Major Neurocognitive Disorder.

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This is a post about the DSM V. If you aren’t familiar with the American Psychological Association’s model of classifying disorders, this post probably won’t be of interest to you. Otherwise, read on!

The DSM V came out a while back and, as expected, caused a lot of clamor in the psych world. The DSM doesn’t get revised very frequently (the first edition came out in 1952, and, unless you’re counting a few revision texts, we are only on the 5th one.) The biggest uproar that this version received was about the classification changes related to Autism.

My issue, however, is really with regards to the changes made to “dementia” in the text. The dementia chapter in the DSM IV was called “Delirium, Dementia, Amnestic, and Other Cognitive Disorders.” The chapter in the DSM V is now called “Major Neurocognitive Disorders.”

Dementia is now being called a “neurocognitive disorder,” as if it weren’t confusing enough. There are, apparently, a few reasons for this change in wording. For one, the APA decided that the word “dementia” had too much stigma attached to it. Additionally, the APA noted that memory loss is not necessarily the first domain affected by dementia, so they wanted a phrase that would encompass more than just memory problems. Although both of these things are true, I feel that this major change is a major mistake. 

There are also “minor neurocognitive disorders” listed in this chapter. I can only imagine that this phrase refers mostly to what we used to call “MCI” or Mild Cognitive Impairment, which is often a stepping stone to dementia. This definitely adds to the confusion. 

After a physician diagnoses a major neurocognitive disorder, they must then decide what type of disorder it is. Lewy Body? Alzheimer’s? Traumatic Brain Injury? The DSM V lists a number of potential dementias.

Dementia is confusing enough as it is. Most people don’t even realize that Alzheimer’s is merely a type of dementia. Now we’ve added, I feel, a lot more confusion to this already challenging topic. I really believe that people were finally starting to learn more about dementia, but now the APA is going to make that harder. I don’t think that “major neurocognitive disorder” is going to catch on quickly, especially outside of the medical field. I guess we will see. 

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Rachael Wonderlin is an internationally-recognized dementia care expert and consultant. She has a Master’s in Gerontology and is the author of three published books with Johns Hopkins University Press. Rachael owns Dementia By Day, a dementia care consulting and education company.

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