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I Have Alzheimer’s or Another Dementia
My diagnosis has been eliminated.
My diagnosis, cognitive impairment not otherwise specified, has been eliminated in the latest DSM-5.
The definition of "nos" used to refer to cognitive impairment due to the direct physiological effect of a general medical condition.
I now have a neurocognitive disorder.
To me, this is less descriptive. The old definition meant that my cognitive impairments came from a disease or diseases, other than Alzheimer's Disease. Now, there is no indication of where the cognitive impairments come from.
The new definition seems more vague.
The new titles have to do with trying to end the stigma of dementia...by no longer calling it that. There is mild neurocognitive disorder which MCI falls under...and major neurocognitive disorder which is the new fancy name for dementia.
I have actually been thinking lately to stop using the word dementia and start just calling it neurocognitive disorder...as why keep branding out-dated stigma name on self?!
They can also specify what from.
Hope it isn't too hard on you switching names. I find it a bit of a pain having to educate literally everyone tell dx to. But such is life right?
Hi, I am MCI and have been called an early, early which means that I funtion normally.
I am going into a drug study soon and will get a pet SCAN free with the die, I take Melatonin which is a sleep aid and cheep which might slow the progression of Alz.
Hi, Lehman. MCI has also been eliminated as a diagnosis. Best wishes on your clinical trial.
In DSM-5, a minor neurocognitive disorder is defined by the following:
• There is evidence of modest cognitive decline from a previous level of performance in one or more of the domains outlined above based on the concerns of the individual, a knowledgeable informant, or the clinician; and a decline in neurocognitive performance, typically involving test performance in the range of one and two standard deviations below appropriate norms (ie, between the third and 16th percentiles) on formal testing or equivalent clinical evaluation.
• The cognitive deficits are insufficient to interfere with independence (eg, instrumental activities of daily living, like more complex tasks such as paying bills or managing medications, are preserved), but greater effort, compensatory strategies, or accommodation may be required to maintain independence.
• The cognitive deficits do not occur exclusively in the context of a delirium.
• The cognitive deficits are not primarily attributable to another mental disorder (eg, major depressive disorder, schizophrenia).
I do not see much change between MCI and minor neurocognitive disorder. But cognitive impairment nos has been completely eliminated.
These are the standards for major neurocognitive disorder:
In DSM-5, a major neurocognitive disorder is defined by the following:
• There is evidence of substantial cognitive decline from a previous level of performance in one or more of the domains outlined above based on the concerns of the individual, a knowledgeable informant, or the clinician; and a decline in neurocognitive performance, typically involving test performance in the range of two or more standard deviations below appropriate norms (ie, below the third percentile) on formal testing or equivalent clinical evaluation.
• The cognitive deficits are sufficient to interfere with independence (ie, requiring minimal assistance with instrumental activities of daily living).
Note that in diagnosing a minor neurocognitive disorder, one and two standard deviations below appropriate norms is required. In diagnosing a major neurocognitive disorder, two or more standard deviations below appropriate norms are required.
This is from the same site referenced above,
It is bit hard to understand all at first. Dementia, all them...always classed as "mental health" issue. But this because is those doctors than deal with brain, thinking, and cognition. Reg docs deal with blood, bone, organs. But is no chemical imbalance like other mental health issues.
Another compare is Aricept increase neurotransmitter choline...antipsychs increase neurotransmitters serotonin and dopamine.
Other interest...Parkinson's is issue with dopamine.
So you can start to see clinical why is classed this way.
Is long hist stigma mental health anything. People worked to decrease stigma...doctors first and only peop listen...change in DSM5, no long dememtia...now neurocognitive disorder. Now is up to people to further differentiate two...but no longer calling us "sufferers " of this...like we say "sufferers of depression". If you want more be thought of like cancer...time to call us "fighters" like we call peop "cancer fighters". Is no that we no suffer, peop with cancer suffer too...world know that...but world no know that until wording changed.
It is...these diseases...most little understood of them all. Docs no real know what we experien...caregivers no real know...orgs no real know. Is up us tell what is doing us. To hope find peop listen. 1 by 1 peop listen world slow start change.
Thank you for your post. It helped me to have a better understanding.
I'm glad it was helpful to you, Tay. To me, it is as clear as mud. The diagnosis I understood is no longer. Where am I now? I don't know.
Many of the psychiatric diagnoses have biologic etiologies. Example schizophrenia, major depression, autism.
I tried to search to see what the neurologists have to say about the new DSM-5, but I have not found anything yet.
The idea for the changes was to avoid the stigma of the word "dementia", by replacing it with neurocognitive disorder.
The public does not know what neurocognitive disorder is. Nor do most doctors.
My own neurologist still uses cognitive impairment as a diagnosis.
I think it will be a long time before there is acceptance of the changes, because the new terms are so vague.
