TN 96 (04-26)

DI 23022.385 Young-Onset Alzheimer's Disease

COMPASSIONATE ALLOWANCES INFORMATION

YOUNG-ONSET ALZHEIMER’S DISEASE

ALTERNATE NAMES

AD; Early-onset Alzheimer's Disease; EOAD; FAD; Familial AD; Presenile Dementia; Presenile Alzheimer’s Disease

DESCRIPTION

Young-onset Alzheimer’s disease (YOAD) is the diagnosis of Alzheimer's disease (AD) for an individual younger than age 65, and accounts for approximately 5-10% of all AD cases. AD is a degenerative, irreversible brain disease that usually affects older individuals and causes a type of dementia characterized by the gradual loss of cognitive abilities, such as memory, language, judgment, and the ability to function.

YOAD is also known as familial AD (FAD) when associated with three specific genes: presenilin 1, presenilin 2, and amyloid precursor protein, which cause less than 5% of AD.

Hallmark changes in the brain include the development of beta-amyloid plaques and neurofibrillary tangles (NFT), also known as tau tangles, which interrupt normal brain activity and contribute to the eventual deterioration and death of brain cells.

The onset of YOAD is subtle; memory impairment is frequently its earliest manifestation, quickly followed by learning and language impairments.

Because individuals with YOAD often are employed, it is not uncommon for the disease to first manifest as a decline or loss in their ability to perform work-related activities. YOAD affects each individual differently and symptoms will vary. However, problems with memory, problem-solving, and depression are common complaints in the early stages of YOAD. In later stages, agitation, changes in personality and behavior, restlessness, and withdrawal become evident.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: There is no single test used to diagnose YOAD. The diagnosis is made using the individual's medical history and other diagnostic tools, including:

  • History of onset and description of cognitive and functional impairments at home and at work;

  • Results of neurological examinations;

  • Cognitive and functional assessments including, but not limited to mini-mental status examination (MMSE), best if recorded over time to document any decline;

  • Genetic testing;

  • Neuroimaging such as magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET) scans to observe changes in the brain and exclude other causes of dementia;

  • Cerebrospinal fluid (CSF) analysis; or

  • Blood testing to detect the presence of amyloid plaques.

Physical findings: The non-memory impairment symptoms of YOAD are variable and may include:

  • Balance and coordination problems;

  • Difficulty with fine motor skills; and

  • Difficulty walking, speaking, or swallowing.

ICD-9: 290.0; 290.1; 290.10; 290.11; 290.12; 290.13; 294.1; 331.0

ICD-10: G30.0; G30.8; G30.9

PROGRESSION

Individuals with YOAD experience gradual cognitive decline until death. As the condition progresses, brain cells die and connections among cells are lost, causing cognitive symptoms to worsen. An individual’s quality of life may also be impacted by a variety of behavioral and psychological symptoms that accompany dementia, such as sleep disturbances, agitation, hallucinations, and delusions. Death usually results from pneumonia, malnutrition, or general body wasting. The average time of survival after diagnosis of YOAD varies but generally is 8-10 years, and many individuals with YOAD require long-term care in a medical facility or in-home care from caregivers.

TREATMENT

There is no cure for YOAD. The current modalities for treatment for this condition may include cholinesterase inhibitors, N-methyl D-aspartate (NMDA) receptor antagonist (memantine), combination therapy, and supportive therapies.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

  • Clinical information documenting a progressive dementia is critical and required for disability evaluation of YOAD. Clinical records from the individual's medical source(s) are the preferable source of this information;

  • Activities of daily living report or a similar report completed by relative or caregiver; and

  • Results of cognitive and functional assessments.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets

11.17 B

 

12.02

 

Equals

 

 

* 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.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022385
DI 23022.385 - Young-Onset Alzheimer's Disease - 04/23/2026
Batch run: 04/23/2026
Rev:04/23/2026