Alzheimer's Dementia

143 Pages·2015·5.33 MB·English

Underwriting Neurologic Diseases in
Older Age Applicants
AAIM 124th Annual Meeting
Dave Rengachary, MD
Vice President and Medical Director
October 23, 2015
Outline
2
Alzheimer’s Definitions and Criteria
3
Alzheimer’s Disease Criteria
Why does it matter?
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2011 represents 1st time criteria have undergone major revision since
1984
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Represents major (and controversial) undertaking of Alzheimer’s
Association and National Institutes of Health
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Critical illness definitions often hinge on these criteria
http://www.alz.org/documents_custom/alz_diag_criteria_faq.pdf1
4
Alzheimer’s Criteria
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What are the major differences?
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Previous criteria were entirely clinical. Updated
criteria now emphasize consideration of Biomarkers
(not necessary to make diagnosis but provide
adjunctive support)
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Identifies 3 stages of cognitive dysfunction 1)
Preclinical Alzheimer’s disease 2) MCI due
Alzheimer’s Dementia 3). Dementia due to
Alzheimer’s Disease
5
Alzheimer’s Dementia
Core Clinical Criteria (All Causes)2
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Interfere with the ability to function at work or at usual activities
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Represent a decline from previous levels of functioning
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Are not explained by delirium or major psychiatric disorder
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Cognitive impairment is diagnosed through a combination of (1)
history-taking and (2) an objective cognitive assessment
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The cognitive or behavioral impairment involves a minimum of two of
the following domains:
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Impaired ability to acquire and remember new information
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Impaired reasoning and handling of complex tasks, poor judgment
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Impaired visuospatial abilities
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Impaired language functions
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Changes in personality or behavior, or comportment
6
Alzheimer’s Criteria
Probable Alzheimer’s Disease
Core Clinical Criteria
Carrier of Causative Genetic Mutation
With Evidence of AD pathophysiologic process
7
Mild Cognitive Impairment Criteria
Cognitive
Objective
concerns or
cognitive deficits
complaints
Absence of other
psychiatric or
systemic Preservation of
disorder that activities of Daily
would explain Living
the cognitive
deficit
8
Lawton Instrumental Activities of Daily Living
3
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Telephone
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Shopping
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Cooking
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Housekeeping
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Laundry
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Transportation
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Medication Administration
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Finances
9
Preclinical Alzheimer's Dementia
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Positive Biomarkers (amyloid imaging,
PET, functional MRI, and CSF
studies) but *largely asymptomatic
patients
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