Result card

  • CUR1: What is the disease in the scope of this assessment?

What is the disease in the scope of this assessment?

Authors: Antonio Migliore, Tapani Keranen, Sinikka Sihvo

Internal reviewers: Kristian Lampe

Dementia is an overall term for a decline in mental ability severe enough to reduce a person's ability to perform everyday activities. Alzheimer's disease is the most common type of dementia, which accounts for 60 to 80 percent of cases {76}.

Alzheimer's is a progressive disease, where dementia symptoms gradually worsen over time. In ICD-10-CM the code is G30 and in the ICD-10 classification of mental and behavioral disorders, diagnostic criteria for research the code is F00. According to DSM-IV criteria for Alzheimer’s disease memory deficit must be objectively demonstrated plus at least one other cognitive deficit: aphasia (abnormal speech), executive function impairment (difficulty with planning, judgment, mental flexibility, abstraction, problem-solving, etc.), agnosia (impaired recognition of people or objects), or apraxia (impaired performance of learned motor skills). These cognitive deficits must result in impairment in performance of daily activities. In the newest Diagnostic and Statistical Manual of Mental Disorders (DSM-5)  “dementia” is replaced by “major neurocognitive disorder” {3} {75}.The diagnosis is confirmed by post mortem evidence of neurofibrillary tangles and neuritic plaques in excess of those found in normal ageing of the brain (ICD-10).

Those with Alzheimer's live an average of 3.6 to 6.6 years after the diagnosis, depending on age and other health conditions {78}.

Mild cognitive impairment (MCI) describes a transitional state between normal aging and pathological decline {10} {49} {81}. Many terms and definitions have been used to describe mild forms of cognitive impairment. According to Petersen et al. {63} mild cognitive impairment is classified as 1) MCI that primarily affects memory is known as "amnestic MCI, aMCI" and 2) MCI that affects thinking skills other than memory is known as "nonamnestic MCI, A person with MCI is at an increased risk of developing Alzheimer's disease and other dementias, however, many individuals revert to normal or do not progress {81}. The conversion rate from MCI to Alzheimer's is low, about 7% in community based samples and 15% in specialized care samples {49}. Therefore MCI diagnosis alone cannot be equaled with a pre-dementia stage {48}. In order to allow treatments like medication, MCI diagnosis should be supplemented with predictors of a rapid cognitive decline, such as older age, vascular risk factors, neurological symptoms, apoE ɛ4genotype, etc.) {48}. In the DSM-5 a term “mild neurocognitive disorder” is used instead of mild cognitive impairment {3} {75}.

Migliore A et al. Result Card CUR1 In: Migliore A et al. Health Problem and Current Use of the Technology In: Jefferson T, Cerbo M, Vicari N [eds.]. Use of Intravenous immunoglobulins for Alzeheimer’s disease including Mild Cognitive Impairment [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali ; 2015. [cited 31 October 2020]. Available from: