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[ICD-11: Neurocognitive Disorders]
1Universitätsklinikum Köln, Klinik und Poliklinik für Psychiatrie und Psychotherapie.
Insights
The International Statistical Classification of Diseases and Related Health Problems (ICD-11) revision for mental disorders drops "organic" syndromes. While dementia classification remains syndromal, it lacks biomarker integration, impacting targeted Alzheimer
Area of Science:
- Neurology
- Psychiatry
- Medical Classification Systems
Background:
- The International Statistical Classification of Diseases and Related Health Problems (ICD-11) Beta Draft introduces significant changes to the classification of mental, behavioral, or neurodevelopmental disorders (Section 06), replacing the ICD-10 F0-section.
- Progress includes dropping the
- organic
- syndromes concept and focusing on acquired conditions with cognitive symptoms.
- The classification of neurodegenerative disorders, particularly Alzheimer's disease (AD), has been revised.
Purpose of the Study:
- To analyze the changes in the ICD-11 Beta Draft concerning the classification of mental, behavioral, or neurodevelopmental disorders, with a focus on dementia and Alzheimer's disease.
- To evaluate the implications of the syndromal approach in ICD-11 for diagnosis and treatment, especially in resource-limited settings.
- To highlight the limitations of ICD-11 in incorporating biomarkers for neurodegenerative diseases like Alzheimer's disease.
Main Methods:
- Comparative analysis of ICD-11 Beta Draft (Section 06 and Section 08) with ICD-10.
- Review of diagnostic criteria for dementia and minor neurocognitive disorder within ICD-11.
- Assessment of the impact of biomarker exclusion on the classification of Alzheimer's disease.
Main Results:
- ICD-11 Section 06 adopts a syndromal approach for dementia, such as dementia due to Alzheimer's disease (AD), but does not yet incorporate biomarkers or the molecular concept of AD.
- Alzheimer's disease can be classified in Section 08 without reference to symptoms, but also lacks biomarker integration, creating diagnostic uncertainty.
- Minor neurocognitive disorder classification in Section 06 has been modified to allow association with a disease (e.g., AD) but still without mandatory biomarker reference.
Conclusions:
- The syndromal approach in ICD-11 Section 06 is practical for global access to diagnosis and treatment, as biomarkers are not universally available and current therapies target dementia rather than molecular pathology.
- The absence of biomarker integration in ICD-11 is a significant limitation for the development and application of targeted treatments for Alzheimer's disease, such as anti-amyloid therapies.
- Further revisions of ICD-11 are needed to incorporate advancements in biomarker research and molecular understanding of neurodegenerative diseases to improve diagnostic accuracy and therapeutic development.
Abstract:
The section 06 (Mental, Behavioural or Neurodevelopmental Disorders) of the current version Beta Draft (Mortality and Morbidity Statistics, 16.12.2017) of the ICD 11 (International Statistical Classification of Diseases and Related Health Problems) replaces the F0-section of the ICD-10. Several changes, particularly with regard to the classification of neurodegenerative disorders have been introduced. It can be considered a progress that the concept of "organic" syndromes has been dropped and that the section focusses on acquired conditions with cognition as the main area of symptoms. Regarding dementia, the 06 section still uses a syndromal approach of for example dementia due to Alzheimer disease (AD). The development of biomarkers and the molecular concept of AD is not incorporated, yet. In section 08 (Diseases of the Nervous System) Alzheimer disease without reference to symptoms can be classified, however, this section also misses reference to biomarkers, which leaves uncertainty of how the diagnosis should be made.In section 06 the condition of minor neurocognitive disorder was originally only defined as a syndrome without reference to a disease. This has been modified and it is now possible to classify the condition in association with a disease (e. g. AD), however, also without reference to biomarkers.The syndromal approach of section 06 is of value, since in many parts of the world, there is no access to AD biomarkers and all current therapies are tested and in some cases approved for Alzheimer dementia rather than AD as a molecular condition. The lack of any reference to AD biomarkers within ICD-11 so far, however, is a highly relevant limitation with the development of treatments, which target specific components of pathology (e. g. anti-amyloid treatment).
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