The Evolving Language of Cognitive Health
The conversation around cognitive health is changing, and a significant part of that change involves the words we use. For decades, "dementia" has been the go-to term for a set of symptoms related to cognitive decline. However, while it remains in common use for continuity with patients and the public, the medical community has formally shifted its terminology [1.4.1, 1.4.2]. This evolution reflects a deeper understanding of the conditions themselves and a growing movement to reduce the stigma associated with them [1.5.3].
From Dementia to Major Neurocognitive Disorder
In 2013, the American Psychiatric Association released the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In this update, "dementia" was officially replaced with "Major Neurocognitive Disorder" (MND) [1.7.2, 1.7.5]. A less severe category, "Mild Neurocognitive Disorder," was also introduced [1.7.4].
There were several key reasons for this change:
- Reducing Stigma: The word "dementia" and its adjective form "demented" originate from the Latin for "out of one's mind" [1.5.3]. This carries heavy historical baggage and contributes to fear, shame, and negative stereotypes [1.5.1, 1.5.4]. Surveys show that a majority of older adults believe the word itself is stigmatizing [1.5.3].
- Improving Accuracy: "Dementia" is an umbrella term, not a specific disease [1.2.5]. It describes a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily life [1.8.5]. The shift to "Major Neurocognitive Disorder" allows for a more precise and less pejorative diagnostic framework. It defines a significant decline in at least one of six key cognitive domains:
- Complex attention
- Executive function
- Learning and memory
- Language
- Perceptual-motor function
- Social cognition [1.7.5]
- Broadening the Scope: The term dementia is often exclusively associated with older adults and Alzheimer's disease [1.4.2]. However, cognitive decline can affect younger individuals and can result from various causes like vascular issues, Lewy bodies, or frontotemporal degeneration [1.3.1, 1.3.5]. "Neurocognitive disorder" is seen as a more inclusive and accurate term across all age groups and causes [1.4.1].
Dementia vs. Alzheimer's Disease: Understanding the Difference
It's crucial to understand that dementia and Alzheimer's disease are not interchangeable. This is a common point of confusion [1.8.3].
- Dementia is the syndrome—the collection of symptoms [1.8.1].
- Alzheimer's Disease is the most common cause of dementia, accounting for 60-80% of cases [1.8.4]. It is a specific progressive brain disease characterized by the buildup of amyloid plaques and tau tangles [1.8.3, 1.8.4].
Think of it this way: Having a sore throat is a symptom, but the cause could be a common cold, strep throat, or allergies. Similarly, having dementia is the set of symptoms, while the cause could be Alzheimer's disease, vascular dementia, or another condition [1.8.4].
Comparison of Key Terms
| Term | Category | Description | Common Usage |
|---|---|---|---|
| Dementia | Syndrome (umbrella term) | A group of symptoms (memory loss, impaired reasoning) that affect daily function [1.2.5]. | Still used widely in public and for continuity in clinical settings [1.4.2]. |
| Major Neurocognitive Disorder | Official Diagnosis (DSM-5) | Significant cognitive decline from a previous level in one or more domains that interferes with independence [1.7.2]. | The formal medical term used by clinicians for diagnosis. |
| Alzheimer's Disease | Disease | A specific neurodegenerative disease that is the most common cause of dementia [1.8.4]. | Used to describe the specific disease, not the symptom set. |
The Importance of Person-First Language
Beyond the clinical terminology, advocacy organizations like the Alzheimer's Association stress the importance of using person-first language [1.6.1]. This means focusing on the individual, not the diagnosis. This approach helps to fight stigma and maintain the dignity of those with cognitive conditions [1.6.2].
Instead of saying:
- "a demented person" or "a sufferer"
Use respectful, person-first alternatives:
- "a person living with dementia"
- "a person with a diagnosis of Alzheimer's"
Similarly, derogatory terms like "wanderer" or descriptions of behavior as "challenging" are being replaced with more neutral, needs-focused language like "expressions of unmet need" [1.6.1]. This reframing acknowledges that behaviors are often a form of communication for someone who may not be able to express their needs verbally.
For more information on respectful communication, visit the Alzheimer's Association's guide on inclusive language [1.6.5].
Conclusion: A Gradual but Necessary Shift
So, is the term dementia still used? Yes, it is. It remains a familiar and widely understood term that helps bridge communication between doctors and the public [1.4.2]. However, the official diagnostic landscape has changed. "Major Neurocognitive Disorder" is the more precise, less stigmatizing term that reflects our current understanding. As awareness grows, the language we use in everyday conversation will hopefully continue to shift towards more accurate, respectful, and person-first terminology, helping to reduce fear and improve the quality of life for everyone affected by cognitive decline.
