Alzheimer's disease classification

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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
  • 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

References

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  2. Berg L (1988). "Clinical Dementia Rating (CDR)". Psychopharmacol Bull. 24 (4): 637–9. PMID 3249765. 
  3. 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. PMC 3409562Freely accessible. PMID 18695059. doi:10.1001/archneur.65.8.1091. 
  4. Morris JC (1993). "The Clinical Dementia Rating (CDR): current version and scoring rules". Neurology. 43 (11): 2412–4. PMID 8232972. 
  5. 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. 
  6. "Alzheimer Disease Overview - GeneReviews® - NCBI Bookshelf". 
  7. 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. PMID 16966510. doi:10.1001/archneur.63.9.1307. 
  8. 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. PMC 1377972Freely accessible. PMID 10441572. doi:10.1086/302553. 
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  12. Arnáiz E, Almkvist O (2003). "Neuropsychological features of mild cognitive impairment and preclinical Alzheimer's disease". Acta Neurol. Scand., Suppl. 179: 34–41. PMID 12603249. doi:10.1034/j.1600-0404.107.s179.7.x. 
  13. 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. PMID 15785034. doi:10.1159/000084559. Retrieved 2008-06-12. 
  14. 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. PMID 15703322. doi:10.1176/appi.ajgp.13.2.134. 
  15. 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. 
  16. 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. PMID 15956265. doi:10.1176/appi.ajgp.13.6.460. 
  17. 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. PMID 16567037. doi:10.1016/j.clineuro.2006.02.003. 
  18. 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. PMID 17485646. doi:10.1212/01.wnl.0000260968.92345.3f. 
  19. 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. 
  20. 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. 
  21. Petersen RC. "The current status of mild cognitive impairment—what do we tell our patients?". Nat Clin Pract Neurol. 3 (2): 60–1. PMID 17279076. doi:10.1038/ncpneuro0402. 
  22. Frank EM. "Effect of Alzheimer's disease on communication function". J S C Med Assoc. 90 (9): 417–23. PMID 7967534. 
  23. 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. PMID 8821346. doi:10.1017/S1041610295002134. 
  24. Becker JT, Overman AA (2002). "[The semantic memory deficit in Alzheimer's disease]". Rev Neurol (in Spanish; Castilian). 35 (8): 777–83. PMID 12402233. 
  25. 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. 
  26. Benke T. "Two forms of apraxia in Alzheimer's disease". Cortex. 29 (4): 715–25. PMID 8124945. 
  27. Forbes KE, Shanks MF, Venneri A. "The evolution of dysgraphia in Alzheimer's disease". Brain Res. Bull. 63 (1): 19–24. PMID 15121235. doi:10.1016/j.brainresbull.2003.11.005. 
  28. 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. 
  29. Neuropsychiatric symptoms:
    • Scarmeas N, Brandt J, Blacker D; et al. "Disruptive behavior as a predictor in Alzheimer disease". Arch. Neurol. 64 (12): 1755–61. PMID 18071039. doi:10.1001/archneur.64.12.1755. 
    • 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. PMID 16670248. doi:10.1097/01.JGP.0000218218.47279.db. 
    • 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. PMID 17931577. doi:10.1016/j.jamda.2007.05.005. 
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  31. 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. 
  32. 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. 
  33. 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. 
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  35. 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 1736445Freely accessible. PMID 10369823. 

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