Current RMA Instruments

Changes from previous Instruments

SOP Bulletin 177

ICD Coding

• ICD-9-CM Codes: 290.12, 290.4
• ICD-10-AM Codes: F01

Brief description

Vascular dementia is significant cognitive impairment caused by cerebrovascular disease or impaired cerberal blood flow.  It is the second most common form of dementia, after Alzheimer disease. 

Confirming the diagnosis

This diagnosis is complex and other causes of dementia need to be evaluated.  The diagnosis requires the presence of dementia, the presence of cerberovascular diease (by history of stroke or by neuroimaging (CT or MRI)) and a judgement that the cerberovascular diease is the cause of the cognitive impairment.  Neuropsychological testing may also be required.

The appropriate medical specialist is a neurologist.  

Additional diagnoses covered by the SOP

• Acquired diffuse white matter disease (Binswanger's disease)
• Major vascular cognitive disorder
• Multi-infarct dementia
• Strategic infarct dementia
• Subcortical vascular dementia

Conditions not covered by SOP

• Alzheimer disease*
• Dementia pugilistica*
• Inherited diffuse white matter disease^#
• Lewy body disease*
• Mild neurocognitive disorder due to vascular disease (without dementia)^#

* another SOP applies

^# non-SOP condition

Clinical onset

Clinical onset may become evident following a stroke, with a post stroke decline in cognitive function.  There can also be progressive decline without a clinically apparent stroke.  In either case clinical onset will be based on a clinical assessment of when congitive impairment first became significant.

Clinical worsening

Progressive or stepwise decline in function and hastened mortality are the normal course for this condition, with an average survival time of around 5 years after onset.  Clinical worsening due to service is a very unlikely scenario for this condition given its typical age of onset (> 65 yrs) and the need for the condition to have manifest before the end of service for clinical worsening to be a consideration.