16 Nov 0
As we all become comfortable with ICD10, we need to also be aware of changes in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) released by the American Psychiatric Association in 2013. The latest iteration called DSM 5 introduces new terminology for a number of conditions we see in PACE
For example, the word “dementia” is being phased out and replaced with “Major (or Minor) Neurocognitive Impairment”. Minor Cognitive impairment implies evidence of modest cognitive decline from baseline (typically 1-2 standard deviations below on standard testing), but insufficient to interfere with independence (IADL’s) but requiring greater effort, strategies, or accommodation to maintain independence. This would be similar to what is implied by “Mild Cognitive Impairment (MCI).” Major Neurocognitive Impairment implies substantial cognitive decline (≥2 standard deviations below on standard testing) sufficient enough to cause interference with independence (impaired IADL’s or greater).
Criteria for Neurocognitive Impairment have changed slightly as well. In DSM IV, to diagnose dementia there needed to be memory loss plus impairment in an additional domain such as aphasia, apraxia, agnostic or problems with executive function. In DSM 5, there needs to be impairment in two of the domains listed without memory loss necessarily being one of them. The change reflects the fact that certain dementias, notably Frontotemporal Dementia, the dementia can be profound with minimal memory loss.
However, though new to us, ICD10 was originally over 20 years ago as DSM IV was being developed and therefore still uses the word dementia in the “F” chapter that deals with mental/behavioral codes. However, I wanted to draw attention to this terminology change as it is beginning to creep into the literature and medical lexicon. I’ll have more to say on this in future newsletters.