Delirium, Dementia, And Amnestic And Other Cognitive Disorders

Front 1

Delirium Due to... (indicate general medical condition)

Back 1

A. Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention.
B. A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia.
C. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.
D. There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by the direct physiological consequences of a general medical condition.

Front 2

Substance Intoxication Delirium (specify substance)

Back 2

A. Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention.
B. A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia.
C. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.
D. There is evidence from the history, physical examination, or laboratory findings of either (1) or (2):
(1) the symptoms in Criteria A and B developed during Substance Intoxication
(2) medication use is etiologically related to the disturbance*
Note: This diagnosis should be made instead of a diagnosis of Substance Intoxication only when the cognitive symptoms are in excess of those usually associated with the intoxication syndrome and when the symptoms are sufficiently severe to warrant independent clinical attention.
*Note: The diagnosis should be recorded as Substance-Induced Delirium if related to medication use. Refer to Appendix G for E-codes indicating specific medications.

Front 3

Substance Withdrawal Delirium (specify substance)

Back 3

A. Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention.
B. A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia.
C. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.
D. There is evidence from the history, physical examination, or laboratory findings that the symptoms in Criteria A and B developed during, or shortly after, a withdrawal syndrome.

Front 4

Delirium Due to Multiple Etiologies

Back 4

A. Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention.
B. A change in cognition (such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a preexisting, established, or evolving dementia.
C. The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.
D. There is evidence from the history, physical examination, or laboratory findings that the delirium has more than one etiology (e.g., more than one etiological general medical condition, a general medical condition plus Substance Intoxication or medication side effect).

Front 5

Dementia of the Alzheimer's Type

Back 5

A. The development of multiple cognitive deficits manifested by both
(1) memory impairment (impaired ability to learn new information or to recall previously learned information)
(2) one (or more) of the following cognitive disturbances:
(a) aphasia (language disturbance)
(b) apraxia (impaired ability to carry out motor activities despite intact motor function)
(c) agnosia (failure to recognize or identify objects despite intact sensory function)
(d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)

B. The cognitive deficits in Criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.
C. The course is characterized by gradual onset and continuing cognitive decline.
D. The cognitive deficits in Criteria A1 and A2 are not due to any of the following:
(1) other central nervous system conditions that cause progressive deficits in memory and cognition (e.g., cerebrovascular disease, Parkinson's disease, Huntington's disease, subdural hematoma, normal-pressure hydrocephalus, brain tumor)
(2) systemic conditions that are known to cause dementia (e.g., hypothyroidism, vitamin B12 or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection)
(3) substance-induced conditions

E. The deficits do not occur exclusively during the course of a delirium.
F. The disturbance is not better accounted for by another Axis I disorder (e.g., Major Depressive Disorder, Schizophrenia).

Front 6

Vascular Dementia

Back 6

A. The development of multiple cognitive deficits manifested by both
(1) memory impairment (impaired ability to learn new information or to recall previously learned information)
(2) one (or more) of the following cognitive disturbances:
(a) aphasia (language disturbance)
(b) apraxia (impaired ability to carry out motor activities despite intact motor function)
(c) agnosia (failure to recognize or identify objects despite intact sensory function)
(d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)

B. The cognitive deficits in Criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.
C. Focal neurological signs and symptoms (e.g., exaggeration of deep tendon reflexes, extensor plantar response, pseudobulbar palsy, gait abnormalities, weakness of an extremity) or laboratory evidence indicative of cerebrovascular disease (e.g., multiple infarctions involving cortex and underlying white matter) that are judged to be etiologically related to the disturbance.
D. The deficits do not occur exclusively during the course of a delirium.

Front 7

Dementias Due to Other General Medical Conditions

Back 7

Dementia Due to HIV
Dementia Due to Head Trauma
Dementia Due to Parkinson's Disease
Dementia Due to Huntington's Disease
Dementia Due to Pick's Disease
Dementia Due to Creutzfeldt-Jakob Disease

Front 8

Criteria for Dementia Due to Other General Medical Conditions

Back 8

A. The development of multiple cognitive deficits manifested by both
(1) memory impairment (impaired ability to learn new information or to recall previously learned information)
(2) one (or more) of the following cognitive disturbances:
(a) aphasia (language disturbance)
(b) apraxia (impaired ability to carry out motor activities despite intact motor function)
(c) agnosia (failure to recognize or identify objects despite intact sensory function)
(d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)

B. The cognitive deficits in Criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.
C. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition other than Alzheimer's disease or cerebrovascular disease (e.g., HIV infection, traumatic brain injury, Parkinson's disease, Huntington's disease, Pick's disease, Creutzfeldt-Jakob disease, normal-pressure hydrocephalus, hypothyroidism, brain tumor, or vitamin B12 deficiency).
D. The deficits do not occur exclusively during the course of a delirium.

