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Classifying neurocognitive disorders: the DSM-5 approach

Key Points

  • The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides a framework for the diagnosis of neurocognitive disorders based on three syndromes: delirium, mild neurocognitive disorder and major neurocognitive disorder

  • Major neurocognitive disorder is mostly synonymous with dementia, although the criteria have been modified so that impairments in learning and memory are not necessary for diagnosis

  • DSM-5 describes criteria to delineate specific aetiological subtypes of mild and major neurocognitive disorder

  • The diagnostic certainty of an aetiological diagnosis is based on clinical features and biomarkers, and can be qualified as probable or possible

  • The DSM-5 criteria are consistent with those developed by various expert groups for the different aetiological subtypes of neurocognitive disorders

  • Further validation in clinical practice is necessary, but we expect these criteria will have high reliability and validity, and widespread adoption will bring consistency to the diagnosis of diverse neurocognitive disorders

Abstract

Neurocognitive disorders—including delirium, mild cognitive impairment and dementia—are characterized by decline from a previously attained level of cognitive functioning. These disorders have diverse clinical characteristics and aetiologies, with Alzheimer disease, cerebrovascular disease, Lewy body disease, frontotemporal degeneration, traumatic brain injury, infections, and alcohol abuse representing common causes. This diversity is reflected by the variety of approaches to classifying these disorders, with separate groups determining criteria for each disorder on the basis of aetiology. As a result, there is now an array of terms to describe cognitive syndromes, various definitions for the same syndrome, and often multiple criteria to determine a specific aetiology. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides a common framework for the diagnosis of neurocognitive disorders, first by describing the main cognitive syndromes, and then defining criteria to delineate specific aetiological subtypes of mild and major neurocognitive disorders. The DSM-5 approach builds on the expectation that clinicians and research groups will welcome a common language to deal with the neurocognitive disorders. As the use of these criteria becomes more widespread, a common international classification for these disorders could emerge for the first time, thus promoting efficient communication among clinicians and researchers.

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Figure 1: Timeline of the DSM-5 consultation and revision process.
Figure 2: Neurocognitive domains.

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Acknowledgements

The authors would like to thank Prof. Igor Grant, the members of the DSM-5 Task Force and the other Work Groups, as well as many external advisers and consultants who provided invaluable input to the development of the classification. M.G. was supported in part by the National Institute on Aging, the National Institutes of Health, and the Department of Health and Human Services, USA (grant K07 AG044395). D.V.J. was supported in part by the National Institute of Mental Health, USA (grant R01 MH099987), and by the Sam and Rose Stein Institute for Research on Aging. P.S. was supported in part by the National Health and Medical Research Council of Australia (grant 568969).

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All authors researched data for the article and made substantial contributions to discussion of the content, writing of the article and to review and/or editing of the manuscript before submission.

Corresponding author

Correspondence to Perminder S. Sachdev.

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Competing interests

The authors were members of the Neurocognitive Disorders Work Group for DSM-5. D.V.J. was President of the American Psychiatric Association from 2012–2013 when DSM-5 was published.

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Sachdev, P., Blacker, D., Blazer, D. et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol 10, 634–642 (2014). https://doi.org/10.1038/nrneurol.2014.181

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