A. Alzheimer's disease is characterized by progressive decline and ultimately loss of multiple cognitive functions, including both:

• Memory impairment--impaired ability to learn new information or to recall previously learned information.
  
  
• And at least one of the following:
  Loss of word comprehension ability, for example, inability to respond to "Your daughter is on the phone." (aphasia);
  Loss of ability to perform complex tasks involving muscle coordination, for example, bathing or dressing (apraxia);
  Loss of ability to recognize and use familiar objects, for example, clothing (agnosia);
  Loss of ability to plan, organize, and execute normal activities, for example, going shopping.

B. The problems in "A" represent a substantial decline from previous abilities and cause significant problems in everyday functioning.

C. The problems in "A" begin slowly and gradually become more severe.

D. The problems in "A" are not due to:

• Other conditions that cause progressive cognitive decline, among them: stroke, Parkinson's disease, Huntington's chorea, brain tumor, etc.
  
• Other conditions that cause dementia, among them: hypothyroidism, HIV infection, syphilis, and deficiencies in niacin, vitamin B12, and folic acid.

E. The problems in "A" are not caused by episodes of delirium.

F. The problems in "A" are not caused by another mental illness: depression, schizophrenia, etc.

NINCDS/ADRDA

Adapted from McKhann, G. et al. "Clinical Diagnosis of Alzheimer's Disease: Report of the NINCDS/ADRDA Work Group, Dept. of HHS Task Force on Alzheimer's Disease," Neurology (1984) 34:939.

• Dementia established by clinical examination, and documented by a standard test of cognitive function (e.g. Mini-Mental State Examination, Blessed Dementia Scale, etc.), and confirmed by neuropsychological tests.
  
  
• Significant deficiencies in two or more areas of cognition, for example, word comprehension and task-completion ability.
  
  
• Progressive deterioration of memory and other cognitive functions.
  
  
• No loss of consciousness.
  
  
• Onset from age 40 to 90, typically after 65.
  
  
• No other diseases or disorders that could account for the loss of memory and cognition.

A Diagnosis of Probable Alzheimer's Disease is Supported By:

• Progressive deterioration of specific cognitive functions: language (aphasia), motor skills (apraxia), and perception (agnosia).
  
  
• Impaired activities of daily living and altered patterns of behavior.
  
  
• A family history of similar problems, particularly if confirmed by neurological testing.
  
  
• The following laboratory results:
  
  Normal cerebrospinal fluid (lumbar puncture test).
  
  Normal electroencephalogram (EEG) test of brain activity.
  
  Evidence of cerebral atrophy in a series of CT scans.

Other Features Consistent with Alzheimer's Disease

• Plateaus in the course of illness progression.
  
  
• CT findings normal for the person's age.
  
  
• Associated symptoms, including: depression, insomnia, incontinence, delusions, hallucinations, weight loss, sex problems, and significant verbal, emotional, and physical outbursts.
  
  
• Other neurological abnormalities, especially in advanced disease: including: increased muscle tone and a shuffling gait.

Features That Decrease the Likelihood of Alzheimer's Disease:

• Sudden onset.
  
  
• Such early symptoms as: seizures, gait problems, and loss of vision and coordination.

Criteria for Diagnosis of Probable Alzheimer's Disease:

• Dementia established by clinical examination, and documented by a standard test of cognitive function (e.g. Mini-Mental State Examination, Blessed Dementia Scale, etc.), and confirmed by neuropsychological tests.
  
  
• Significant deficiencies in two or more areas of cognition, for example, word comprehension and task-completion ability.
  
  
• Progressive deterioration of memory and other cognitive functions.
  
  
• No loss of consciousness.
  
  
• Onset from age 40 to 90, typically after 65.
  
  
• No other diseases or disorders that could account for the loss of memory and cognition.

A Diagnosis of Probable Alzheimer's Disease is Supported By:

• Progressive deterioration of specific cognitive functions: language (aphasia), motor skills (apraxia), and perception (agnosia).
  
  
• Impaired activities of daily living and altered patterns of behavior.
  
  
• A family history of similar problems, particularly if confirmed by neurological testing.
  
  
• The following laboratory results:
  
  Normal cerebrospinal fluid (lumbar puncture test).
  
  Normal electroencephalogram (EEG) test of brain activity.
  
  Evidence of cerebral atrophy in a series of CT scans. (atrophy means shrinking so atrophy seen in a CT scan would mean shrinking in the brain)

Other Features Consistent with Alzheimer's Disease

• Plateaus in the course of illness progression.
  
  
• CT findings normal for the person's age.
  
  
• Associated symptoms, including: depression, insomnia, incontinence, delusions, hallucinations, weight loss, sex problems, and significant verbal, emotional, and physical outbursts.
  
  
• Other neurological abnormalities, especially in advanced disease: including: increased muscle tone and a shuffling gait.

Features That Decrease the Likelihood of Alzheimer's Disease:

• Sudden onset.
  
  
• Such early symptoms as: seizures, gait problems, and loss of vision and coordination.

NINCDS/ADRDA

Adapted from McKhann, G. et al. "Clinical Diagnosis of Alzheimer's Disease: Report of the NINCDS/ADRDA Work Group, Dept. of HHS Task Force on Alzheimer's Disease," Neurology (1984) 34:939.

Several sets of criteria have been developed to diagnose Alzheimer's disease. Two sets are the most widely used -- one from the fourth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the other from a joint task force of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association (NINCDS/ADRDA). According to neurologist Robert Friedland, M.D., chief of the laboratory of Neurogeriatrics at Case Western Reserve University School of Medicine in Cleveland, application of these criteria by experienced clinicians diagnoses Alzheimer's disease with about 90 percent accuracy.

DSM-IV
Adapted from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Ed. (DSM-IV), American Psychiatric Association, Washington, D.C., 1994.