276 Vascular Dementia (formerly Multi-Infarct Dementia) (290.4x)
DSM-IV-TR criteria
- A. The development of multi cognitive deficits manifested by both:
- 1) memory impairment (impaired ability to learn new information or to recall previously learned information) and
- 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
- Code based on predominant features:
- 290.41 With Delirium: if delirium is superimposed on the dementia
- 290.42 With Delusions: if delusions are the predominant feature
- 290.43 With Depressed Mood: if depressed mood (including presentations that meet full symptom criteria for a Major Depressive Episode) is the predominant feature. A separate diagnosis of Mood Disorder Due to a General Medical Condition is not given.
- 290.40 Uncomplicated: if none of the above predominates in the current clinical presentation
- Specify if:
- With Behavioral Disturbance
- *Coding note: Also cerebrovascular condition on Axis III**
Associated Features
- Associated descriptive features and mental disorders.
- Associated laboratory findings. The extent of central nervous system lesions detected by CT and MRI in Vascular Dementia typically exceeds in the extent of changes detected in the brains of healthy elderly persons (e.g., periventricular and white matter hyperintensities noted on MRI scans). Lesions often appear in both white matter and gray matter structures, including subcortical regions and nuclei. Evidence of old infarctions (e.g., focal atrophy) may be detected, as well as findings of more recent laboratory evidence of associated cardiac and systemic vascular conditions (e.g., ECG abnormalities, laboratory evidence of renal failure).
- Associated physical examination findings and general medical conditions. Common neurological signs (e.g., abnormal reflexes, weakness of an extremity, gait disturbance) are discussed in the “Diagnostic Features” section. There is often evidence of long-standing arterial hypertension (e.g., funduscopic abnormalities, enlarged heart), valvular heart disea