Front 9

Substance-Induced Persisting Dementia (specify substance)

Back 9

A. The development of multiple cognitive deficits manifested by both
(1) memory impairment (impaired ability to learn new information or to recall previously learned information)
(2) one (or more) of the following cognitive disturbances:
(a) aphasia (language disturbance)
(b) apraxia (impaired ability to carry out motor activities despite intact motor function)
(c) agnosia (failure to recognize or identify objects despite intact sensory function)
(d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)

B. The cognitive deficits in Criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.

C. The deficits do not occur exclusively during the course of a delirium and persist beyond the usual duration of Substance Intoxication or Withdrawal.

D. There is evidence from the history, physical examination, or laboratory findings that the deficits are etiologically related to the persisting effects of substance use (e.g., a drug of abuse, a medication).

Front 10

Dementia Due to Multiple Etiologies

Back 10

A. The development of multiple cognitive deficits manifested by both
(1) memory impairment (impaired ability to learn new information or to recall previously learned information)
(2) one (or more) of the following cognitive disturbances:
(a) aphasia (language disturbance)
(b) apraxia (impaired ability to carry out motor activities despite intact motor function)
(c) agnosia (failure to recognize or identify objects despite intact sensory function)
(d) disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)

B. The cognitive deficits in Criteria A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning.
C. There is evidence from the history, physical examination, or laboratory findings that the disturbance has more than one etiology (e.g., head trauma plus chronic alcohol use, Dementia of the Alzheimer's Type with the subsequent development of Vascular Dementia).
D. The deficits do not occur exclusively during the course of a delirium.

Front 11

Amnestic Disorder Due to . . . [Indicate the General Medical Condition]

Back 11

A. The development of memory impairment as manifested by impairment in the ability to learn new information or the inability to recall previously learned information.
B. The memory disturbance causes significant impairment in social or occupational functioning and represents a significant decline from a previous level of functioning.
C. The memory disturbance does not occur exclusively during the course of a delirium or a dementia.
D. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition (including physical trauma).

Specify if:

Transient: if memory impairment lasts for 1 month or less

Chronic: if memory impairment lasts for more than 1 month

Front 12

Substance-Induced Persisting Amnestic Disorder

Back 12

A. The development of memory impairment as manifested by impairment in the ability to learn new information or the inability to recall previously learned information.
B. The memory disturbance causes significant impairment in social or occupational functioning and represents a significant decline from a previous level of functioning.
C. The memory disturbance does not occur exclusively during the course of a delirium or a dementia and persists beyond the usual duration of Substance Intoxication or Withdrawal.
D. There is evidence from the history, physical examination, or laboratory findings that the memory disturbance is etiologically related to the persisting effects of substance use (e.g., a drug of abuse, a medication).

Front 13

Cognitive Disorder NOS

Back 13

This category is for disorders that are characterized by cognitive dysfunction presumed to be due to the direct physiological effect of a general medical condition that do not meet criteria for any of the specific deliriums, dementias, or amnestic disorders listed in this section and that are not better classified as Delirium Not Otherwise Specified, Dementia Not Otherwise Specified, or Amnestic Disorder Not Otherwise Specified. For cognitive dysfunction due to a specific or unknown substance, the specific Substance-Related Disorder Not Otherwise Specified category should be used.

Examples include

1. Mild neurocognitive disorder: impairment in cognitive functioning as evidenced by neuropsychological testing or quantified clinical assessment, accompanied by objective evidence of a systemic general medical condition or central nervous system dysfunction (see page 762 for suggested research criteria)
2. Postconcussional disorder: following a head trauma, impairment in memory or attention with associated symptoms (see page 760 for suggested research criteria)