Alzhiemer's Disease


Alzheimer's Disease

LCD Guideline

Dementia due to Alzheimer’s Disease and Related Disorders

Patients will be considered to be in the terminal stage of dementia (life expectancy of six months or less) if they meet the following criteria. Patients with dementia should show all the following characteristics:

1. Stage seven or beyond according to the Functional Assessment Staging Scale

2. Unable to ambulate without assistance

3. Unable to dress without assistance

4. Unable to bathe without assistance

5. Urinary and fecal incontinence, intermittent or constant

6. No consistently meaningful verbal communication: stereotypical phrases only or the ability to speak is limited to six or fewer intelligible words

Patients should have had one of the following within the past 12 months:

1. Aspiration pneumonia

2. Pyelonephritis or other upper urinary tract infection

3. Septicemia

4. Decubitus ulcers, multiple, stage 3-4

5. Fever, recurrent after antibiotics

6. Inability to maintain sufficient fluid and calorie intake with 10% weight loss during the previous six months or serum albumin <2.5 gm/dl

Note: This section is specific for Alzheimer’s Disease and related disorders, and is not appropriate for other types of

dementia, such as multi-infarct dementia.

Comparative Data

Fast Score - Document on continually, on admit Fast 7a now 7c

PPS/ADL - PPS score change, 1 month ago PPS 50% now PPS 30%. Patient was two-person transfer, now Hoyer lift Intake change - Was eating 100% of meals now only eats 50% meals. Patient pocketing food. Diet change from regular to pureed. Patient was eating independently now needs assistance

Weight Change - lost 10lbs in last month, in last 6 months has lost 10% of body weight

Alertness/Orientation - On admission patient was sleeping 10 hours a day, now sleeping 15+ hours a day

Skin issues - should be documented on every visit. Redness noted to coccyx, previously had no skin issues

Activity - Can no longer propel him/herself in wheelchair, on admission could propel around independently. Need for lateral supports, patient now leaning in wheelchair and needs support laterally.

New infections, Recurrent Infections

Fever noted, recurrent fever


Kidney failure



Skin Problems




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