Home Safety Checklist
RSS Feed Print
My diagnosis has been eliminated.
Iris L.
Posted: Wednesday, January 20, 2016 7:53 PM
Joined: 12/15/2011
Posts: 18342


 

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.


Iris L.

 

The_Sun_Still_Rises
Posted: Wednesday, January 20, 2016 9:06 PM
Joined: 7/24/2015
Posts: 3020


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?


lhoagjr
Posted: Wednesday, January 20, 2016 9:49 PM
Joined: 1/24/2015
Posts: 6


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.

Lehman

alz.


Iris L.
Posted: Wednesday, January 20, 2016 10:07 PM
Joined: 12/15/2011
Posts: 18342


Hi, Lehman.  MCI has also been eliminated as a diagnosis.  Best wishes on your clinical trial.

Iris L.


TayB4
Posted: Thursday, January 21, 2016 8:29 AM
Joined: 8/8/2014
Posts: 886


Is MCI now diagnosed as mild neurocognitive disorder?
BillBRNC
Posted: Thursday, January 21, 2016 8:49 AM
Joined: 12/2/2015
Posts: 1018


This looks to me to be a total bunch of junk. I just read up on it. First off, they call this a mental problem, not a disease. They even want to do away with Alzheimer's and dementia. It is just a bunch of people with nothing better to do than dream up new ways to look and sound like they might be intelligent. Why do I have this sinking feeling that we are only going to end up worse off with having psychiatrists who likely don't know enough to come in out of the rain run the show when it comes to Alzheimer's or cognitive impairment. It is a whole lot easier to write us off if we have mental illness than if we have a disease they can actually do something to prevent or treat.
BillBRNC
Posted: Thursday, January 21, 2016 9:06 AM
Joined: 12/2/2015
Posts: 1018


Gosh, I read more. Of interest is the fact that I think it is easier to be diagnosed with Alz under these new standards, but it is a close call. They absolutely call Alz a mental illness. Looks to me like the shrinks are trying to take over the field of dementias and related conditions. It seems to be power play by those with no power, but who are in need of funding. Just my two cents, from someone they say has mental illness.
Iris L.
Posted: Thursday, January 21, 2016 10:25 AM
Joined: 12/15/2011
Posts: 18342


The signs and symptoms of MCI are now classified under minor neurocognitive disorder.

Here is an explanation from a geriatric journal.

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).

Dementia and DSM-5
Changes, Cost, and Confusion

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

I do not see much change between MCI and minor neurocognitive disorder.  But cognitive impairment nos has been completely eliminated.

Iris L.


Iris L.
Posted: Thursday, January 21, 2016 10:52 PM
Joined: 12/15/2011
Posts: 18342


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).

• 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).

 

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,

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

 

 

Iris L.

 

 

 


The_Sun_Still_Rises
Posted: Thursday, January 21, 2016 11:58 PM
Joined: 7/24/2015
Posts: 3020


BillBRNC wrote:
Gosh, I read more. Of interest is the fact that I think it is easier to be diagnosed with Alz under these new standards, but it is a close call. They absolutely call Alz a mental illness. Looks to me like the shrinks are trying to take over the field of dementias and related conditions. It seems to be power play by those with no power, but who are in need of funding. Just my two cents, from someone they say has mental illness.

--------------------------------------------------------------------------------------------------

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.



TayB4
Posted: Friday, January 22, 2016 11:45 AM
Joined: 8/8/2014
Posts: 886


Iris,

Thank you for your post.  It helped me to have a better understanding.


Iris L.
Posted: Friday, January 22, 2016 1:24 PM
Joined: 12/15/2011
Posts: 18342


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.

 

Iris L.


Iris L.
Posted: Friday, January 22, 2016 1:24 PM
Joined: 12/15/2011
Posts: 18342


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.

 

Iris L.


BillBRNC
Posted: Friday, January 22, 2016 1:58 PM
Joined: 12/2/2015
Posts: 1018


I read somewhere yesterday that the Alz Association has refused to recognize this new thing from the psychiatrists. I also asked a couple of primary care docs I know well, and they both said that nobody pays attention to this rating or listing by the shrinks. Don't know if either is true, but that's what I heard and read. I'm still madder than all get out that anyone with an MD next to their name would suggest that Alz is a mental illness, but then that is just me and my dying brain's opinion. Oh, and the same comments apply to MCI as well.
Iris L.
Posted: Friday, January 22, 2016 3:21 PM
Joined: 12/15/2011
Posts: 18342


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.

