Current RMA Instruments
| Reasonable Hypothesis SOP | 33 of 2019 |
| Balance of Probabilities SOP | 34 of 2019 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 331.0
- ICD-10-AM Codes: G30
Brief description
The SOP covers both dementia (major neurocognitive disorder) and also mild neurocognitive disorder from Alzheimer disease. Alzheimer disease is the commonest form of dementia, and affects approximately 1 in 9 people aged over 65. The condition is unlikely to be present before age 60.
Confirming the diagnosis
The diagnosis is made clinically, based on history and examination, including cognitive testing. Neuroimaging and other testing may be performed. Such tests are not diagnostic but can rule out other causes or support an Alzheimer diagnosis. Characteristic features of Alzheimer disease include memory impairment, particularly for recent events, decline in executive function, decline in judgment/problem solving, and visuospatial impairment.
The condition can be difficult to diagnose clinically and to distinguish from vascular dementia, dementia with Lewy bodies or other neurodegenerative dementias. The diagnosis can also be confirmed pathologically, at autopsy.
The relevant medical specialist is a neurologist or geriatrician.
Additional diagnoses covered by these SOPs
- Alzheimer’s disease
- Alzheimer's dementia
Conditions not covered by these SOPs
- Dementia with Lewy bodies* - neurocognitive disorder with Lewy bodies SOP
- Frontotemporal dementia#
- Multi-infarct dementia* (vascular dementia SOP)
- Preclinical Alzheimer disease (asymptomatic, cognitively normal) - not a disease or injury
- Vascular dementia*
- Any other identifiable cause of dementia, ICD code as appropriate
* another SOP applies
# non-SOP condition
Clinical onset
Clinical onset will be when symptoms and findings on clinical examination were first sufficent to allow an appropriate medical practitioner to say the condition was present. Onset is typically after age 65.
Clinical worsening
Alzheimer dementia inevitably progresses in all patients. Mild congnitive imapirment does not always progress. For both forms, there is no treatment available that modifies the course of the condition.