Shirah Vollmer MD

The Musings of Dr. Vollmer

Dementia Exits: Neurocognitive Disorder Enters

Posted by Dr. Vollmer on June 16, 2013

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.

4 Responses to “Dementia Exits: Neurocognitive Disorder Enters”

  1. Jon said

    With regard to cleaning up, one must always consider the very powerful Second Law of Thermodynamics. Loosely stated, it says that messes increase. More accurately stated, it says that in a closed system, entropy will not decrease. Following form this statement is the concept that it takes both a trashcan and an influx of energy to clean something up. If we take your concept that the DSM-5 is a temporary clean up of psychiatry, then both a large trash can and much intellectual (psychic?) energy will need to be used to have the improved DSM-5.1 or DSM-6 become what it needs to be.

    As for cognitive vs. neurocognitive, yes it does seem to be from the Department of Redundancy Department. But, perhaps, repetition is a good thing. Repetition is a good thing. However, quoting the ubiquitous Wikipedia:

    • “Neurocognitive functions are cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain substrate layers of neurological matrix at the cellular molecular level.”

    • “In science, cognition is a group of mental processes that includes attention, memory, producing and understanding language, learning, reasoning, problem solving, and decision making. Various disciplines, such as psychology, philosophy, linguistics, and computer science all study cognition.”

    Thus, it seems that neurocognitive is focused more on specific brain functions while cognitive is a more general term dealing with a functioning brain.

  2. Shelly said

    Ok, so let’s say we put everything under umbrellas. What does this mean practically for your profession. Who uses the DSM? Psychiatrists, therapists, psychologists, social workers, insurance companies. Does it help or hinder? Does it help people get more services? Does it prevent people from getting the help they need? That’s the bottom line.

    • As usual, you bring up a good point. There is the International Classification of Disease (ICD) which is used throughout the world, which, generally speaking, trumps the DSM. Having said that, the DSM can be used by insurance companies and educational institutions to determine benefits. Rest assured that without objective data, subjective diagnoses are vulnerable to inappropriate usage. That is a difficult part of my profession, speaking both as a physician and as a psychiatrist.

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