By Mindy S. Moore, PhD, Licensed Clinical Psychologist
Supervisory Clinical Lead
The Importance of Recognizing Mental Illness Awareness Week
In 1990, Congress established the first full week of October as Mental Illness Awareness Week. According to the National Alliance on Mental Illness, one in five adults in the U.S. experience mental illness each year. Mental illness impacts people of all ages, race and background. This week offers a chance to recognize the importance of prioritizing mental illness and offering education, resources and support. This article discusses Major Neurocognitive Disorders (NCDs), specifically Dementia, and how to best manage it in a post-acute care setting.
How Are Major Neurocognitive Disorders Diagnosed
In 2013, the American Psychiatric Association released the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), which introduced the diagnoses of “Major Neurocognitive Disorders” that provides behavioral health with ways to indicate more specific etiologies of changes in cognition that are more commonly referred to as “dementias.” Dementia is a more medical diagnosis, while Major NCD is a psychiatric or behavioral health diagnosis, though both have similar ICD-10 codes (e.g., F01.xx – F03.xx).
Major Neurocognitive Disorders/Dementia criteria include:
- significant cognitive decline from previous functioning,
- substantial impairment on clinical tools,
- problems that interfere with independence in daily living (not due to delirium or another mental disorder)
Major NCDs are diagnosed through cognitive and neuropsychological assessment and appropriate medical tests to rule out other issues. Major Neurocognitive Disorders include all dementias, amnestic disorders, Major Neurocognitive Disorders due to medical conditions, cerebrovascular disease and alcohol-related dementias. Other causes can include seizures, brain tumor, ALS, MS, infectious etiologies, metabolic etiologies, head injuries and MS.
The most common etiologies of NCDs are Alzheimer’s disease, vascular dementia or mixed Alzheimer’s and vascular. These account for 90% of all Neurocognitive disorders. The other 10% include Lewy Body disease, Frontotemporal dementia (Picks disease), Normal pressure hydrocephalus, alcoholic etiologies, infection (HIV, syphilis), Parkinson’s disease, and Huntington’s disease. Some reversible etiologies include thyroid disorders, nutritional disorders, pseudo-dementia or hydrocephalus.
Managing Major NCDs/dementia in the Post-Acute Care Landscape
Managing Major NCDs/dementia in the post-acute setting can be a challenge that requires a multidisciplinary approach including psychology, psychiatry, medical providers and facility staff to meet resident needs and prevent caregiver burnout. In addition to cognitive decline, many individuals with Major NCDs experience personality changes, exhibit challenging behaviors (e.g., wandering/exit seeking, resistance to care, rummaging), and perseverations or confabulations. These changes can be stressful for the resident, their family, and the staff involved in care.
In managing challenging behaviors of individuals living with Major NCDs/dementia, it is important to understand the idea of retrogenesis, or “reverse aging” from the furthest point in development back through young adulthood, adolescence, childhood and infancy. While pharmacological interventions can help with some of the behaviors and symptoms, assessing the resident’s current developmental stage can guide practitioners in determining what level of vocabulary and types of interventions will be the most effective with residents exhibiting behaviors of all kinds.
Statistics about Dementia in the U.S.
It is estimated that 6.7 million U.S. residents are living with Alzheimer’s dementia in 2023, about one in nine people ages 65 and older. The prevalence of this most common etiology of Major NCD/dementia is projected to increase to 7.2 million by 2025 and 13.8 million people ages 65 and older by 2060 (barring any successful treatments for preventing, slowing, or curing the disease). The effects of COVID-19 infection are also being studied in relation to the known immediate effects on cognition and the potential for longer-term effects on cognitive decline. With the increase in the aging population in the U.S., it is critical for mental health practitioners to become familiar with the diagnoses and management of Major NCDs/dementia.
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