Dementia Exits: Neurocognitive Disorder Enters
Posted by Dr. Vollmer on June 16, 2013
- Dementia and amnestic disorder became major or mild neurocognitive disorder (major NCD, or mild NCD). DSM-5 has a new list of neurocognitive domains. New separate criteria are now presented” for major or mild NCD due to various conditions. Substance/medication-induced NCD and unspecified NCD are new diagnoses.
So, mental retardation is now intellectual disability and dementia is now a neurocognitive disorder. Old wine in new bottles. Mild Cognitive Impairment (MCI), has become mild NCD. Ditto. Why are we changing nomenclature? The cynic in me says, the ten years to produce DSM 5 had to yield change, whether it was good, bad or lateral. The more generous person in me says that it makes sense to broaden the notion that as one ages, one’s brain declines, sometimes at a slow rate, consistent with the aging process, and sometimes, tragically speaking, the brain has an accelerated decline, a phenomena we used to call dementia and now we call NCD. This accelerated decline has rumblings which perceptive patients and family members detect, and now we can label those rumblings as mild NCD. The theme of DSM 5 seems to be to create umbrellas and then deal with the details later. There is the autistic spectrum umbrella, the trauma and stressor related disorders umbrella, the obsessive compulsive umbrella and the neurocognitive decline or disorder umbrella. It reminds me of cleaning up a messy room, the first step is to make piles. There is the pile you want to give away. There is the pile to keep and the pile you are not sure what to do with. Breaking things down into piles makes the process of change less overwhelming. As such, DSM 5 feels like a temporary clean-up of psychiatry, leading the way to a more sophisticated understanding of the brain, downstream. Now, I want to take issue with the word neurocognitive. What is the difference between cognitive and neurocognitive? Is that not redundant? Sometimes cleaning up makes things messier.