Alcohol Dementia - Diagnosis

Diagnosis

The existence of alcohol-related dementia is widely acknowledged but not often used as a diagnosis, due to a lack of widely accepted, non-subjective diagnostic criteria; more research is needed.

Ideally, the person suspected of having any form of dementia should have a complete medical and mental health work-up done. A simple test for intellectual function, like the Folstein Mini-Mental Status Examination, is the minimum screen for dementia. The test requires 15 - 20 minutes to administer and is available in mental health centers.

Diagnosing alcohol related dementia can be difficult, due to the wide range of symptoms, and a lack of specific brain pathology. The Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV), is a guide to aid doctors in diagnosing a range of psychiatric disorders, and may be helpful in diagnosing dementia.

There are problems with DSM diagnostic criteria, however. Firstly, they are vague and subjective. Furthermore, the criteria for diagnosis of dementia were inspired by the clinical presentation of Alzheimer's disease and are poorly adapted to the diagnosis of other dementias. This has led to efforts to develop better diagnostic models.

Oslin (Int J Geriatr Psychiatry 1998) proposed alternative clinical diagnostic criteria which were validated. The criteria include a clinical diagnosis of dementia at least 60 days after last exposure to alcohol, significant alcohol use (i.e. minimum 35 standard drinks/week for males and 28 for women) for more than 5 years, and significant alcohol use occurring within 3 years of the initial onset of cognitive deficits.

Criteria for alcohol-induced persistent dementia in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

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 deficits are etiologically related to the persisting effects of substance use (e.g. drug of abuse; medication).