1. Classifying the Manifestations of Alzheimer’s Disease in DSM-IV-TR Eric D. Caine, M.D. John Romano Professor and Chair Departmet of Psychiatry University of Rochester Medical Center Rochester, N.Y.

2. The Expression of Diseases Fundamental pathobiological processes –molecular –biochemical/physiological “Primary” manifestations –histopathological “Secondary” manifestations –clinical signs and symptoms

3. Huntington’s disease (“chorea”) CAG repeats Basal ganglia histopathology/degeneration Cognitive, psychiatric, motor signs and symptoms

4. Alzheimer’s disease Multiple unknown molecular mechanisms Characteristic histopathology Cognitive and psychiatric signs and symptoms

5. Past DSM-IV Classification of Dementia of the Alzheimer’s Type DAT, with early onset 290.10uncomplicated 290.11with delirium 290.12 with delusions 290.13with depressed mood (uncoded specifier: with behavioral disturbance) DAT, with late onset 290.0uncomplicated 290.3with delirium 290.20with delusions 290.21with depressed mood (uncoded specifier: with behavioral disturbance) Code Alzheimer’s disease (331.0) on Axis III

6. DSM-IV-TR Coding of Dementia due to Alzheimer’s Disease Dementia due to Alzheimer’s disease 294.10 without behavioral disturbance 294.11 with behavioral disturbance Code Alzheimer’s disease (331.0) on Axis III

7. DSM-IV Mental Disorders due to Alzheimer’s Disease Psychotic Disorder due to …293.8 Mood Disorder due to …293.83 Anxiety Disorder due to …293.89 Personality Change due to …310.1 Sleep Disorder due to …780.5 Code Alzheimer’s disease (331.0) on Axis III

8. Proposed ICD-10-CM Coding of Dementia due to Alzheimer’s Disease Dementia due to AD, with early onset (G30.0x) G30.00without behavioral disturbance G30.01with behavioral disturbance G30.00unspecified Dementia due to AD, with late onset (G30.1x) G30.10without behavioral disturbance G30.11with behavioral disturbance G30.10unspecified (G codes = ICD-10-CM Diseases of the Nervous System)