| EARLY-ONSET
ALZHEIMER’S DISEASE |
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ALTERNATE NAMES
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Presenile dementia; Presenile Alzheimer’s disease; Young-onset Alzheimer’s disease;
Familial AD; FAD; AD; EOAD
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DESCRIPTION
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Early-onset Alzheimer’s Disease (AD) is the diagnosis of AD for a person younger than age 65, and accounts for approximately
5 to 10 percent of all cases of AD. AD is a degenerative, irreversible brain disease
that usually affects older people and causes a dementia characterized by the gradual
loss of cognitive abilities, such as memory, language, judgment, and the ability to
function.
Physiological changes in the brain include the rampant growth of two abnormal structures,
amyloid plaques and neurofibrillary tangles, which interrupt normal brain activity.
The onset of AD is subtle; memory impairment is frequently its earliest manifestation,
quickly followed by learning and language impairments. Because people with early-onset
AD are often in the work force, it is not uncommon for the disease to first manifest
as a decline or loss in their ability to perform work-related activities. In the earlier
stages of AD, depression is a common complaint. In later stages, agitation, changes
in personality and behavior, restlessness, and withdrawal become evident.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing:
There is no specific clinical or laboratory diagnostic test for AD. Diagnosis can
only be confirmed by brain biopsy or postmortem examination of the brain. The diagnosis
of early-onset AD is based on the combination of clinical and family history; neurological,
cognitive, or neuropsychological examination; and neuroimaging.
Pertinent clinical information includes history of onset and description of cognitive
and functional impairments at home and at work. A decline in Mini-Mental Status Examination
(MMSE) scores over time is a likely indicator of possible dementia. Neuroimaging,
such as computerized tomography (CT) or magnetic resonance imaging (MRI) is useful
for observing changes in the brain and excluding other causes of dementia.
ICD-9: 290.0, 290.1, 290.10, 290.11, 290.12, 290.13, 294.1 and 331.0
ICD-10: G30.0, G30.8, G30.9
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PROGRESSION
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People diagnosed with early-onset AD experience gradual cognitive decline until death.
Death usually results from pneumonia, malnutrition, or general body wasting. The average
time of survival after diagnosis of early-onset AD varies but generally is 8 to 10
years, and many people with early-onset AD require institutionalization.
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TREATMENT
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There is no treatment to cure or slow the progression of early-onset AD. Treatment
for the symptoms of early-onset AD may include drugs such as cholinesterase inhibitors
(galantamine, rivastigmine, or donepezil) and an N-methyl D-aspartate (NMDA) antagonist
(memantine).
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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Clinical information documenting a progressive dementia is critical and required for disability evaluation of early-onset AD. The preferable source of this information
is the clinical records from the claimant’s medical source(s).
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Activities of daily living report or a similar report completed by relative or caregiver.
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Documentation of dementia by standardized testing such as the Clinical Dementia Rating
(CDR) scale with a score of = 1, MMSE with a score of = 24, or equivalent test is
helpful but not required.
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Suggested Listings for Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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| Meets |
11.17
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12.02
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| Equals |
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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