There are distinct differences from dementia and mental illness, although they may share symptomatic similarities. In the Diagnostic Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, dementia is listed as a neurocognitive disorder. This classification differentiates dementia from such mental disorders as schizophrenia, bipolar disorder and autism and acknowledges that dementia-related disorders are linked to impairment in the functioning of the brain.
NOS (Not Otherwise Specified) has been removed entirely from the DSM 5. Some of the other disorders also bearing the classification of NOS has been changed to unspecified or other.
If anyone is confused about the changes from the previous DSM-IV to the new edition of the DSM-5 do not feel and join the club of Dr's, clinicians, Social Workers, APN (Advanced Practice Nurses) around the world in the psychiatric and psychology field who are also confused.
Many of the professionals in the field don't like the changes either. Training in the field for the DSM-5 started 2 years ago and the confusion seems to indicate that the learning curve will be slow. I am fortunate in that our electronic health record system made the change over to the DSM-5 diagnoses more easy. Nevertheless, the lack of understanding for even the Dr's is predominant.
I do not see that the change over to neurocognitive disorders, mild or major will raise public awareness and whether or not it will reduce stigma remains to be seen.
Thanks for your input and your explanations, Ilee. This is especially valuable since you are in the field.
IMO the term "disorder"for major neurocognitive disorder is too lightweight and minimalistic. The term disorder does not adequately depict progression or the extremely important degenerative features of dementia for either the patient or the novice professional just coming into the field. The brainiacs who developed the new edition of the diagnostic statistical manual should have at the least included neurodegenerative in the terminology. The term "disorder" to me sounds like a disease that can be managed by taking a pill and perhaps going to therapy. I am not buying into the propaganda that the changes will reduce stigma in fact I see the potential for the changes to create more confusion.
The critics of the DSM-5 and many professionals in the field are saying that the DSM-5 has "low inter-rater reliability" and "low construct validity" and have gone so far as to say the DSM-5 is "unsafe." An uproar in the field began in 2011 around the development of the new DSM.
Jack Carney, DSW writes:
So who’s in charge here? Ultimately, of course, the question is moot, since none of these diagnoses has any construct validity, i.e, any scientific basis for its existence. As the president of the APA reminded us only this past December, none of DSM-5’s presumed diagnoses have any biomarkers. Which makes me wonder all the more who the folks are who dream up these diagnoses and what they look like, particularly in the midst of their learned discussions. I imagine they look very much like the bearded and mortar-boarded professors in Horse Feathers who surround Quincy Adams Wagstaff, played by the inimitable Groucho Marx, the new president of Huxley U., as he’s introduced to the university community. There he is, onstage, fending off the academy’s wise men – could they be anything else? – whom he proceeds to tell, “Whatever it is, I’m against it.” Click on it and have a good laugh.
Sorry for the numerous posts but I am taking longer to write and as consequence somehow get signed out in the process and keep losing posts.
BTW the new DSM manual costs on average $200 per copy!
“Whatever it is, I’m against it.” LOL
I can't think of any other serious disease that is called a disorder. Perhaps, eating disorder. Does anyone have an alcoholic disorder, or drug abuse disorder? What about a cancer disorder? AIDS disorder? No, that's a syndrome.
The term major neurocognitive disorder does not relay a sense of seriousness or progressiveness or terminality.
I think Bill has a point about certain people wanting to take control. There is lots of money to be made in the dementia field. Meanwhile, we patients are still on the outside, looking in.
I can't see neurocognitive disorder on a headstone. "LO died of major neurocognitive disorder," instead of "LO died of Alzheimer's Disease." The former sounds like LO had a bad headache.
At least some professionals are fighting back. I predict a revision soon.
I can't think of any other serious disease that is called a disorder. Perhaps, eating disorder. Does anyone have an alcoholic disorder, or drug abuse disorder?
Oh yes, Iris,
That's the other half of the story! Alcoholism in the new manual is classified as alcohol abuse/use disorder, either mild, moderate or severe. Substance abuse disorder is the same mild, moderate or severe. The main feature of alcohol abuse vs dependence as well as, drug abuse vs dependence has been eliminated in the diagnosis.
The DSM-5 and the changes are a hot mess!
llee, I'll stop beating the dead horse. You are, of course, correct. Happy Monday.
Alcohol abuse/use disorder? Substance abuse disorder? What were they thinking???
It is worse than I thought! I can't see anything constructive coming out of these changes.
I am a student from the University of St. Augustine, in the Occupational Therapy program. I was wondering if I could possibly ask you a few questions regarding your diagnosis. If you feel comfortable with this, could you please email me at email@example.com? If not, would it be okay to ask you the questions on this platform?
I hope to hear from you soon, and I look forward to talking with you. Thank you!Justine
I can understand the need to change the stigma of "dementia" as no one wants to be called/seen ad demented. What I don't understand is why they've decided to change cognitive impairment... it doesn't sound bad, and it has a line between that and cognitive disorder (dementia) so that people know the difference.
Now everyone is going to be confused, not very dementia friendly if you ask me!