What is the better term for dementia?

Dementia affects an estimated 55 million people worldwide, yet the term itself is evolving. Understanding what is the better term for dementia requires looking at both medical advancements and the push for more person-centered, respectful language in senior care. The right words can significantly impact how individuals and families navigate this journey.

Quick Summary

The most accurate term depends on the context; 'major neurocognitive disorder' is the current medical diagnosis, while 'a person living with dementia' is the preferred respectful, person-first language. It's crucial to understand why this terminology has shifted from the broad, often stigmatized, term 'dementia'.

Key Points

• Medical Terminology: The clinical term 'major neurocognitive disorder' (NCD) has replaced 'dementia' in the DSM-5 to provide a more specific diagnosis.

• Person-First Language: The most respectful approach is to use person-first language, such as 'a person living with dementia,' to prioritize the individual over their condition.

• Not a Single Disease: Dementia is a syndrome, a collection of symptoms, caused by various underlying diseases like Alzheimer's, vascular dementia, or Lewy body dementia.

• Distinguishing Decline: It's important to differentiate normal age-related cognitive changes, Mild Cognitive Impairment (MCI), and major NCD, which varies by severity and impact on daily independence.

• Combating Stigma: The shift away from the historically negative term 'dementia' helps reduce stigma and fosters a more respectful, inclusive environment for those with cognitive decline.

• Empowering Communication: Using compassionate and clear language is vital for effective communication and for maintaining the dignity of individuals living with dementia.

The Evolving Landscape of Dementia Terminology

Historically, 'dementia' served as a broad term for symptoms of cognitive decline. However, its Latin origins, meaning 'madness' or 'without a mind,' carry a negative stigma that can reduce a person to their condition. There is a growing movement towards more precise and respectful language in both medical and advocacy communities to acknowledge that individuals with cognitive decline are more than their diagnosis.

The Clinical Shift to Neurocognitive Disorders

The American Psychiatric Association officially replaced "dementia" with "major neurocognitive disorder" (major NCD) in the DSM-5 in 2013. This change aimed for a more accurate and less stigmatizing diagnostic approach. The DSM-5 also introduced "mild neurocognitive disorder" (mild NCD) for less severe cognitive decline that does not impact daily independence.

How Neurocognitive Disorders are Diagnosed

Diagnosis of major or mild NCD involves evaluating cognitive decline in six areas:

• Complex Attention: Ability to focus.
• Executive Function: Planning and organizing.
• Learning and Memory: Recalling information.
• Language: Communication.
• Perceptual-Motor Function: Visual and spatial skills.
• Social Cognition: Understanding others.

A major NCD diagnosis indicates decline significantly impacting independence in daily tasks, while a mild NCD involves a more modest decline where independence is maintained with greater effort.

Embracing Person-First Language

Advocates emphasize person-first language to respect individuals with dementia by putting the person before the condition. Recommended phrases include "a person living with dementia" or "a person with Alzheimer's disease," rather than labels like "demented". This language combats stigma and ageism, recognizing the individual's full identity beyond their diagnosis.

Dementia is a Syndrome, Not a Disease

Dementia is a syndrome, a collection of symptoms caused by various diseases, not a single disease itself. A proper diagnosis identifies the underlying cause, as some dementia-like symptoms are treatable.

Causes of dementia include:

• Alzheimer's Disease: The most common cause.
• Vascular Dementia: Due to reduced blood flow to the brain.
• Lewy Body Dementia: Involves protein deposits affecting various functions.
• Frontotemporal Dementia (FTD): Affects personality and behavior.
• Mixed Dementia: A combination of types, often Alzheimer's and vascular.

Comparing Terminology: Traditional vs. Modern Approach

The table below highlights the shift in language:

Traditional/Lay Term	Clinical/Modern Term	Person-First Language	Rationale for Change
Dementia	Major Neurocognitive Disorder	A person living with dementia	Removes stigma, provides greater clinical precision
Senility	Normal Age-Related Cognitive Change	An older adult experiencing typical changes	Rejects the notion that decline is a normal part of aging
Demented Person	Person with a diagnosis of NCD	A person with dementia	Prioritizes the individual's humanity over their condition

The Role of Communication in Senior Care

Precise and respectful communication significantly improves the lives of those with dementia by creating a supportive environment and reducing anxiety. Caregivers should use clear, simple language and observe nonverbal cues. An excellent resource on respectful language is the Alzheimer's Society guide: How to talk about dementia.

Conclusion: Choosing the Better Term

There isn't one universal "better" term. In clinical settings, major neurocognitive disorder is the accurate term. In general use, person-first language, like "a person living with dementia," is most respectful. Mindful language honors the individual's dignity, recognizing their condition as only one part of their identity.

Frequently Asked Questions

Is the word 'dementia' still used?

Yes, the word 'dementia' is still widely used by the general public and in many medical settings for familiarity. However, the official clinical term is now 'major neurocognitive disorder,' and using person-first language is preferred.

What is the difference between dementia and Alzheimer's?

Dementia is a general term for a set of symptoms, while Alzheimer's disease is the most common specific disease that causes dementia. It's like the relationship between 'cancer' (the general term) and 'lung cancer' (the specific disease).

Why is 'person-first' language important for people with dementia?

Person-first language, such as 'a person with dementia,' emphasizes that an individual is not defined by their condition. It helps to reduce stigma and ensures they are treated with dignity and respect, seeing them as a whole person rather than just a diagnosis.

Is minor memory loss a sign of major neurocognitive disorder?

Minor memory loss can be a normal part of aging. Mild cognitive impairment (MCI) involves more noticeable decline but doesn't affect independence. Major neurocognitive disorder is a more severe decline that interferes with daily life. It's crucial to consult a doctor for a proper evaluation.

What are some examples of disrespectful language to avoid?

Avoid terms like 'demented,' 'senile,' or calling someone a 'victim' or 'sufferer.' These labels can be dehumanizing and focus on deficits rather than the person. Always strive for respectful, person-centered language.

How can I tell if someone has major vs. mild cognitive disorder?

The key difference is the impact on daily life. If the cognitive decline interferes significantly with independence (like managing finances or driving), it's likely a major neurocognitive disorder. If they can still manage but with greater effort, it may be mild neurocognitive disorder.

What if a family member with cognitive decline refers to themselves with the old term?

Respect the language they use for themselves. The goal of respectful communication is to make the person feel comfortable and understood. You can model newer, more respectful language in your own speech, but do not correct them if they prefer a certain term.