Diagnostic Codes and Management for Agitated and Behavioral Disturbances in Early Onset Alzheimer's Disease
The diagnostic codes for agitated and behavioral disturbances in early onset Alzheimer's disease should be documented using the NPI-Q (Neuropsychiatric Inventory Questionnaire) which assesses both symptom severity in patients and caregiver distress, providing a comprehensive evaluation of behavioral symptoms. 1
Diagnostic Criteria and Assessment
Diagnostic Codes for Behavioral Disturbances
- Behavioral and psychological symptoms of dementia (BPSD) should be assessed using validated tools such as the NPI-Q, which covers key behavioral domains and provides severity ratings 1
- The Cohen Mansfield Agitation Index (CMAI) specifically documents agitation and related disruptive behaviors including verbal aggression, repetitiveness, screaming, hitting, grabbing, and sexual advances 1
- Cornell Scale for Depression in Dementia (CSDD) is well-suited for detecting and monitoring depression across the severity spectrum of Alzheimer's disease 1
- For anxiety symptoms, the Geriatric Anxiety Inventory (GAI) or Penn State Worry Questionnaire Abbreviated (PSWQ-A) provide standardized assessment 1
Behavioral Symptoms to Document
- Agitation is one of the most common behavioral disturbances in Alzheimer's disease and can have various triggers including pain, medications, and psychosocial stressors 1
- Psychotic symptoms (hallucinations, delusions) increase in frequency as the disease progresses 1, 2
- Changes in personality, behavior, or comportment including uncharacteristic mood fluctuations, impaired motivation, apathy, social withdrawal, and socially unacceptable behaviors 1
- Depression and anxiety symptoms should be specifically documented using PHQ-9 or GDS for depression and GAI or PSWQ-A for anxiety 1
Management Approach for Behavioral Disturbances
Initial Assessment
- Evaluate for drug toxicity, medical conditions, psychiatric disorders, or environmental factors that may underlie behavioral changes 1
- Reassessment every six months is necessary as new behaviors emerge over the course of Alzheimer's disease 1
- Rule out iatrogenic causes and treatable contributing factors before implementing specific interventions 1, 3
Non-Pharmacological Management
- Non-pharmacological interventions should be first-line therapy due to modest evidence for pharmacological approaches and greater risk of harm 2
- Care plan should include precautions to reduce risk of harm to the patient and others 1
- Environmental modifications and caregiver education are essential components of managing behavioral symptoms 4
- Structured activities and routines can help minimize agitation and other behavioral disturbances 5
Pharmacological Management
- Pharmacological interventions should be considered when symptoms are dangerous and/or severely distressing to patients or caregivers 2
- For patients with less severe behavioral symptoms, cholinesterase inhibitors and memantine may be appropriate 6
- Psychotropic medications may be warranted for severe behavioral and psychological symptoms, but should be used judiciously due to potential adverse effects 3, 6
Special Considerations
Caregiver Support
- Behavioral problems are a major cause of caregiver distress and one of the principal determinants of institutionalization 1
- The NPI-Q specifically assesses caregiver distress related to each behavioral symptom 1
- Caregiver education and support are crucial components of managing behavioral disturbances 4
Disease Progression
- The number and types of behavioral problems typically increase with cognitive decline 5
- Different types of problems may emerge at different stages of disease progression 5
- Behavioral symptoms can occur even in early stages of Alzheimer's disease, including in those with mild cognitive impairment 6
Monitoring and Follow-up
- Regular monitoring of behavioral symptoms using validated tools helps track progression and treatment response 1
- Behavioral symptoms should be reassessed at least every six months as the disease progresses 1
- Treatment approaches may need to be modified as the disease advances and different behavioral symptoms emerge 1, 5