Alzheimer disease
Meaning of alzheimer disease: For the purposes of this Statement of Principles, Alzheimer disease means a central nervous system neurodegenerative disorder meeting the following clinical diagnostic criteria (derived from DSM-5): A. Evidence of major neurocognitive disorder or mild neurocognitive disorder. B. There is insidious onset and gradual progression of impairment in one or more cognitive domains. There is steady progressive, gradual decline in cognition, without extended plateaus. C. There is either: (i) evidence of a causative Alzheimer disease genetic mutation from family history or genetic testing; or (ii) clear evidence of decline in memory and learning, except where there are atypical presentations of Alzheimer disease. D. The cognitive deficits in Criteria A, B and C are not primarily due to any of the following: (i) delirium; (ii) another mental disorder (for example, major depressive disorder, schizophrenia); or (iii) cerebrovascular disease, another neurodegenerative disease (for example, neurocognitive disorder with Lewy bodies, Parkinson's disease, Huntington's chorea), brain tumour, subdural haematoma, the effects of a substance, or systemic disorder (for example, hypothyroidism, vitamin B12
Reasonable Hypothesis (RH) — Statement of Principles No. 33 of 2019
At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting Alzheimer disease or death from Alzheimer disease with the circumstances of a person's relevant service:
- (1)having moderate to severe traumatic brain injury at least ten years before the clinical onset of Alzheimer disease;
- (2)smoking at least 20 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of Alzheimer disease, and where smoking has ceased, the clinical onset of Alzheimer disease has occurred within five years of cessation;
Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.
- (3)undergoing a course of therapeutic radiation for cancer, where the brain was in the field of radiation, at least ten years before the clinical onset of Alzheimer disease;
- (4)having received a cumulative dose of at least ten microTesla-years of extremely low frequency electromagnetic field (ELF-EMF), at least ten years before the clinical onset of Alzheimer disease;
Note: cumulative dose and extremely low frequency electromagnetic field (ELF-EMF) are defined in the Schedule 1 - Dictionary.
- (5)being obese for at least ten years before the clinical onset of Alzheimer disease;
Note: being obese is defined in the Schedule 1 - Dictionary.
- (6)having dyslipidaemia before the age of 65 years and at least ten years before the clinical onset of Alzheimer disease;
Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.
- (7)having diabetes mellitus for at least the ten years before the clinical onset of Alzheimer disease;
- (8)having hypertension at least ten years before the clinical onset of Alzheimer disease;
- (9)having hyperhomocysteinaemia at least ten years before the clinical onset of Alzheimer disease;
Note: hyperhomocysteinaemia is defined in the Schedule 1 - Dictionary.
- (10)having major depressive disorder at least ten years before the clinical onset of Alzheimer disease;
- (11)having posttraumatic stress disorder at least ten years before the clinical onset of Alzheimer disease;
- (12)an inability to undertake any physical activity greater than three METs for at least five years, at least ten years before the clinical onset of Alzheimer disease;
Note: MET is defined in the Schedule 1 - Dictionary.
- (13)being treated with an anticholinergic drug from the specified list of anticholinergic drugs, at the time of the clinical worsening of Alzheimer disease;
Note: specified list of anticholinergic drugs is defined in the Schedule 1 - Dictionary.
- (14)inability to obtain appropriate clinical management for Alzheimer disease;
Aggravation-only factors: the factors in subsections 9(13) and 9(14) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
Balance of Probabilities (BoP) — Statement of Principles No. 34 of 2019
8 factors
At least one of the following factors must exist before it can be said that, on the balance of probabilities, Alzheimer disease or death from Alzheimer disease is connected with the circumstances of a person's relevant service:
- (1)smoking at least 20 pack-years of cigarettes, or the equivalent thereof in other tobacco products, before the clinical onset of Alzheimer disease, and where smoking has ceased, the clinical onset of Alzheimer disease has occurred within five years of cessation;
Note: pack-years of cigarettes, or the equivalent thereof in other tobacco products is defined in the Schedule 1 - Dictionary.
- (2)undergoing a course of therapeutic radiation for cancer, where the brain was in the field of radiation, at least ten years before the clinical onset of Alzheimer disease;
- (3)being obese for at least ten years before the clinical onset of Alzheimer disease;
Note: being obese is defined in the Schedule 1 - Dictionary.
- (4)having dyslipidaemia before the age of 65 years and at least ten years before the clinical onset of Alzheimer disease;
Note: dyslipidaemia is defined in the Schedule 1 - Dictionary.
- (5)having diabetes mellitus for at least the ten years before the clinical onset of Alzheimer disease;
- (6)having hyperhomocysteinaemia at least ten years before the clinical onset of Alzheimer disease;
Note: hyperhomocysteinaemia is defined in the Schedule 1 - Dictionary.
- (7)an inability to undertake any physical activity greater than three METs for at least five years, at least ten years before the clinical onset of Alzheimer disease;
Note: MET is defined in the Schedule 1 - Dictionary.
- (8)inability to obtain appropriate clinical management for Alzheimer disease;
Aggravation-only factors: the factors in subsection 9(8) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.
