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New DSM guidelines coming out next year.
Mimi S.
Posted: Friday, November 9, 2012 3:52 PM
Joined: 11/29/2011
Posts: 7027


http://www.agingwellmag.com/archive/110612p12.shtml

Sophisticated reading, but interesting for some.


Lisa428
Posted: Saturday, November 10, 2012 10:52 AM
Joined: 12/5/2011
Posts: 795


Thanks Mimi,

 

But I can't click on it.

 

Help????

 

Lisa


Mimi S.
Posted: Saturday, November 10, 2012 1:47 PM
Joined: 11/29/2011
Posts: 7027


Lisa, Unless it's in blue, you can't. Iris knows how and puts it that way. I don't know how.

 So cut and paste.




John50
Posted: Thursday, November 15, 2012 1:12 AM
Joined: 3/14/2012
Posts: 140


http://to.ly/hb

this is a shortcut I created to the same place. If you highlight any link and then push Ctrl key in lower left of keyboard and the c letter key it will copy the link and then go to another tab in your browser and click in the address bar, remove anything there and press Ctrl (control) key and the V key it will paste that in the address bar so you can go to that site. I hope that is clear enough for you to follow. Sorry. I couldn't figure out any option to do anything different on posting a link.

ALSO, in case you don't know how to highlight what you want to copy hold down the left mouse button and use the cursor to turn the area blue or highlighted.


Iris L.
Posted: Thursday, November 15, 2012 1:40 AM
Joined: 12/15/2011
Posts: 18354


I'm sorry I missed this post. I was distracted by several heavy-duty problems popping up in my life.

This article looks very interesting.

Here is a clickable link:

http://www.agingwellmag.com/archive/110612p12.shtml 

Iris L.

Mimi S.
Posted: Thursday, November 15, 2012 3:29 PM
Joined: 11/29/2011
Posts: 7027


Hi Iris, Glad you found it. I posted it somewhere with a few comments.

I know Jim. He's from near-by in NE PA, very active in the Alz. community. 

I don't like that they are phasing out the term dementia, because of its bad connotations, but are leaving in Alzheimer's.

I can still recall waiting for the verdict after all my failures during testing. I was prepared for the word dementia, but the AD tag didn't sit well!

The best part is no more dxs after a 5 minute mini-mental. You must have a complete diagnostic work up before given a diagnosis. Do you remember if blood tests and brain scans were part of the requirement? I don't.


dayn2nite
Posted: Saturday, November 17, 2012 2:30 PM
Joined: 12/18/2011
Posts: 3097


I do not see any imaging studies required for diagnosis.

 

This will be a big blow to the "early diagnosis" crowd - the additional cognitive testing will add more appointments and more cost to the patient and insurer, making it very likely that people resistant to such a diagnosis will not complete the testing, and will only be seen later in the disease when circumstances force them to be seen.

 

So again, we will have lots of people diagnosed in mid to late stage. 


Iris L.
Posted: Saturday, November 17, 2012 3:26 PM
Joined: 12/15/2011
Posts: 18354


The first time I had neurocognitive testing in 2003 it cost me $2000 cash and the dx was depression and cognitive disorder.  Nothing was really done until 2009.  This time the neurocognitive testing done by a different neuropsychologist was covered by Medicare.  My portion was ~$200.  The diagnosis was depression and cognitive impairment nos.  I finally got some helpful medications, which were Exelon patch and Namenda.  The multiple antidepressants I took did not help my cognition at all.

The entire area of diagnosis and treatment of early dementia patients is fraught with incompetence.  I complained of a significant decline nine years ago.  Fortunately I have a good neurologist who began treatment albeit several years later.  What will happen when so many early patients are undiagnosed for years until it is too late for medications to help them?  Just put them in nursing homes?

Iris L.

Iris L.
Posted: Saturday, November 17, 2012 3:56 PM
Joined: 12/15/2011
Posts: 18354


"It is crucial that professionals in the field of aging are prepared to sufficiently explain the concepts to the population in general who, with the correct guidance, will continue to age well."

I read the entire article.  Apparently the DSM-5 and the Alzhiemer's Association will be using different terminology. 

I anticipate lots of confusion for a long time, especially from professionals who even now have a hard time explaining to patients and family members what is happening with their LOs. 

Why make the distinction between MINOR neurocognitive disorder and MAJOR neurocognitive disorder?  I never liked the term mild cognitive impairment.  A disorder that is mild or MINOR does not disrupt your entire life!

I prefer the terms EARLY neurocognitive disorder versus MID or LATE neurocognitive disorder.  Then the patient and family know that there is something significant wrong and that something needs to be done about it.

