Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Alzheimer's Disease


Related Terms

  • Alzheimer's Sclerosis
  • Presenile Dementia
  • Senile Dementia

Differential Diagnosis

  • Alcoholic dementia
  • Aphasia
  • Cortical basal ganglionic degeneration
  • Dementia in motor neuron disease
  • Dementia with Lewy bodies (DLB)
  • Depression
  • Drug overdose
  • Frontal and temporal lobe dementia
  • Hypothyroidism
  • Lyme disease
  • Multiinfarct dementia
  • Neurosyphilis
  • Parkinson's disease
  • Parkinson's-plus syndromes
  • Prion-related diseases
  • Thyroid disease
  • Vitamin deficiency
  • Wilson's disease

Specialists

  • Neurologist
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Psychiatrist

Comorbid Conditions

Factors Influencing Duration

Factors that may influence the length of disability include the general health and fitness of the individual before being diagnosed with Alzheimer's disease, evidence of pre-existing diseases affecting any of the major body systems (e.g., diabetes, chronic obstructive lung disease, and chronic heart disease), diagnosis of an acute disease or condition that requires surgery, the individual's mental and emotional stability, access to rehabilitation facilities and home health care, and the strength of the individual's support system.

Medical Codes

ICD-9-CM:
331.0 - Cerebral Degenerations, Other; Alzheimers Disease

Overview

Alzheimer's disease (AD) is a progressive, irreversible, degenerative organic brain disorder (dementia) characterized by loss of memory (subtle deterioration progressing to profound memory loss), loss of mental powers (the ability to think, understand, reason, learn, and solve problems), personality changes, and an increasing inability to carry out the activities of daily living (eating, bathing, grooming, dressing, and toileting).

The cause of the disease remains unclear. Acetylcholine, a neurotransmitter thought to be involved in learning and memory, is severely diminished in the brains of individuals with Alzheimer's disease. The reason for this condition is unknown. In the past, it was believed that excessive levels of aluminum contributed to the development of Alzheimer's disease, but today there is no conclusive evidence to show that individuals with aluminum toxicity have a greater incidence of the disease.

Age is the most significant risk factor for the onset of Alzheimer's disease. Scientists believe individuals who develop signs of Alzheimer's before age 65 (early onset) have a variation of the disease that is genetically transmitted across multiple generations of the same family. Children who inherit any one of three genes (APP, Presenlin-1, or Presenlin-2) will develop the disease before age 65 and as early as their late twenties. A fourth gene (Apoe4) is a risk factor for early onset Alzheimer's, but not everyone who inherits this gene develops the disease later in life. The genetic variation of Alzheimer's, however, occurs in under 10% of all individuals with the disorder (Kuljis).

Researchers are looking for a connection between Down syndrome and Alzheimer's disease. Individuals with Down syndrome exhibit symptoms of Alzheimer's at a much younger age than the general population (late forties or early fifties), and nearly all individuals with Down syndrome who live past the age of 60 develop the disease. At autopsy, the degenerative changes in the brains of individuals with Down syndrome are almost identical to the changes seen in the brains of individuals with Alzheimer's disease. Previous head trauma or central nervous system infection may also predispose an individual to develop Alzheimer's later in life.

Alzheimer's disease is the fourth leading cause of death among US adults, following heart disease, cancer, and stroke. It is now recognized as a major health problem in the US, particularly in individuals over the age of 65 (late onset). The number of individuals diagnosed with Alzheimer's disease will increase dramatically in the next 10 to 20 years as the population born after the end of World War II begins to reach the age of 65.

Incidence and Prevalence: Among individuals over 65, 14% have AD; among those older than 80, the prevalence is 40%; the worldwide incidence is similar to that in western countries (Kuljis).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Women have an increased risk of developing AD (Kuljis).

Source: Medical Disability Advisor



Diagnosis

History: Because individuals with Alzheimer's are often unaware of changes in their mental powers or behavior, their families and friends become key factors in relating histories during the diagnostic process. The cognitive symptoms of Alzheimer's disease include memory loss (the inability to recall recent events or new information), disorientation, confusion, and problems with reasoning and thinking. Behavioral symptoms include agitation, anxiety, delusions, depression, hallucinations, insomnia, and wandering.

The DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision), requires the following for a diagnosis of Alzheimer's disease: an individual must experience memory loss that affects job skills, as well as one or more of the following symptoms: problems with physical activities (apraxia), problems with language (aphasia), problems with registering things presented to them (agnosia), or problems with executive function (connecting events, abstract thinking, organization, putting things in order). These deficits cause the patient to have difficulty functioning socially and at work. The symptoms occur over a long period of time and represent a stepwise mental decline. They cannot be explained by neurological disorders such as Parkinson's or Huntington's disease, medical conditions that lead to dementia such as vitamin B-12 deficiency, illicit drug use, major mental disorders, or delirium. In individuals with Down syndrome, behavioral symptoms are sometimes more accurate warning signs of Alzheimer's disease than cognitive symptoms. The most easily detected symptoms in individuals with Down syndrome are a sudden change in the ability to complete the activities of daily living, withdrawal from daily and social routines, aggression, frustration, and lack of interest in regular activities.

Physical exam: The diagnosis of Alzheimer's can only be confirmed by postmortem examination of brain tissue. The brain afflicted with Alzheimer's exhibits significant atrophy, the presence of sticky protein plaques outside the nerve cells, and tangles (neurofibrillary tangles). For purposes of treatment, ruling out all other possible conditions that can cause mental impairment must be done before diagnosing for Alzheimer's disease. In addition to a complete physical exam, psychological and neurological exams may also be performed. Depending on how advanced the disease is, physical examination can confirm some of the reported symptoms.

Tests: There are no definitive tests to positively diagnose Alzheimer's. Laboratory tests such as a complete blood count, cobalamin, liver enzymes, cortisol level in the blood, analysis of cerebrospinal fluid from a lumbar puncture and rapid plasma reagin (RPR) are all helpful in ruling out other etiologies of dementia. CT and MRI scans are usually performed and may reveal shrinkage of the brain (cerebral atrophy) and enlarged cavities (ventricles), but these signs are also found in other forms of dementia. Single photon emission computer tomography (SPECT) is used to measure the rate of brain cell metabolism. PET Scans and SPECT scabs are sometimes used to asses brain metabolism. An electroencephalogram (EEG) can establish the diagnosis as well. Neuropsychological testing such as the Mini-Mental Status Examination (MMSE) is performed to determine the extent of cognitive dysfunction. Additional tests that may be performed to rule out other diseases include blood tests, a chest x-ray, and thyroid function tests.

Source: Medical Disability Advisor



Treatment

The pharmaceutical treatment of Alzheimer's disease is aimed at improving and controlling the decline in mental powers (cognition) and the undesirable behavioral symptoms that the individual may exhibit. Several anticholinesterase inhibitors have shown to slow the decline in cognitive function during the early or middle stages of Alzheimer's. Other helpful drugs are on the horizon, but some of these drugs are toxic to the liver and require frequent laboratory monitoring of liver function. N-methyl-D-aspartate (NMDA) antagonist has recently received approval for the treatment of moderate and severe stages of AD.

Unfortunately, no pharmaceutical treatments are available for the disease's late stages. Studies have shown that estrogen may help protect against development of Alzheimer's and may slow progression in those who already have the disease. Any depression that may accompany Alzheimer's can be treated with antidepressants, particularly the newer selective-serotonin re-uptake inhibitors. Other treatment (supportive rather than therapeutic) is intended to maintain functional ability for as long as possible, meet personal care needs, and maintain a safe environment with a minimum of injuries.

Current research focuses on early diagnosis and treatment. A vaccine that may significantly delay the onset of Alzheimer's is in its first human trials. Individuals treated for other diseases with nonsteroidal anti-inflammatory drugs (NSAIDs) seem to have a lower risk of developing Alzheimer's. Researchers are interested in the role these drugs could play in reducing the risk of developing Alzheimer's disease.

In most cases, individuals with Alzheimer's disease do not noticeably improve but rather gradually deteriorate as they lose their mental and physical capacities. The goal of treatment and rehabilitation is to support the individual in performing daily activities and to forestall further deterioration in memory and mental powers for as long as possible. For those individuals who are sufficiently aware of their situation, early diagnosis offers an opportunity to plan retirement from work, arrange for management of their finances, and discuss the management of future medical problems while they are still competent. Skilled, supportive care can improve the quality of the individual's life.

