Magazine article Clinical Psychiatry News

'Major Neurocognitive Disorder' Is the Old 'Dementia'

Magazine article Clinical Psychiatry News

'Major Neurocognitive Disorder' Is the Old 'Dementia'

Article excerpt


ORLANDO -- This May, the hallowed term "dementia" is supposed to be tossed onto the scrapheap of discarded psychiatric nomenclature, replaced by "major neurocognitive disorder."

When the DSM-5 was released in May 2013, the American Psychiatric Association gave a year's grace period for the world to absorb the changes before they take effect. "Dementia" was replaced in the DSM-5 because the term was deemed stigmatizing; the rough translation from the Latin roots is "loss of mind." Acknowledging that old habits die hard, however, the DSM-5 also states that use of the term is not precluded "where that term is standard."

The old DSM-IV category of delirium, dementia, and amnestic and other cognitive disorders has been replaced in the DSM-5 by the neurocognitive disorders category. Major or mild neurocognitive disorder from Alzheimer's disease is included under this new category. At the annual meeting of the American Association for Geriatric Psychiatry, Dr. W Vaughn McCall and Dr. George T. Grossberg highlighted the changes.

"Major neurocognitive disorder" is a syndrome, which includes what was formerly known as dementia. The distinction between it and the new "mild neurocognitive disorder," previously known as mild cognitive impairment or MCI, is necessarily somewhat arbitrary. Major neurocognitive disorder requires "significant" cognitive decline in one or more cognitive domains as noted by the patient, family member, or clinician along with objective evidence of "substantial" impaired cognition compared to normative test values.

"In contrast, the requirements for mild neurocognitive disorder are 'mild' cognitive decline observed by patient, family member, or clinician and 'modest' impairment on testing, explained Dr. McCall, professor of psychiatry and health behavior at the Medical College of Georgia, Augusta.

Dr. Grossberg offered two practical tips in drawing the distinction between major and mild neurocognitive disorder. One is whether the cognitive deficits are sufficiently limited in scope that the patient is still able to function independently in everyday activities. "If they're not, I'm moving from [mild] to major," said Dr. Grossberg, professor of psychiatry, neurobiology, and internal medicine at Saint Louis University.

Also, if neuropsychologic testing focusing on memory is performed, Dr. Grossberg wants to see at least a one standard deviation below the expected age- and education-adjusted norms before calling it objective evidence of "substantial" impaired cognition rising to the level of major neurocognitive disorder. …

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