Major or Mild Neurocognitive Disorder Due to Alzheimers Disease DSM-5 331.0 (G30.9)

Major or Mild Neurocognitive Disorder Due to Alzheimers Disease DSM-5 331.0 (G30.9)

DSM-5 Category: Neurocognitive Disorders


Major or Mild Neurocognitive Disorder due to AD (Alzheimer’s Disease) also commonly referred to as Alzheimer's Dementia, is a DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), diagnosis assigned to individuals who are experiencing cognitive deficits directly related to the onset and progression of Alzheimer's Dementia. Alzheimer's Dementia is neurological disorder in which an individual experiences progressive cognitive dysfunction, due to the incursion of beta amyloid plaques and neurofibrillary tangles in cholinergic neurons. The acetylcholine production of the effected neurons decreases, which is clinically manifested as progressive memory loss, and associated behavioral symptoms.

Symptoms of Alzheimer's Disease

According to the DSM-5, there are three Criterion for Alzheimer's Disease:

A. The diagnostic criteria for major or minor neurocognitive disorder is fulfilled,

B. Insidious onset and gradual decline of cognitive function in one or more areas for mild neurocognitive disorder, or two or more areas for major neurocognitive disorder, and

C. The diagnostic criteria for either possible or probable Alzheimer's Dementia are fulfilled, as defined by the following:

Presence of causal Alzheimer's Dementia genetic mutation based on family history or genetic testing.

The following three indicators are present:

1. Decline in memory or learning, and one other cognitive area, based on history or trials of neuropsychological testing

2. Steady cognitive decline, without periods of stability, and

3. No indicators of other psychological, neurological, or medical problems responsible for cognitive decline.

There are further specifiers for mild neurocognitive disorder: Probable Alzheimer's Dementia if symptom 1 is present, and possible if symptom 1 is absent, but symptoms 1, 2, and 3 are present, and the cognitive dysfunction cannot be attributed to another medical, neurological, or mental disease process, or the use of prescribed or illicit substances (American Psychiatric Association, 2013).


The DSM-5 notes that early onset of Alzheimer's Disease can occur in the fifties and sixties, with onset of symptoms in the eighties and nineties (American Psychiatric Association, 2013).


According to the DSM-5, the prevalence of Alzheimer's Disease is 5-10% in persons in their seventies, and 25% for those age 80 and over (American Psychiatric Association, 2013).

Risk Factors and Risk markers

The DSM-5 indicates that risk factors for Alzheimer's Disease are TBI (Traumatic Brain Injury) and old age (American Psychiatric Association, 2013). A correlation has been found between size of living space and incidence of Alzheimer's Disease. In an eight year longitudinal study of n=1300 elderly people with no indicators of dementia, subjects who did not venture outside their immediate home were two times more likely to have Alzheimer's Disease (Graber, 2011). Speculation as to causality would be the role of neuroplastic adaptation to environmental stimuli- the greater the amount of sensory stimuli exposure, resulting a a larger pool of potential memory storage and stimulation of the hippocampi and the cholinergic system involved in memory acquisition and storage, the more resistant the brain is to the development and progression of Alzheimer's Disease. Disrupted sleep may be an early warning indicator of Alzheimer's Disease. Poorly maintained sleep, with daytime fatigue and the need for hypnotics is correlated with the onset of Alzheimer's Disease within two years according to a study involving n=14,600 age 50 and up. It was noted the strongest predictor of the onset of Alzheimer's Disease was daytime fatigue (Constandi, 2012). There has been a longstanding debate about the role of aluminum (Al) in Alzheimer's Disease, Al is an established neurotoxin, but the causal link between environmental aluminum exposure and Alzheimer's Disease remains inconclusive and controversial (Kawahara, & Kato-Negishi, 2011)


The DSM-5 indicates that APD is comorbid with multiple medical problems (American Psychiatric Association, 2013). The comorbidity of Alzheimer's Disease with Down's Syndrome is 75% in individuals with Down Syndrome over age 65 (Alzheimer's Association, 2014a).

Treatment for Alzheimer's Disease

The DSM-5 does not specify treatment options for Alzheimer's Disease (American Psychiatric Association, 2013). Detection of Cognitive impairment can b detected by a protocol developed by the Alzheimer's association for Medicare annual wellness visits in a primary care setting, for possible early detection of AD (Cordell, et al, 2013) There are a number of cholinesterase inhibitors which are utilized to delay the progression of Alzheimer's Disease. There have also been clinical trials exploring the use of transdermal nicotine to treat MCI (Newhouse, et al, 2012), as it has been established that nicotine binds to nicotinic acetylcholine receptors, and is responsible for facilitating memory storage. There is currently no pharmacological intervention which can halt the progression. The delay of the progression of the disorder can give an individual with Alzheimer's Disease a longer period of cognitive functioning, and an opportunity to settle financial and business matters, to say goodbye to or make amends to family and friends, and to enjoy a fuller quality of life and retain independence as long as possible, as well as delay financial and emotional burdens on family The impact of Alzheimer's Disease on family members and caregivers is substantial, with financial and emotional considerations predominating. Family therapy may be useful, particularly if there has been a history of family strife, and supportive, solution focused counseling and psychoeducation may be useful for the person with Alzheimer's Disease as well as their family and caregivers, to learn how to best support the patient.

