Prion disease can be definitively confirmed only by biopsy or at autopsy. Although there are no distinctive findings on cerebrospinal ﬂuid analysis across the prion diseases, reliable bio- markers are being developed and include 14-3-3 protein (particularly for sporadic CID) as well as tau protein. Magnetic resonance brain imaging is currently considered the most sen- sitive diagnostic test when DWI is performed, with the most common finding being multi~ focal gray matter hyperintensities in subcortical and cortical regions. In some individuals, the electroencephalogram reveals periodic sharp, often triphasic and synchronous dis- charges at a rate of 0.5—2 Hz at some point during the course of the disorder.
Other major neurocognitive disorders. Major NCD clue to prion disease may appear similar in its course to other NCDs, but prion diseases are typically distinguished by their rapid progression and prominent cerebellar and motor symptoms.
Due to Parkinson’s Disease
The criteria are met for major or mild neurocognitive disorder.
The disturbance occurs in the setting of established Parkinson's disease.
. There is insidious onset and gradual progression of impairment.
. The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.
Major or mild neurocognitive disorder probably due to Parkinson’s disease should be diagnosed if 1 and 2 are both met. Major or miid neurocognitive disorder possibly due to Parkinson’s disease should be diagnosed if 1 or 2 is met: 1. There is no evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease or another neurological, mental, or systemic disease or con- dition likely contributing to cognitive decline).
2. The Parkinson’s disease clearly precedes the onset of the neurocognitive disorder.
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Coding note: For major neurocognitive disorder probably due to Parkinson’s disease, with behavioral disturbance, code first 332.0 (620) Parkinson’s disease, followed by 294.11 (F02.81) major neurocognitive disorder probably due to Parkinson’s disease, with behavioral disturbance. For major neurocognitive disorder probably due to Parkinson’s disease, without behavioral disturbance, code first 332.0 (620) Parkinson’s disease, fol-
Major or Mild Neurocognitive Disorder Due to Parkinson's Disease 637 lowed by 294.10 (F02.80) major neurocognitive disorder probably due to Parkinson’s dis- ease, without behavioral disturbance.
For major neurocognitive disorder possibly due to Parkinson’s disease, code 331.9 (631.9) major neurocognitive disorder possibly due to Parkinson’s disease. (Note: Do not use the additional code for Parkinson's disease. Behavioral disturbance cannot be coded but should still be indicated in writing.)
For mild neurocognitive disorder due to Parkinson's disease, code 331.83 (631.84).
(Note: Do not use the additional code for Parkinson’s disease. Behavioral disturbance cannot be coded but should still be indicated in writing.)
The essential feature of major or mild neurocognitive disorder (NCD) due to Parkinson’s disease is cognitive decline following the onset of Parkinson’s disease. The disturbance must occur in the setting of established Parkinson’s disease (Criterion B), and deficits must have developed gradually (Criterion C). The NCD is viewed as probably due to Parkinson’s disease when there is no evidence of another disorder that might be contributing to the cognitive decline and when the Parkinson’s disease clearly precedes onset of the NCD. The
NCD is considered possibly due to Parkinson’s disease either when there is no evidence of another disorder that might be contributing to the cognitive decline or when the Parkin- son’s disease precedes onset of the NCD, but not both.