Source: Medical Disability Advisor



Prognosis

The general course of Alzheimer's disease, from the mild stages to death, averages 8 to 10 years. The three stages that individuals with Alzheimer's predictably move through are mild, moderate, and severe. During the mild stage, the individual may seem normal to the casual observer but is beginning to have a decline in memory and mental powers. In the middle stage, the individual is obviously impaired and requires a caregiver's supervision during the performance of daily activities. Delusions, agitation, pacing, and wandering often develop during this stage. In the severe stage, the individual is unable to communicate, cannot recognize family members, has bowel and bladder incontinence, and is unable to perform the activities of daily living. Death usually occurs as a result of other disease or injury brought on by the individual's weakened condition.

Source: Medical Disability Advisor



Rehabilitation

Individuals with Alzheimer's disease may require occupational therapy to help compensate for cognitive deficits. This type of therapy focuses on maintaining realistic caregiver goals and maximizing safety in the home. Individuals and their caregivers learn to structure the individual's environment to allow for greater independence. Individuals can perform daily tasks better if the environment does not change and the tasks are performed as part of the same daily routine.

Individuals aware of their memory loss can compensate for forgetfulness by writing notes to remember daily tasks. Caregivers also learn to provide time cues such as a clock. Occupational therapy does not ordinarily focus on teaching new skills to individuals with Alzheimer's disease because this disease decreases problem-solving ability.

Individuals aware of their memory loss may require psychological counseling to help treat the depression that often accompanies this disease. Group counseling may be necessary for individuals and their families to address the anger and aggressiveness that individuals with Alzheimer's disease often exhibit. Support groups can address individuals' concerns about their prognosis.

Source: Medical Disability Advisor



Complications

Individuals with Alzheimer's disease are susceptible to all the acute and chronic diseases and conditions common to the elderly and physically disabled population, including cancer, heart and vascular disease, stroke, blood clots, choking and aspiration, infectious disease, diabetes, respiratory disease, and neuromuscular complications associated with decreased mobility. Since these individuals are often unable to communicate health symptoms, caregivers must be responsible for alerting the individual's physician to changes in behavior, movement, consciousness, and bodily functions.

Individuals with Alzheimer's are also at increased risk for injury associated with impaired judgment, violence directed at others (as a result of neurologic changes, sensory overload, lack of appropriate coping mechanisms, and an unfamiliar environment), gait instability, muscle weakness, and sensory and perceptual changes. Recurrent falls are commonly seen in later stages. If surgical intervention is required for any of these conditions, the individual is subject to the usual surgical complications (infection, adverse reaction to the anesthetic, pneumonia, and poor wound closure). The tendency to wander away from caretakers and familiar surroundings puts these individuals at risk for traumatic injury, drowning, victimization, and death from unnatural causes.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Very early in the course of the disease, limited work activities may be possible, depending on the nature of the work and the individual's degree of deficiency in areas critical to the performance of a particular job. In most cases, however, a plan for retirement may need to be arranged fairly soon after the diagnosis of Alzheimer's disease.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was a presumptive diagnosis of Alzheimer's made?
  • Were underlying medical and psychological conditions identified or ruled out?
  • Is caregiver diligent in alerting individual's physician to changes in behavior, movement, consciousness, and bodily functions?
  • Has individual experienced health-related complications?
  • How are coexisting conditions being addressed?

Regarding treatment:

  • To what extent is individual impaired?
  • Can individual and/or family members still adequately care for needs? Would family benefit from social services in making long-range plans? Has family accessed appropriate services to care for individual?

Regarding prognosis:

  • Are individual and family realistic in planning for the future?
  • Will family be able to care for individual in home?
  • Were other options investigated?

Source: Medical Disability Advisor



References

Cited

Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Kuljis, Rodrigo O. "Alzheimer Disease." eMedicine. Eds. Joseph Quinn, et al. 13 Oct. 2004. Medscape. 22 Oct. 2004 <http://emedicine.com/neuro/topic13.htm>.

Source: Medical Disability Advisor






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