The following proposal was approved by the DSM Steering Committee and is being posted for a 45-day public comment period.
Comment Period Opens: October 2, 2023
Comment Period Closes: November 17, 2023
Correction to the Criteria for Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease
Description of Proposed Change:
The DSM Steering Committee is recommending removal of criterion C.2.c in the Major Neurocognitive Disorder component of the criteria set for Major or Mild Neurocognitive Disorder due to Alzheimer’s disease and criterion C.3 in the Mild Neurocognitive Disorder component of the criteria set for Major or Mild Neurocognitive Disorder due to Alzheimer’s disease. The change is intended to correct an inconsistency in the current criteria set that would not allow for cases of Neurocognitive Disorder due to multiple etiologies in which Alzheimer’s disease is one of the etiologies.
Background to the Proposal:
When a Neurocognitive Disorder is believed to be due to more than one etiology, the DSM coding note instructs clinicians to code each of the etiologies separately, with the medical etiologies listed first and then the ICD-10-CM codes for the Neurocognitive Disorders themselves listed next. The following example can illustrate how this works:
“For example, for a presentation of Major Neurocognitive Disorder, moderate, with psychotic disturbance that is judged to be due to Alzheimer’s disease, cerebrovascular disease, and HIV infection, and in which heavy chronic alcohol use is judged to be a contributing factor, code the following: G30.9 Alzheimer’s disease; B20 HIV infection; F02.B2 Major Neurocognitive Disorder due to Alzheimer’s disease and HIV infection, with psychotic disturbance; F01.B2 Major Neurocognitive Disorder probably due to vascular disease, moderate, with psychotic disturbance; and F10.27 alcohol-induced Major Neurocognitive Disorder, non-amnestic-confabulatory type, with moderate alcohol use disorder.”DSM-5-TR, page 731.
However, the current DSM-5-TR criteria for Major Neurocognitive Disorder due to Alzheimer’s disease would not allow for cases of Major Neurocognitive Disorder due to multiple etiologies (as in the example above) in which Alzheimer’s disease is one of the etiologies since criterion C.2.c (in the Major Neurocognitive Disorder component of the criteria set for Major or Mild Neurocognitive Disorder due to Alzheimer’s disease) excludes other etiologies. A parallel problem exists for Mild Neurocognitive Disorder due to Alzheimer’s disease. The problematic criteria currently read as follows:
Major Neurocognitive Disorder criterion C.2.c/Mild Neurocognitive Disorder criterion C.3: No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological or systemic disease or condition likely contributing to cognitive decline).
To correct this inconsistency, both criterion C 2.c.in Major Neurocognitive Disorder due to Alzheimer’s disease and criterion C.3 in Mild Neurocognitive Disorder due to Alzheimer’s disease should be removed.
The proposed change was approved by the DSM Steering Committee, Council on Geriatric Psychiatry, and the Serious Mental Illnesses Review Committee. And is currently posted for public comments.
The DSM Steering Committee recommends the following proposed modifications:
Major or Mild Neurocognitive Disorder due Alzheimer’s Disease Diagnostic Criteria
- There is insidious onset and gradual progression of impairment in one or more cognitive domains (for major neurocognitive disorder, at least two domains must be impaired).
- Criteria are met for either probable or possible Alzheimer’s disease as follows:
For major neurocognitive disorder:
Probable Alzheimer’s disease is diagnosed if either of the following is present; otherwise, possible Alzheimer’s disease should be diagnosed.
- Evidence of a causative Alzheimer’s disease genetic mutation from family history or genetic testing.
- All three of Both of the following are present:
- Clear evidence of decline in memory and learning and at least one other cognitive domain (based on detailed history or serial neuropsychological testing).
- Steadily progressive, gradual decline in cognition, without extended plateaus.
- No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline).
For mild neurocognitive disorder:
Probable Alzheimer’s disease is diagnosed if there is evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history.
Possible Alzheimer’s disease is diagnosed if there is no evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history, and the both of following are present:
- Clear evidence of decline in memory and learning.
- Steadily progressive decline in cognition, without extended plateaus.
- No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological or systemic disease or condition likely contributing to cognitive decline).
- The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.