Underwriting Neurologic Diseases in Older Age Applicants AAIM 124th Annual Meeting Dave Rengachary, MD Vice President and Medical Director October 23, 2015 Outline 2 Alzheimer’s Definitions and Criteria 3 Alzheimer’s Disease Criteria Why does it matter? (cid:1) 2011 represents 1st time criteria have undergone major revision since 1984 (cid:1) Represents major (and controversial) undertaking of Alzheimer’s Association and National Institutes of Health (cid:1) Critical illness definitions often hinge on these criteria http://www.alz.org/documents_custom/alz_diag_criteria_faq.pdf1 4 Alzheimer’s Criteria (cid:1) What are the major differences? (cid:1) Previous criteria were entirely clinical. Updated criteria now emphasize consideration of Biomarkers (not necessary to make diagnosis but provide adjunctive support) (cid:1) Identifies 3 stages of cognitive dysfunction 1) Preclinical Alzheimer’s disease 2) MCI due Alzheimer’s Dementia 3). Dementia due to Alzheimer’s Disease 5 Alzheimer’s Dementia Core Clinical Criteria (All Causes)2 (cid:1) Interfere with the ability to function at work or at usual activities (cid:1) Represent a decline from previous levels of functioning (cid:1) Are not explained by delirium or major psychiatric disorder (cid:1) Cognitive impairment is diagnosed through a combination of (1) history-taking and (2) an objective cognitive assessment (cid:1) The cognitive or behavioral impairment involves a minimum of two of the following domains: (cid:1) Impaired ability to acquire and remember new information (cid:1) Impaired reasoning and handling of complex tasks, poor judgment (cid:1) Impaired visuospatial abilities (cid:1) Impaired language functions (cid:1) Changes in personality or behavior, or comportment 6 Alzheimer’s Criteria Probable Alzheimer’s Disease Core Clinical Criteria Carrier of Causative Genetic Mutation With Evidence of AD pathophysiologic process 7 Mild Cognitive Impairment Criteria Cognitive Objective concerns or cognitive deficits complaints Absence of other psychiatric or systemic Preservation of disorder that activities of Daily would explain Living the cognitive deficit 8 Lawton Instrumental Activities of Daily Living 3 (cid:1) Telephone (cid:1) Shopping (cid:1) Cooking (cid:1) Housekeeping (cid:1) Laundry (cid:1) Transportation (cid:1) Medication Administration (cid:1) Finances 9 Preclinical Alzheimer's Dementia (cid:1) Positive Biomarkers (amyloid imaging, PET, functional MRI, and CSF studies) but *largely asymptomatic patients 10