What is dementia now called? Exploring the updated medical terminology

According to the Alzheimer's Association, the term dementia is a general term describing a set of symptoms, not a single disease. For this reason, professional medical and diagnostic contexts have officially shifted to a more precise classification system, leading to questions like, "What is dementia now called?".

Quick Summary

In medical settings, the term dementia has been largely replaced by "major neurocognitive disorder," and "mild neurocognitive disorder" for less severe cases. This change, reflected in the DSM-5, emphasizes a more accurate classification of cognitive impairment and its underlying causes.

Key Points

• Term Replacement: In formal medical settings, "major neurocognitive disorder" has replaced "dementia" as the official diagnostic term in the DSM-5.

• New Terminology's Purpose: The shift to "neurocognitive disorder" was made to reduce stigma associated with the term "dementia" and provide more clinical specificity.

• Major vs. Mild NCD: Cognitive impairment is classified as either Major Neurocognitive Disorder (severe enough to impede daily life) or Mild Neurocognitive Disorder (less severe).

• Not a Single Disease: Dementia is an umbrella term for a collection of symptoms, not a specific disease. Alzheimer's is the most common cause of dementia.

• Focus on Underlying Cause: The Major NCD diagnosis includes the specific cause, such as Major NCD due to Alzheimer's disease, Lewy body disease, or vascular disease.

The shift from 'Dementia' to 'Neurocognitive Disorder'

In 2013, the American Psychiatric Association's DSM-5 officially replaced "dementia" with "major neurocognitive disorder" (Major NCD). This change aimed for more specific and less stigmatizing language in diagnosis. While "dementia" is still used publicly, the medical shift favors precision and compassion.

Why the change in terminology was necessary

The term 'dementia' was considered stigmatizing due to its Latin roots meaning "loss of mind". "Neurocognitive disorder" offers a more accurate medical description without the negative connotation and differentiates between major and mild forms.

Major neurocognitive disorder vs. mild neurocognitive disorder

The DSM-5 introduced a distinction based on severity:

• Major Neurocognitive Disorder (Major NCD): Significant cognitive decline interfering with independence in daily life. This is comparable to the traditional concept of dementia and specifies the cause (e.g., Major NCD due to Alzheimer's disease).
• Mild Neurocognitive Disorder (Mild NCD): Detectable cognitive decline that does not impact independence. Individuals with Mild NCD may not necessarily develop Major NCD.

This two-tiered system supports earlier detection and intervention, potentially allowing for lifestyle changes and research participation at an earlier stage.

Types of neurocognitive disorders and their causes

Neurocognitive disorders are an umbrella term covering various conditions affecting cognition, with specific causes determining the type and treatment. Below is a comparison of some common types:

Feature	Major NCD Due to Alzheimer's Disease	Major NCD with Lewy Bodies	Major NCD Due to Vascular Disease	Major NCD Due to Frontotemporal Degeneration
Primary Cause	Amyloid plaques and tau tangles.	Alpha-synuclein clumps (Lewy bodies).	Reduced blood flow or strokes.	Degeneration in frontal and temporal lobes.
Common Symptoms	Memory loss, confusion, gradual decline.	Hallucinations, sleep issues, fluctuating alertness, movement problems.	Step-wise cognitive decline, often post-stroke.	Personality, behavior, or language changes.
Onset	Usually after 65; gradual.	Unpredictable; overlaps with Alzheimer's/Parkinson's.	Often linked to stroke; can be gradual.	Often earlier (45-65) than Alzheimer's.
Progression	Progressive.	Symptoms fluctuate.	May be step-wise with sudden declines after strokes.	Progressive deterioration.

The importance of an accurate diagnosis

An accurate diagnosis is vital for appropriate treatment and managing expectations. It helps rule out treatable conditions that can mimic NCD symptoms, like nutritional deficiencies or medication side effects.

Understanding the difference between dementia and Alzheimer's disease

Dementia is a general term for cognitive decline symptoms, while Alzheimer's disease is the most frequent cause of these symptoms, accounting for 60-80% of cases. A person has dementia (the symptoms), and the specific cause might be Major NCD due to Alzheimer's disease. Other causes include Lewy body or vascular disease.

The future of dementia nomenclature

Efforts continue to refine terminology, reduce stigma, and improve research access through initiatives like the Dementia Nomenclature Initiative. Organizations like the Alzheimer's Society advocate for accurate, respectful, and empowering language, reflecting a broader medical trend towards person-first language.

Conclusion: Navigating updated terminology for better understanding

In conclusion, medical professionals now primarily use Major Neurocognitive Disorder and Mild Neurocognitive Disorder instead of "dementia" for more precise and less stigmatizing diagnosis. This change, based on the DSM-5, helps clarify that dementia is a set of symptoms and Major NCD is the diagnostic category that identifies the specific underlying cause, such as Alzheimer's disease. This evolution in language aims to improve care and reduce stigma. More details on diagnostic criteria can be found in the DSM-5 from the American Psychiatric Association.

Frequently Asked Questions

Has the term 'dementia' been completely replaced?

No, the term 'dementia' is still widely used in public and some clinical settings for familiarity. However, in medical and diagnostic manuals like the DSM-5, the official term is now "major neurocognitive disorder".

What is the primary reason for changing the term?

The main reason for the change was to use more precise and less stigmatizing language. The new terms, "major neurocognitive disorder" and "mild neurocognitive disorder," also allow for a more specific diagnosis based on severity.

Is major neurocognitive disorder the same as Alzheimer's disease?

No. Major neurocognitive disorder is the diagnostic category for cognitive decline, while Alzheimer's disease is the most common specific cause of that decline. For example, a diagnosis might be Major NCD due to Alzheimer's disease.

What does 'mild neurocognitive disorder' mean?

Mild neurocognitive disorder describes a noticeable but less severe cognitive decline than Major NCD, which does not yet significantly interfere with a person's independence in daily activities.

Does this terminology change affect care or treatment?

While the name change itself does not alter treatment, the more specific diagnosis under the Neurocognitive Disorder framework can improve care planning. For instance, distinguishing between Major NCD due to vascular disease versus Lewy bodies can guide specific therapeutic strategies.

What did doctors call dementia before these changes?

Before the changes in the DSM-5 in 2013, the diagnostic manual used the term "dementia." In previous eras, outdated and inaccurate terms like "senility" or "senile dementia" were used, which implied that cognitive decline was a normal part of aging.

Are there other types of neurocognitive disorders besides Alzheimer's?

Yes. Other types include Vascular NCD, NCD with Lewy bodies, Frontotemporal NCD, and NCD due to Huntington's disease, among others. The underlying cause determines the specific type of neurocognitive disorder.