Impact on Functioning

Alzheimer's Disease will have a progressive major impact on most areas of functioning. It is inexorable and terminal. (American Psychiatric Association, 2013). The degree of impact will depend on what stage the disease process is in:

Stage 1: No impairment- no detectable cognitive impairment in an individual with risk factors for Alzheimer's Disease.

Stage 2: Very mild decline- subjective experience of occasional aphasia or STM (Short Term Memory) failure which cannot be objectively verified. This may me MCI instead of Alzheimer's Disease. (see note at the end of this section).

Stage 3: Mild decline- objective indicators of aphasia, STM impairment including problems with name recall, or concentration may be present.

Stage 4: Moderate decline- difficulty with Short term, recall, inability to perform serial seven's, impaired episodic LTM (Long Term Memory) recall, and difficulty successfully completing multi-step tasks.

Stage 5: Moderately severe decline- disoriented to time and place, difficulty dressing appropriately for weather and occasion, deeper episodic LTM deficits.

Stage 6: Severe decline- disoriented to person, time, place, more profound episodic LTM deficits, reversed sleep pattern, loss of bladder and bowel control, enhancement of previously suppressed personality characteristics, and paranoid delusions.

Stage 7: Very severe decline- unresponsive, loss of motor control, abnormal reflexes, difficulty swallowing, death. (Alzheimer's Association, 2014b)

MCI (Mild Cognitive Impairment) involves minor deficits in STM which do not have a substantial impact on daily functioning, can be compensated for with organizational tools, There is speculation MCI could represent an early stage of Alzheimer's Disease (The Regents of the University of California, 2014)

Differential Diagnosis

There are diagnostic rule-outs for Alzheimer's Disease which the clinician must consider, In the DSM -5, disorders such as Major Depressive Disorder, and other medical conditions which impact cognitive clarity, such as thyroid dysfunction (American Psychiatric Association, 2013). Other differential diagnostic considerations according to the DSM-5 and other sources are: CBD (Cortical Basal Degeneration), CJD (Creutzfeldt-Jakob Disease), DLB, (Dementia with Lewy Bodies), FTD (Frontotemporal Dementia) MND, (Motor Neuron Disease), and PSP (Progressive Supranuclear Palsy) (American Psychiatric Association, 2013; Alzheimer's Association 2014a). Korsakoff's syndrome should be ruled out based on history of alcohol use. Poly-pharmacy, or more limited use of certain prescribed or illicit mediation or alcohol that can produce cognitive deficits, such as benzodiazepines can account for MCI (The Regents of the University of California, 2014). Isolation, loneliness, and sensory deficits can all produce effects which may resemble early stage dementia.


Alzheimer's Association. (2014a). Health care professionals and Alzheimer's. Alzheimer's Association. Retrieved March 7, 2014, from:

Alzheimer's Association (2014b). 7 Stages of Alzheimer's. Alzheimer's Association. Retrieved March 7, 2014 from:

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders.(5th Edition). Washington, DC.

Cordell, C.B., Borson, S., Boustani, M., Chodosh, J., Reuben, D.,Verghese, J.,Thies, W., and Fried, L.B. (2013) Alzheimer’s Association recommendations for operationalizing

the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimer's and Dementia. Retrieved March 6, 2014, from

Constandi, M. (2012). Disrupted Sleep Might Signal Early Stages of Alzheimer's Scientific American. Retrieved March 6, 2014, from

Graber, C. (2011).Constricted Living Space Associated with Dementia Risk Scientific American. Retrieved March 6, 2014 from

Kawahara, M. and Kato-Negishi, M. (2011).Link between Aluminum and the Pathogenesis of Alzheimer's Disease: The Integration of the Aluminum and Amyloid Cascade Hypotheses. International Journal of Alzheimer's Disease. Doi: 10.4061/2011/276393. PMCID: PMC3056430

The Regents of the University of California. (2014) Mild Cognitive Impairment. What is mild cognitive impairment (MCI)? The Regents of the University of California. Retrieved March 6, 2014, from

Newhouse, P., Kellar, K., Aisen, P., White, H., Wesnes, K., Coderre, E., Pfaff, A., Wilkins, A., Howard, D., and Levin, E.D. (2012). Nicotine treatment of mild cognitive impairment A 6-month double-blind pilot clinical trial. Neurology. (78). 2. 91-101. doi:10.1212/WNL.0b013e31823efcbb

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