Neurocognitive Disorders: DSM-5 vs. DSM-IV-TR Compared
This paper examines neurocognitive disorders (NCDs) as classified in the DSM-IV-TR and DSM-5, tracing the evolution of terminology and diagnostic criteria across both editions. It reviews the essential psychopathology of delirium, dementia, and amnestic disorders, including their causes, symptoms, and management. The paper then compares DSM-IV-TR and DSM-5, highlighting key changes such as the replacement of "cognitive" and "organic" with "neurocognitive," the introduction of major and mild NCD categories, and the expanded etiological subtypes. A fictional case study of an 85-year-old woman diagnosed with progressive dementia and possible Alzheimer's disease illustrates how these diagnostic frameworks apply in clinical practice.
- Introduction to Neurocognitive Disorders: Overview of NCD cluster and terminology evolution
- Essential Psychopathology: Delirium, Dementia, and Amnesia: Symptoms, causes, and management of core NCDs
- Neurocognitive Disorders in DSM-IV-TR: DSM-IV-TR criteria for delirium, dementia, amnesia
- Neurocognitive Disorders in DSM-5: DSM-5 NCD categories, subtypes, and domains
- Comparing DSM-IV-TR and DSM-5: Key differences and Task Force guiding principles
- Fictional Case Study: 85-year-old diagnosed with dementia and Alzheimer's
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What makes this paper effective
- Systematically moves from foundational definitions to comparative analysis, building the reader's understanding before introducing the more complex DSM-5 changes.
- Grounds abstract diagnostic criteria in a concrete fictional case study, making the clinical relevance of the classification systems tangible.
- Accurately distinguishes between DSM-IV-TR and DSM-5 terminology (e.g., "organic" vs. "neurocognitive," "dementia" vs. "major NCD") and explains the rationale behind each change.
Key academic technique demonstrated
The paper demonstrates effective comparative analysis by first establishing each diagnostic system on its own terms before directly contrasting them. This approach allows the reader to appreciate both the continuities and the meaningful departures between DSM-IV-TR and DSM-5, supported by direct citation of primary APA sources and peer-reviewed commentary.
Structure breakdown
The paper opens with a general introduction to the neurocognitive disorder cluster, followed by a section on essential psychopathology drawn from Maxmen and Ward. It then addresses DSM-IV-TR criteria in detail, transitions to DSM-5 updates, performs a direct comparison guided by the DSM-5 Task Force principles, and closes with a brief illustrative case study. The structure is clear and logically sequenced, making it suitable as an undergraduate-level overview of this diagnostic category.
Introduction to Neurocognitive Disorders
The first of five clusters of mental disorders covers neurocognitive disorders — that is, dementia, delirium, amnestic and other cognitive disorders in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and organic, including symptomatic mental disorders in the tenth revision of the International Classification of Diseases (ICD) (Sachdev et al., 2009). The term neurocognitive has replaced cognitive and organic, respectively, in these two documents. The disorders in this cluster distinguish themselves by possessing demonstrable neural substrate abnormalities, cognitive symptoms, and deficits. The causes of these disorders vary, but they share common neurobiological characteristics that set them apart from any of the other disorder clusters (Sachdev et al., 2009).
Essential Psychopathology: Delirium, Dementia, and Amnesia
Delirium is a cognitive disorder characterized mainly by a decreased awareness of one's environment, often described as a clouding of consciousness (Maxmen & Ward, 1995). Its signs occur without warning over the course of many hours to days, and fluctuate erratically, especially at night and in the dark. Other signs and symptoms include agitation and fright, illusions, hallucinations, incoherent speech, a disturbed sleep-wake cycle, and disorientation to time and place. Behavioral changes can be sudden and unexplained, and accidents often occur in delirious patients. The cause may be medical, surgical, chemical, neurological, or related to sensory isolation — often in an intensive or cardiac care unit. It can be mistaken for normal personality traits, dementia, strokes, or schizophrenia. Management consists of all measures to keep the patient alive, prevent brain damage, and prevent self-harm. Review of family history, referral to a physician, careful nursing care, constant observation, and physical control are also often called for (Maxmen & Ward, 1995).
Dementia involves a loss of intellectual abilities, particularly memory, judgment, abstract thinking, and language, accompanied by personality changes and impaired impulse control (Maxmen & Ward, 1995). The condition may develop gradually or suddenly, as after a fall or head injury. Deterioration of functions may go unnoticed for months or years, or may be mistakenly attributed to normal aging. Its subtypes include Alzheimer's disease (the most common form), vascular dementia, dementia associated with medical conditions, and substance-induced dementia. Secondary dementias may be treatable. Dementia is life-shortening and renders patients susceptible to medical illness and delirium. Its incidence rises with age, most commonly between ages 70 and 80. Biological causes differ according to subtype, while psychological causes depend on one's personality and circumstances. During diagnosis, dementia may be mistaken for delirium, pseudodementia, or depression. Management or treatment may take the form of biomedical interventions, such as calming medications, or psychosocial interventions, including appropriate patient care and family counseling (Maxmen & Ward, 1995).
Amnestic disorders involve loss of memory, often due to a specific occurrence such as a strike to the hippocampus or exposure to toxins like alcohol (Maxmen & Ward, 1995). Memory of remote events may deteriorate while other mental functions remain intact. These disorders are managed by eliminating alcohol use and exposure to toxins, improving nutrition, and controlling hypertension (Maxmen & Ward, 1995).
References
American Psychological Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
American Psychological Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). American Psychiatric Publishing.
Ganguli, M., et al. (2012). Classification of neurocognitive disorders in DSM-5: a work in progress. Journal of American Geriatric Psychiatry, 9(13). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3076370/
Heyman, R. E., et al. (2009). Relationship problems and the DSM: needed improvements and suggested solutions. World Psychiatry, 8(1). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654406/
Maxmen, J. S., & Ward, N. G. (1995). Essential psychopathology and its treatment: Revised for DSM-IV (Chapter 7). New York: W. W. Norton & Company.
Sachdev, P., et al. (2009). Neurocognitive disorders: cluster 1 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine, 39(2). Cambridge University Press. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19796426
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