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New DSM-V guidelines for dementia characterisation

A new version of the psychology ‘bible’ released in May 2013, has had implications for people with dementia.

Dementia is now called Major Neurocognitive Disorder in DSM-V, but the term dementia will still be frequently used. The DSM-V Task Force on Neurocognitive Disorders said the aim of removing the emphasis on the term dementia was an attempt to remove the stigma surrounding dementia and related conditions. Dementia as a Major Neurocognitive Disorder includes Alzheimer’s disease, cerebrovascular disease, frontotemporal lobar degeneration, Lewy Body disease, Huntington’s disease, traumatic brain injury and HIV associated dementia. In the new edition the Task Force has removed the subcategories ‘With Early Onset’ (onset at age 65 years or below) and ‘With Late Onset’ stating that “there is little scientific rationale for retaining the distinction between early and late onset, as the underlying pathology is the same, and the threshold of age 65 is arbitrary at best.” Another change is that memory impairment will not be a mandatory requirement for classification, as dementia can be diagnosed in the absence of memory impairment if other areas of cognitive function are impaired.

A new category has been created in the 2010 DSM-V proposal called Minor Neurocognitive Disorder. This new category will be for people that do not have severe dementia symptoms. The diagnostic criteria for Minor Neurocognitive Disorder could capture people that have age-related memory decline, rather than anything pathological. The symptoms of Minor Neurocognitive Disorder include “decline from a previous level of performance” based on a persons’ self-report, or having a slight reduction from their previous score in a cognitive assessment.

“It will take some time for the new criteria to become widely used in clinical practice.But we are already seeing changes providing more accurate diagnosis of the various forms of dementia” - said Dr Maree Farrow, cognitive neuroscientist and Research Fellow with Alzheimer’s Australia and the Dementia Collaborative Research Centre - Early Diagnosis and Prevention.

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