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Disclosures
No financial relationship with the pharmaceutical industry p y
OUTLINE
General Background
Neurocognitive g Disorders Mild Neurocognitive Disorder Major Neurocognitive Disorder (Dementia) Associated Behavioral Disturbances Future
Global Aging
In 2000, 420 million p people p worldwide were > 65; this number is projected to y 2030 hit 1 billion by In 2000, 59% of the worlds seniors lived in developing nations; this is projected to reach 70% in 2030
S Source: 65+ in i the th United U it d States: St t US C Census B Bureau, 2005
What is Diagnosis?
Origin (Greek): Thorough Knowledge Determining g the nature and the cause/s of an illness by studying symptoms Diagnosis g is generally g y the first step p toward optimal treatment Model of acute infections vs. chronic, , complex diseases with varied course
OUTLINE
DSM DSM-5: 5: General Background
Neurocognitive g Disorders
Mild Neurocognitive Disorder M j Neurocognitive Major N iti Disorder Di d (Dementia) (D ti ) Associated Behavioral Disturbances Future
Delirium Specifications
Substance intoxication Substance withdrawal Medication-induced Due to another medical condition Due to multiple etiologies
Acute vs. Persistent Hyperactive vs. Hypoactive vs. Mixed level of activity Other Specified and Unspecified Delirium
UCSD Geriatric Psychiatry
OUTLINE
DSM DSM-5: 5: General Background Neurocognitive Disorders
1. Neurocognitive decline 2. Significant impairment in one neurocognitive domain (usually) 3 Preservation of 3. independence (albeit with extra effort, etc.)
1. Neurocognitive g decline 2. Significant impairment p in one, , or usually, multiple cognitive domains 3. Loss of independence
UCSD Geriatric Psychiatry
3001109-1
Specification by Etiology
Alzheimers disease Frontotemporal lobar degeneration Lewy body Disease Vascular disease Traumatic brain injury Substance/Medication Use HIV infection Multiple M ltiple etiologies Unspecified
UCSD Geriatric Psychiatry
OUTLINE
DSM-5: DSM 5: General Background Neurocognitive Disorders Mild N Neurocognitive iti Disorder Di d
Specification by Etiology
Alzheimers disease Frontotemporal lobar degeneration Lewy body Disease Vascular disease Traumatic brain injury Substance/Medication Use HIV infection Multiple M ltiple etiologies Unspecified
UCSD Geriatric Psychiatry
Othere Specifications
Without behavioral disturbance With behavioral disturbance: Psychotic symptoms, Mood disturbance, Agitation, p y, or Other behavioral disturbance Apathy, Current Severity (of difficulties with activities daily living): Mild vs. Moderate vs. Severe
UCSD Geriatric Psychiatry
ICD-10 Dementia
Evidence of a decline in both memory and thinking, sufficient to impair personal Activities of Daily Living The impairment of memory typically affects the registration, storage, and retrieval of new i f information, i but b previously i l learned l d and d familiar f ili material may also be lost, particularly in later stages The above symptoms and impairments should have been evident for at least 6 months for a confident clinical diagnosis of dementia to be made .x0 Without additional symptoms .x1 Other symptoms, predominantly delusional .x2 Other symptoms, predominantly hallucinatory .x3 Other symptoms, predominantly depressive UCSD Geriatric Psychiatry .x4 Other mixed symptoms
DSM-IV-TR:
th 5 -digit
Specifier
(1) Dementia without Behavioral Disturbance (2) Dementia with Behavioral Disturbance: Delirium Delusions D l i Depressed mood Other (3) Other syndromes of dementia to be coded as additional dxs under axis I e.g., Mood disorder due to AD, with depressive features; Personality change h d due t to AD AD, aggressive i t type
UCSD Geriatric Psychiatry
OUTLINE
DSM 5: General Background DSM-5: Neurocognitive Disorders Mild N Neurocognitive iti Disorder Di d Major Neurocognitive Disorder (Dementia)
OUTLINE
DSM 5: General Background DSM-5: Neurocognitive Disorders Mild N Neurocognitive iti Disorder Di d Major Neurocognitive Disorder (Dementia) Associated Behavioral Disturbances
Future F t
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International Users
Coordination with ICD ICD-11 11 Cultural differences Political/ administrative aspects Cognitive g assessment Language/translation issues Norms Functional assessment: depends on local expectations t ti of f older ld people, l etc. t
UCSD Geriatric Psychiatry
Biomarkers
Biomarkers such as MRI, amyloid imaging, APO-E, CSF a-beta/tau ratio are not yet recommended for clinical diagnosis and are still till in i the th realm l of f research h criteria it i Genetic testing not recommended at this stage t This field is moving fast, and one or more of th these bi biomarkers k may b be i incorporated t di into t the clinical diagnostic criteria in the foreseeable future
UCSD Geriatric Psychiatry
Eventual Outcome
DSM-5 is more consonant with current scientific understanding of most psychiatric disorders Major changes can be difficult in the beginning, but are inevitable with progress Future revisions in DSM-5 will occur on a continual but small-scale basis, affecting specific di d disorders only l (DSM-5.1, (DSM 5 1 5.2, 5 2 .) ) Psychiatric diagnoses will be increasingly driven b scientific by i tifi advances, d with ith i instant t t feedback f db k from the community
UCSD Geriatric Psychiatry