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Delirium & Dementia
Delirium & Dementia.
43
Social Work
Graduate
01/31/2012

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Term
Delirium in General
Definition
a disturbance of consciousness that is accompanied by a change in cognition that cannot be better accounted for by a preexisting or evolving dementia. The disturbance develops over a short period of time, usually hours to days, and tends to fluctuate during the course of the day. There is evidence from the history, physical examination, or laboratory tests that the delirium is a direct physiological consequence of a general medical condition, Substance Intoxication or Withdrawal, use of a medication, or toxin exposure, or a combination of these factors.
Term
Delirium Due to a General Medical Condition Criterion A
Definition
Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention.
Term
Delirium Due to a General Medical Condition Criterion B
Definition
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.
Term
Delirium Due to a General Medical Condition Criterion C
Definition
The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.
Term
Delirium Due to a General Medical Condition Criterion D
Definition
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.
Term
Delirium Coding Notes
Definition
Coding note: If delirium is superimposed on a preexisting Vascular Dementia, indicate the delirium by coding 290.41 Vascular Dementia, With Delirium.
Coding note: Include the name of the general medical condition on Axis I, e.g., 293.0 Delirium Due to Hepatic Encephalopathy; also code the general medical condition on Axis III (see Appendix G for codes).
Term
Substance-Induced Delirium Criterion A
Definition
Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention.
Term
Substance-Induced Delirium Criterion B
Definition
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.
Term
Substance-Induced Delirium Criterion C
Definition
The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.
Term
Substance-Induced Delirium Criterion D1 (either 1 or 2 from history, physical exam, or laboratory findings)
Definition
the symptoms in Criteria A and B developed during Substance Intoxication
Term
Substance-Induced Delirium Criterion D2 (either 1 or 2 from history, physical exam, or laboratory findings)
Definition
medication use is etiologically related to the disturbance*

Code[Specific Substance] Intoxication Delirium:
Term
Substance Withdrawal Delirium Criterion A
Definition
Disturbance of consciousness (i.e., reduced clarity of awareness of the environment) with reduced ability to focus, sustain, or shift attention.
Term
Substance Withdrawal Delirium Criterion B
Definition
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.
Term
Substance Withdrawal Delirium Criterion C & D
Definition
The disturbance develops over a short period of time (usually hours to days) and tends to fluctuate during the course of the day.

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.
Term
Dementia of the Alzheimer's Type A1 (development of multiple cognitive deficits manifested by both A1 and A2)
Definition
memory impairment (impaired ability to learn new information or to recall previously learned information)
Term
Dementia of the Alzheimer's Type A2a (development of multiple cognitive deficits manifested by both A1 and A2)
Definition
one (or more) of the following cognitive disturbances:
aphasia (language disturbance)
Term
Dementia of the Alzheimer's Type A2b (development of multiple cognitive deficits manifested by both A1 and A2)
Definition
one (or more) of the following cognitive disturbances:

apraxia (impaired ability to carry out motor activities despite intact motor function)
Term
Dementia of the Alzheimer's Type A2c (development of multiple cognitive deficits manifested by both A1 and A2)
Definition
one (or more) of the following cognitive disturbances:

agnosia (failure to recognize or identify objects despite intact sensory function)
Term
Dementia of the Alzheimer's Type A2d (development of multiple cognitive deficits manifested by both A1 and A2
Definition
one (or more) of the following cognitive disturbances:

disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)
Term
Dementia of the Alzheimer's Type Criterion B
Definition
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.
Term
Dementia of the Alzheimer's Type Criterion C
Definition
The course is characterized by gradual onset and continuing cognitive decline.
Term
Dementia of the Alzheimer's Type Criterion D1 (The cognitive deficits in Criteria A1 and A2 are not due to any of the following)
Definition
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)
Term
Dementia of the Alzheimer's Type Criterion D2 (The cognitive deficits in Criteria A1 and A2 are not due to any of the following)
Definition
systemic conditions that are known to cause dementia (e.g., hypothyroidism, vitamin B12 or folic acid deficiency, niacin deficiency, hypercalcemia, neurosyphilis, HIV infection)
Term
Dementia of the Alzheimer's Type Criterion D3 (The cognitive deficits in Criteria A1 and A2 are not due to any of the following)
Definition
substance-induced conditions
Term
Dementia of the Alzheimer's Type Criterion E & F
Definition
The deficits do not occur exclusively during the course of a delirium.

The disturbance is not better accounted for by another Axis I disorder (e.g., Major Depressive Disorder, Schizophrenia).
Term
Dementia of the Alzheimer's Type Coding Without Behavioral Disturbance
Definition
if the cognitive disturbance is not accompanied by any clinically significant behavioral disturbance.
Term
Dementia of the Alzheimer's Type Coding With Behavioral Disturbance
Definition
if the cognitive disturbance is accompanied by a clinically significant behavioral disturbance (e.g., wandering, agitation).
Term
Vascular Dementia Criterion A1 (The development of multiple cognitive deficits manifested by both A1 and A2)
Definition
memory impairment (impaired ability to learn new information or to recall previously learned information)
Term
Vascular Dementia Criterion A2a (The development of multiple cognitive deficits manifested by both A1 and A2)
Definition
one (or more) of the following cognitive disturbances:

aphasia (language disturbance)
Term
Vascular Dementia Criterion A2b (The development of multiple cognitive deficits manifested by both A1 and A2)
Definition
one (or more) of the following cognitive disturbances:

apraxia (impaired ability to carry out motor activities despite intact motor function)
Term
Vascular Dementia Criterion A2c (The development of multiple cognitive deficits manifested by both A1 and A2)
Definition
one (or more) of the following cognitive disturbances:

agnosia (failure to recognize or identify objects despite intact sensory function)
Term
Vascular Dementia Criterion A2d (The development of multiple cognitive deficits manifested by both A1 and A2)
Definition
one (or more) of the following cognitive disturbances:

disturbance in executive functioning (i.e., planning, organizing, sequencing, abstracting)
Term
Vascular Dementia Criterion B & D
Definition
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.

The deficits do not occur exclusively during the course of a delirium.
Term
Vascular Dementia Criterion C
Definition
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.
Term
Vascular Dementia Coding With Delirium
Definition
if delirium is superimposed on the dementia
Term
Vascular Dementia Coding With Delusions
Definition
if delusions are the predominant feature
Term
Vascular Dementia Coding With Depressed Mood
Definition
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.
Term
Vascular Dementia Coding Uncomplicated
Definition
if none of the above predominates in the current clinical presentation
Term
Vascular Dementia specify if with behavioral disturbance.
Definition
can also be used to indicate clinically significant behavioral disturbances (e.g., wandering
Term
Dementia Due to Parkinson's Disease A
Definition
he presence of a dementia that is judged to be the direct pathophysiological consequence of Parkinson's disease
Term
Dementia Due to Parkinson's Disease B
Definition
Parkinson's disease is a slowly progressive neurological condition, characterized by tremor, rigidity, bradykinesia, and postural instability.
Term
Dementia Due to Parkinson's Disease C
Definition
Dementia has been reported to occur in approximately 20%–60% of individuals with Parkinson's disease and is more likely to be present in older individuals or those with more severe or advanced disease.
Term
Dementia Due to Parkinson's Disease Features
Definition
s characterized by cognitive and motoric slowing, executive dysfunction, and impairment in memory retrieval. Declining cognitive performance in individuals with Parkinson's disease is frequently exacerbated by depression. Findings on physical examination include the characteristic abnormal motor signs of resting tremor, evidence of slowness and poverty of movement (such as micrographia), or muscular rigidity and loss of associated movements.
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