DSM-IV criteria for the diagnosis of vascular dementia

A. The development of multiple cognitive deficits manifested by both:

  1. Memory impairment (impaired ability to learn new information or to recall previously learned information)
  2. One or more of the following cognitive disturbances:

    (a) aphasia (language disturbance)

    (b) apraxia (impaired ability to carry out motor activities depite 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., exggeration of deep tendon reflexes, extensor plantar response, psuedobulbar palsy, gait abnormalities, weakness of an extremity) or laboratory evidence indicative of cerebrovascular disease (e.g., multiple infarctions involving cortex and underlyig white matter) that are judged to be etiologically related to the disturbance.

D. The deficits do not ocurr 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 (can be applied to any of the above subtypes):
With Behavioral Disturbance: if there is clinically significant behavioral disturbance (i.e. wandering)

Coding note: Also code cerebrovascular condition on Axis III.

Reference

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.