MIXED
DEMENTIAS |
ALTERNATE NAMES
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Dementia due to multiple etiologies; Vascular dementia Alzheimer’s disease (VaD)
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DESCRIPTION
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Mixed Dementias are conditions with more than one etiology for the dementia. The combination of Vascular
dementia and Alzheimer’s disease (VaD) is the most common form.
The vascular component is characterized by focal ischemic infarcts (strokes) and subcortical
ischemic vascular disease, and may cause substantial focal neurological deficits such
as aphasia, apraxia, or agnosia; as well as motor manifestations such as paralysis,
gait impairment, or Parkinsonian syndrome.
The Alzheimer’s component is characterized by a progressive decline of memory and
other cognitive abilities relative to a previous level of functioning. Mixed dementias
are characterized by progressive and persistent intellectual decline compromising
at least two spheres of cognition (i.e. memory, language, orientation, attention,executive
abilities, etc). These individuals may also have motor and gait impairment, affective
disturbances, sleep disturbances, and incontinence.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM CODING |
Diagnostic testing: The diagnoses of mixed dementias are based on a clinical history of cognitive decline,
neurologic and cognitive/neuropsychologic examination, and neuroimaging. Pertinent
clinical information includes history of onset and description of cognitive and functional
impairments at home and at work. History of a previous stroke(s) adds to the likelihood
of the diagnosis, but is not required.
There is no specific clinical or laboratory test for the diagnosis of Alzheimer’s
disease. Diagnosis can only be confirmed by brain biopsy or postmortem examination
of the brain. Neuroimaging, i.e. computerized tomography (CT) or magnetic resonance
imaging (MRI) is useful to demonstrate vascular lesions such as infarcts and lacunes,
and to exclude other causes of dementia, some of which may be treatable.
ICD-9: 290.4
ICD-10: F03.90, F03.91
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PROGRESSION
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Individuals diagnosed with mixed dementias experience a gradual but relentless decline
in cognitive functioning over a period of many years, usually about a decade. The
vascular component of the disease may be marked by episodes of abrupt deterioration
or shortening of the course of the disease.
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TREATMENT
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There is no treatment to cure or slow the progression of the Alzheimer’s component
of mixed dementia. Treatment is symptomatic and may include drugs that increase cholinergic
transmission, antioxidants, glutamate receptor blockers, antipsychotics or neuroleptics,
sedatives, and antidepressant and anxiolytic agents. Management of high blood pressure
and other risk factors for cerebrovacular disease appears as a more effective approach
to prevent brain infarcts and mixed dementias.
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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 mixed dementias. The preferable sources of this information
are the clinical records from the claimant’s medical source(s);
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Documentation of dementia by standardized testing: Clinical Dementia Rating (CDR)
scale with a score of =1, Mini-Mental State Examination (MMSE) with a score of = 20,
or equivalent test is helpful but not required;
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Activities of daily living report completed by relative or caretaker;
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Work activity or performance report completed by supervisor or co-worker; and
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Neuroimaging studies, i.e., computerized tomography (CT) scan or magnetic resonance
imaging (MRI) demonstrating brain infarcts, lacunae, or atrophy constitute helpful
supportive evidence, but are not required.
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Suggested Listings for
Evaluation: |
DETERMINATION
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LISTING
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REMARKS
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Meets |
12.02 |
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Equals |
12.02
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11.04
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11.06
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11.17
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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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