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Cognitive disorders in the DSM-IV-TR included delirium, dementia, amnestic disorder, and cognitive disorders not otherwise specified. DSM-V retains the diagnosis of delirium and introduces the term neurocognitive disorder (NCD), dividing NCDs into major NCD or mild NCD and unspecified NCD. The diagnostic category of major NCD encompasses syndromes that were previously categorized as dementia and amnestic disorder. Memory loss is no longer an essential criterion for major NCD in DSM-V as it was for dementia in DSM-IV-TR. Major NCD also includes progressive neurodegenerative dementias, as well as static cognitive disorders that are not expected to worsen over time. The term dementia is retained in DSM-V because of familiarity of the term to the public and medical practitioners.
Older adults have low rates of psychotherapy use despite the effectiveness of multiple psychotherapeutic modalities in late life. Frequent themes in late-life psychotherapy include coping with losses in the setting of physical and cognitive decline, dependence and debility. Choice of treatment modality is based on the abilities and needs of the individual patient rather than age alone. Therapists decide between more structured therapies like cognitive behavioral therapy (CBT) and problem-solving therapy (PST), and more exploratory, affect-focused modalities like interpersonal therapy (IPT) and brief dynamic psychotherapy (BDP). Cognitive therapies have the strongest evidence base for the treatment of depression and anxiety, especially in the setting of medical illness. Problem-solving therapies offer a behavioral approach to patients with depression and executive dysfunction. Interpersonal therapies are readily applicable for older adults struggling with complicated grief, retirement, or family conflict. Brief psychodynamic treatment can be particularly useful for patients with mild to moderate depression struggling with self-esteem or acceptance of mortality. Clinically relevant differences between treatment modalities are difficult to detect due to limited and underpowered trials. Factors common to all psychotherapies, including empathy, alliance, positive regard, and expectations may account for much of the variability in psychotherapy outcomes. Research focused on understanding the mechanism of change associated with psychotherapy is needed to clarify the role of common versus specific factors.
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