Dementia is defined as a significant deterioration of
cognitive function sufficient to interfere in social or occupational
functioning.
As defined by the Diagnostic and Statistical
Manual of Mental Disorders, 4th edition, this requires a deterioration in
memory and at least one other area of intellectual functioning. Moreover, the
cognitive changes are not attributable to the presence of delirium or
substance-induced intoxication or withdrawal.
Definite Alcohol-Related Dementia
At the current time, there are no acceptable
criteria to define definitively alcohol-related dementia.
Probable Alcohol-Related Dementia
I. The criteria for the clinical diagnosis of
probable alcohol-related dementia include the following:
a. A clinical diagnosis of dementia at least 60
days after the last exposure to alcohol.
b. Significant alcohol use as defined by a minimum
average of 35 standard drinks per week for men and 28 for women for a period
greater than 5 years. The period of significant alcohol use must occur within 3
years of the initial onset of dementia.
II. The diagnosis of alcohol-related dementia is
supported by the presence of any of the following:
a. Alcohol-related hepatic, pancreatic,
gastrointestinal, cardiovascular, or renal disease, i.e., other end-organ
damage.
b. Ataxia or peripheral sensory polyneuropathy (not
attributable to other specific causes).
c. Beyond 60 days of abstinence, the cognitive
impairment stabilizes or improves.
d. After 60 days of abstinence, any neuroimaging
evidence of ventricular or sulcal dilatation improves.
e. Neuroimaging evidence of cerebellar atrophy,
especially of the vermis.
III. The following clinical features cast doubt on
the diagnosis of alcohol-related dementia:
a. The presence of language impairment, especially
dysnomia or anomia.
b. The presence of focal neurological signs or
symptoms (except ataxia or peripheral sensory polyneuropathy).
c. Neuroimaging evidence for cortical or
subcortical infarction, subdural hematoma, or other focal brain pathology.
d. Elevated Hachinski Ischemia Scale score.
IV. Clinical features that are neither supportive
nor cast doubt on the diagnosis of alcohol-related dementia include the
following:
a. Neuroimaging evidence of cortical atrophy.
b. The presence of periventricular or deep white
matter lesions on neuroimaging in the absence of focal infarct(s).
c. The presence of the ApolipoproteinE ε4 allele.
V. The diagnosis of possible alcohol-related
dementia may be made when there are
a. A clinical diagnosis of dementia at least 60
days after the last exposure to alcohol; and
b. Either:
1. Significant alcohol use, as defined by a
minimum average of 35 standard drinks per week for men and 28 for women for 5
or more years; however, the period of significant alcohol use occurred more than
3 years but less than 10 years before the initial onset of cognitive deficits;
or
2. Possibly significant alcohol use, as
defined by a minimum average of 21 standard drinks per week for men and 14 for
women but no more than 34 drinks per week for men and 27 for women for 5 years.
The period of significant alcohol use must have occurred within 3 years of the
onset of cognitive deficits.
No comments:
Post a Comment