Iris L.


llee08032
Posted: Saturday, January 23, 2016 9:05 AM
Joined: 5/20/2014
Posts: 4408



Dementia and Mental Illness: Is Dementia a Psychiatric ...

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.


llee08032
Posted: Saturday, January 23, 2016 9:20 AM
Joined: 5/20/2014
Posts: 4408


Iris,

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.


llee08032
Posted: Saturday, January 23, 2016 10:00 AM
Joined: 5/20/2014
Posts: 4408


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.  



Iris L.
Posted: Saturday, January 23, 2016 1:05 PM
Joined: 12/15/2011
Posts: 18342


Thanks for your input and your explanations, Ilee.  This is especially valuable since you are in the field.


If the professionals are confused, and I know they are, how much further confused are the patients and families?  


Can you imagine a PWD trying to explain to the public, "I have neurocognitive disorder."  Or, now we will have to abbreviate PWNCD instead of PWD.



Iris L.

llee08032
Posted: Sunday, January 24, 2016 8:38 AM
Joined: 5/20/2014
Posts: 4408


Iris,

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. 


llee08032
Posted: Sunday, January 24, 2016 8:50 AM
Joined: 5/20/2014
Posts: 4408


One Last Chance for the APA to Make the DSM-5 Safer ...

www.huffingtonpost.com/.../one-last-chance-for-the...
The Huffington Post
Dec 17, 2012 - Suzy Chapman has eloquently summarized how the DSM-5 criteria set for ... minor neurocognitive disorder, adult ADD, somatic, binge eating, ...

llee08032
Posted: Sunday, January 24, 2016 9:18 AM
Joined: 5/20/2014
Posts: 4408


Inter-rater reliability and construct validity easily explained:

Inter-rater reliability - Wikipedia, the free encyclopedia

 

Construct validity is “the degree to which a test measures what it claims, or purports, to be measuring.” In the classical model of testvalidityconstruct validity is one of three main types of validityevidence, alongside content validity and criterion validity.

 

 


llee08032
Posted: Sunday, January 24, 2016 9:23 AM
Joined: 5/20/2014
Posts: 4408


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!


BillBRNC
Posted: Sunday, January 24, 2016 11:17 AM
Joined: 12/2/2015
Posts: 1018


As I wrote before, in addition to these things being written by the losers who don't have anything better to do with their time, this is really a battle by certain groups to take control of the Alz and overall dementia field, as there will be lots of money for research and treatment by the folks who are seen as the specialists in the field, and this represents an effort to redefine Alz and dementia into the backyard of psychiatrists and psychologists. Look, I got nothing against these professionals, as most of them are solid professionals, but the leadership groups of virtually every professional organization sooner or later gets taken over by those out to pad their own nests. Just an opinion, so I'm not suggesting that I'm stating facts. I'm only stating my opinion to be taken for whatever it may or might not be worth. But I'm still really angry about this.
Iris L.
Posted: Sunday, January 24, 2016 12:59 PM
Joined: 12/15/2011
Posts: 18342


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.


Iris L.






llee08032
Posted: Monday, January 25, 2016 6:21 AM
Joined: 5/20/2014
Posts: 4408


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. 

Bill,

The DSM-5 and the changes are a hot mess!


llee08032
Posted: Monday, January 25, 2016 6:26 AM
Joined: 5/20/2014
Posts: 4408


Mental illnesses were coined mental disorders also in an effort to be politically correct and eliminate stigma. IMO dementia is an illness and NOT a disorder. We should know by now to take everything the so called "experts" tell us with a grain of salt. 
BillBRNC
Posted: Monday, January 25, 2016 7:15 AM
Joined: 12/2/2015
Posts: 1018


llee08032 wrote:
Mental illnesses were coined mental disorders also in an effort to be politically correct and eliminate stigma. IMO dementia is an illness and NOT a disorder. We should know by now to take everything the so called "experts" tell us with a grain of salt. 

=======

llee, I'll stop beating the dead horse. You are, of course, correct. Happy Monday.



Iris L.
Posted: Monday, January 25, 2016 9:58 AM
Joined: 12/15/2011
Posts: 18342


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.


Iris L.


griffin_chan16
Posted: Thursday, February 4, 2016 10:37 AM
Joined: 2/4/2016
Posts: 1


Hello Iris,

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 j.chan2@usa.edu? 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 


Mimi S.
Posted: Thursday, February 4, 2016 1:26 PM
Joined: 11/29/2011
Posts: 7027


Please ask Administration for permission
abeautifulwaytolive
Posted: Thursday, February 4, 2016 7:06 PM
Joined: 8/17/2015
Posts: 86


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!


 
× Close Menu