I've been complaining of significant neurocognitive impairment in my daily life for years.  I'm still being told by doctors that "nothing is wrong with you" because I can relate my history and I know the date and season and dress appropriately. 

This is making my head hurt.  I can imagine the new patients who will visit these message boards with their questions re: these new terminologies.  What will we say to them?

Iris L.

Mimi S.
Posted: Saturday, November 17, 2012 4:22 PM
Joined: 11/29/2011
Posts: 7027


Day to night:

 

The complete diagnostic bundle must be done. I've known too many local people diagnosed with AD after a 5 min. mini mental. A simple blood test might have shown a Vitamin deficiency, or a brain scan shown encephalitis.

 

I was over 65 and so medicare plus my supplementary insurance paid all. I didn't pay a penny.

 

I'm going to have to read Jim's article again. Of course, as I wrote on another thread, getting rid of the word dementia because it frightens people and leaving Alzheimer's ??????

 


dayn2nite
Posted: Sunday, November 18, 2012 4:34 PM
Joined: 12/18/2011
Posts: 3097


Mimi S. wrote:

Day to night:

 

The complete diagnostic bundle must be done. I've known too many local people diagnosed with AD after a 5 min. mini mental. A simple blood test might have shown a Vitamin deficiency, or a brain scan shown encephalitis.

 

I was over 65 and so medicare plus my supplementary insurance paid all. I didn't pay a penny.

 

I'm going to have to read Jim's article again. Of course, as I wrote on another thread, getting rid of the word dementia because it frightens people and leaving Alzheimer's ??????

 

 


I was stating that there is nothing in the new guidelines that requires any imaging to be done.

 

Not everyone can afford a Medicare supplement, what do those people do?  Agree to pay 20% of all this testing? 

 

In an ideal world, everyone would follow up with their doctors and get every test done.  In reality, people who fear having the disease will merely ignore all recommendations and only in a crisis will they present again to a doctor.


Mimi S.
Posted: Sunday, November 18, 2012 8:01 PM
Joined: 11/29/2011
Posts: 7027


And if we get into a discussion of the difference money makes in the medical care one is able to get, we are getting into politics. 

 

One side believes that all deserve good medical care. Others believe that if you weren't industrious enough to make the money required for such, it's your fault and tough.

I believe that all should be eligible for state of the art diagnosis and treatment. If one wants a private room, pay extra.


dayn2nite
Posted: Sunday, November 18, 2012 8:48 PM
Joined: 12/18/2011
Posts: 3097


I wasn't bringing politics into it at all.

 

The bottom line is the process of diagnosis remains confusing and is based on all physicians understanding what constitutes minor and major neurocognitive disorder.  They don't even understand what dementia is yet.

 

It also remains that those people who probably need to be diagnosed the most (who are having difficulty functioning day-to-day) are resistant to seeing a doctor anyway and certainly will not go for repeated appointments for testing.


Iris L.
Posted: Monday, November 19, 2012 12:42 AM
Joined: 12/15/2011
Posts: 18354


The new guidelines will be confusing to the doctors and other professionals. 

There is already too much confusion over what constitutes a thorough cognitive decline work-up. 

The author stated as much in her article.

Iris L.

Mimi S.
Posted: Monday, November 19, 2012 9:12 AM
Joined: 11/29/2011
Posts: 7027


Day2 nite. My apology. I didn't mean to imply that you brought politics into the discussion. I did.

 

By the time a person is resistant to seeing a doctor, nothing is wrong, they are probably past Early Stage. Conventional thought seems to say that's the point where the most can be down to elongate that downward slope.

 

Personally, I like getting rid of mild cognitive impairment designation. However, the new will also be confusing, hopefully just at first.

 

The thing I don't like about MCI is every physician seems to have their own definition of what it is. The most common seems to say if you can live by yourself you just have MCI and most of them seems to add: while it's MCI no meds are necessary. We'll wait until you're worse. How about rethinking that: what can we do now, to prolong this phase?

 

And we need to find out why some MCI patients never progress to full blown AD and others do. Can we distinguish between the two groups by the use of some of the biomarkers we now have?


Iris L.
Posted: Monday, November 19, 2012 11:32 AM
Joined: 12/15/2011
Posts: 18354


Mimi is absolutely correct.  I attended a seminar in which this concept was presented--how to determine which MCI patients are truly EOAD patients and how to use biomarkers to discover them.  Right now this is in the reseach stage, not yet in clinical use with the doctors in their offices and hospitals.

More attention needs to be focused in this area.

Iris L.