DSM-5's New Term: Neurocognitive Disorders


DSM-5's New Term: Neurocognitive Disorders
In 2013, the American Psychiatric Association (APA) announced a major change regarding dementia when they released DSM-5. The noticeable change was that the dementia chapter in DSM-5 is titled "Neurocognitive Disorders", whereas in DSM-IV it was titled "Delirium, Dementia, Amnestic, and Other Cognitive Disorders."

The new term "neurocognitive disorder" attempts to help reduce the stigma associated with both the word dementia and the conditions that it refers to. There are also changes to the criteria for delirium. The new diagnostic criteria for major neurocognitive disorder and minor neurocognitive disorder focus less on memory impairment than the former DSM-IV criteria for dementia did. This change regarding memory impairment allows for variables associated with conditions like frontotemporal dementia (FTD), which sometimes begin with declines in speech and language usage ability, and do not necessarily affect memory immediately.

The differences between the major neurocognitive and minor neurocognitive disorders concern whether the decline is modest or substantial, whether the cognitive deficits interfere with independence and whether there is another mental disorder that the changes can be attributed to. Both neurocognitive disorders presume no delirium is present.

After concluding that the patient meets criteria for one of the neurocognitive disorders, the healthcare provider can then decide on what subtype is appropriate. The subtypes of neurocognitive disorder correspond to the previous types of dementia. The listed subtypes are neurocognitive disorder due to Alzheimer's disease, vascular neurocognitive disorder, frontotemporal neurocognitive disorder, neurocognitive disorder due to traumatic brain injury, Lewy body dementia, Parkinson's disease, or HIV infection, substance-induced neurocognitive disorder, neurocognitive disorder due to Huntington's disease or to another medical condition, and neurocognitive disorder not elsewhere classified.

Although this change was presented in 2013, the public continues to use the terms dementia and Alzheimer's disease and there continues to be some confusion over the appropriate terminology.

Healthcare providers will need to be educated on the criteria and how to correctly diagnose the disorder.

Another point of confusion stems from conflicting usage of terms by other reference guides. A good example of this is the Alzheimer's Association and the National Institute on Aging 2011 guideline, which utilize the terms dementia and mild cognitive impairment (MCI) that do not exist in DSM-5.

To read more about the changes from DSM-5, here are several links to articles written by Today's Geriatric Medicine and the National Institute of Aging.

Today's Geriatric Medicine
National Institute of Aging
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