Does Use of “Alzheimer’s” as a Catch-all Label Cause Confusion?

Recently, a friend who is a neuropsychologist reminded me that the medical profession is moving away from using either dementia or Alzheimer’s as a broad category label.  For example, in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as the DSM followed by a number that indicates the edition, the current edition (DSM-5) replaced the label “Dementia, Delirium, Amnestic and Other Cognitive Disorders” with “Neurocognitive Disorders” or NCDs.  As we talked, it occurred to me that this is an important change, and one that legal professionals should also embrace more strongly.  While short-hand labels can be useful, I think that using dementia alone as a label can invoke a stereotype that has the potential to confuse the public, while also unnecessarily frightening the client or client’s family.  It can invoke an image of nursing homes or institutionalization, rather than what may be more appropriate, such as supported or guided decision-making or use of alternative decision-makers or agents, especially in early stages of the disorders.

As the DSM-5 further explains:

Although cognitive deficits are present in many if not all mental disorders (e.g., schizophrenia, bipolar disorders), only disorders whose core features are cognitive are included in the NCD category.  The NCDs are those in which impaired cognition has not been present since birth or very early life, and thus presents a decline from a previously attained level of functioning.

 

The NCDs are unique among DSM-5 categories in that these are syndromes for which the underlying pathology, and frequently the etiology as well, can potentially be determined.  The various underlying disease entities have all been the subject of extensive research, clinical experience, and expert consensus on diagnostic criteria…. Dementia is subsumed under the newly named entity major neurocognitive disorder, although  the term dementia is not precluded from use in the etiological subtypes in which the term is standard. Furthermore, DSM-5 recognizes a less severe level of cognitive impairment, mild neurocognitive disorder, which can also be a focus of care….

Indeed, greater appreciation for mild neurocognitive disorders is important in legal circles, as the changes may often be subtle or difficult to recognize, but still very important when talking about legal capacity or decision-making under the law.