Psychological Disorders: Dementia Associated With Alcoholsim

American Description
A. The development of multiple cognitive deficits manifested by both:
Memory impairment (impaired ability to learn new information or to recall previously learned information)
One (or more) of the following cognitive disturbances:
Aphasia (language disturbance)
Apraxia (impaired ability to carry out motor activities despite intact motor function)
Agnosia (failure to recognize or identify objects despite intact sensory function)
Disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)

B. The cognitive deficits (above) cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning

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

D. There is evidence from the history, physical examination, or laboratory findings that the cognitive deficits are etiologically related to the persisting effects of alcohol.

Problem Areas (When Initially Diagnosed)
Socio-Economic:
Unemployed
Moderately impaired homemaking
Moderately impaired money management
Requires voluntary institutional care (placement in supervised residence or nursing home)

Addiction-Antisocial:
Severe alcohol abuse

Depression:
Significant loss of interest and motivation
Significant problem with concentration

Intellectual Impairment:
Significant problem with memory or learning
Significant decrease in speech and movement
Significant problem with grooming and hygiene
Significant confusion as to date, place, or person

Onset and Course
The age at onset is rarely before age 20 years.
Onset is typically insidious with a slow progression. Since Alcoholic Dementia persists long after alchohol use may have stopped, blood tests may be negative for alcohol or the associated liver damage.
The cognitive deficits are usually permanent and may worsen even if alcohol use stops, although some cases do show improvement.

Differential Diagnosis
Delirium
Amnestic Disorder
Alzheimer's Dementia
Vascular (Multi-Infarct) Dementia
Other Substance Intoxication, or Substance Withdrawal
Dementia Due to Other General Medical Conditions:
Brain Tumor
Creutzfeldt-Jakob Disease
HIV Infection
Huntington's Disease
Hypercalcemia
Hypothyroidism
Neurosyphilis
Normal-Pressure Hydrocephalus
Parkinson's Disease
Pick's Disease
Subdural Hematoma
Traumatic Brain Injury
Vitamin B12 Deficiency, Folic Acid Deficiency, Niacin Deficiency
Mental Retardation
Schizophrenia
Major Depressive Disorder
Malingering and Factitious Disorder
Age-Related Cognitive Decline

European Description
A disorder in which alcohol- or psychoactive substance-induced changes of cognition, affect, personality, or behaviour persist beyond the period during which a direct psychoactive substance-related effect might reasonably be assumed to be operating.

Diagnostic Guidelines
Onset of the disorder should be directly related to the use of alcohol or a psychoactive substance. Cases in which initial onset occurs later than episode(s) of substance use should be coded here only where clear and strong evidence is available to attribute the state to the residual effect of the substance. The disorder should represent a change from or marked exaggeration of prior and normal state of functioning.

The disorder should persist beyond any period of time during which direct effects of the psychoactive substance might be assumed to be operative (see F1x.0, acute intoxication). Alcohol- or psychoactive substance-induced dementia is not always irreversible; after an extended period of total abstinence, intellectual functions and memory may improve.

The disorder should be carefully distinguished from withdrawal-related conditions (see F1x.3 and F1x.4). It should be remembered that, under certain conditions and for certain substances, withdrawal state phenomena may be present for a period of many days or weeks after discontinuation of the substance.

Conditions induced by a psychoactive substance, persisting after its use, and meeting the criteria for diagnosis of psychotic disorder should not be diagnosed here (use F1x.5, psychotic disorder). Patients who show the chronic end-state of Korsakov's syndrome should be coded under F1x.6.

Differential Diagnosis
Consider: pre-existing mental disorder masked by substance use and re-emerging as psychoactive substance-related effects fade (for example, phobic anxiety, a depressive disorder, schizophrenia, or schizotypal disorder). In the case of flashbacks, consider acute and transient psychotic disorders (F23.-). Consider also organic injury and mild or moderate mental retardation (F70-F71), which may coexist with psychoactive substance misuse.

This diagnostic rubric may be further subdivided by using the following five-character codes:

F1x.70 Flashbacks
May be distinguished from psychotic disorders partly by their episodic nature, frequently of very short duration (seconds or minutes) and by their duplication (sometimes exact) of previous drug-related experiences.

F1x.71 Personality or behaviour disorder
Meeting the criteria for organic personality disorder (F07.0).

F1x.72 Residual affective disorder
Meeting the criteria for organic mood [affective] disorders (F06.3).

F1x.73 Dementia
Meeting the general criteria for dementia as outlined in the introduction to F00-F09.

F1x.74 Other persisting cognitive impairment
A residual category for disorders with persisting cognitive impairment, which do not meet the criteria for psychoactive substance-induced amnesic syndrome (F1x.6) or dementia (F1x.73).