than dementia
iii. Evidence of another neurological disease or medical condition with effects on cognition
6) Possible AD dementia with evidence of AD pathophysiological process: atypical clinical presentation plus the following biomarker data:
a. High probability: positive amyloid PET or CSF + positive CSF tau, FDG-PET, or structural MRI
b. Intermediate probability
c. Uninformative: unavailable, conflicting, or indeterminate amyloid PET or CSF + unavailable, conflicting, or indeterminate CSF tau, FDG-PET, or structural MRI
Amnestic (most typical) variant
Visual variant (posterior cortical atrophy)
Logopenic variant primary progressive aphasia
Executive variant or frontal AD
