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Cited by 1,116Dementia and Cognitive Impairment ResearchMental Health and PsychiatryHistorical and Modern Theater Studies

Classifying neurocognitive disorders: the DSM-5 approach

Open access
Sachdev, Perminder S., Blacker, Deborah, Blazer, Dan G., Ganguli, Mary, Jeste, Dilip V., Paulsen, Jane S., Petersen, Ronald C.·2014·Nature Reviews Neurology
DOI 10.1038/nrneurol.2014.181
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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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Crossref · 10.1038/nrneurol.2014.181

Cites

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Claims the paper makes

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  • Premisecitation

    The DSM-IV classification of neurocognitive disorders had limitations that led to a major revision in DSM-5.

    “The DSM-IV approach to classifying neurocognitive disorders also contained a number of limitations, which prompted a major revision in the fifth edition (DSM-5).4”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th edn (American Psychiatric Association, 2013). source

      Not checked in the free run.

  • Premisecitation

    In earlier diagnostic criteria, deficits in social cognition were usually called personality change.

    “Deficits in social cognition were usually referred to as personality change in previous diagnostic criteria.2”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 4th edn (American Psychiatric Association, 1994).

      Not checked in the free run.

  • Premisenone given

    DSM-5 does not allow a diagnosis of mild or major neurocognitive disorder when the cognitive deficits are better explained by another mental disorder, such as major depression or schizophrenia.

    “DSM-5 does not permit the diagnosis of mild or major neurocognitive disorders if the cognitive deficits can be better explained by another mental disorder, such as major depression or schizophrenia.”
    Quote in the paperSubstantial claim
  • Interpretationreasoning

    Social cognition was newly included as a cognitive domain because socially inappropriate behaviour can be a prominent feature in some neurocognitive disorders.

    “The newly included domain of social cognition is particularly noteworthy, as it recognizes the fact that, in some neurocognitive disorders, socially inappropriate behaviour can manifest as a salient feature.”
    Quote in the paperSubstantial claim
  • Premisereasoning

    Mild and major neurocognitive disorders are subtyped according to aetiology in DSM-5.

    “Mild and major neurocognitive disorders are therefore subtyped according to aetiology.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 37
  • May combine two claims. 29

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    DSM-5 offers a shared framework for diagnosing neurocognitive disorders, first by describing the main cognitive syndromes and then by setting criteria for aetiological subtypes of mild and major neurocognitive disorder.

    “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.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Clinicians and research groups will welcome a common language for neurocognitive disorders.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    DSM-5 does not specify which tests, or how many, should be given for each cognitive domain.

    “The DSM-5 does not specify which tests, or how many, should be administered per cognitive domain.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    Serial assessments may be needed to document decline, but their results should be interpreted cautiously because of practice effects, variable test-retest reliability, and limited normative data on cognitive decline.

    “Serial assessments might be necessary to document decline, but the results must be interpreted cautiously in view of practice effects, variable test-retest reliability, and the dearth of normative data on cognitive decline.21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Ganguli, M. Can the DSM-5 framework enhance the diagnosis of MCI? Neurology 81, 2045–2050 (2013). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    The awareness disturbance in delirium usually develops over hours to days and tends to fluctuate during the day, often worsening in the evening.

    “The disturb ance of awareness tends to develop over hours to days, and typically fluctuates in the course of the day, often worsening in the evening.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    An objective demonstration of cognitive deficits is essential for the diagnosis of mild neurocognitive disorder.

    “the objective demonstration of cognitive deficits is essential.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisenone given

    Major neurocognitive disorder largely replaces the older concept of dementia, although DSM-5 keeps 'dementia' in parentheses.

    “Major neurocognitive disorder mostly obviates the older concept of dementia, even though DSM-5 retains 'dementia' in parentheses to indicate that it may still be used (discussed further below).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The DSM-5 exclusion of cases better explained by another mental disorder is defended on the grounds that neurocognitive disorders are diagnosed only when cognitive deficits are the core or defining feature, and distinct conditions should not be conflated.

    “The argument in favour of the DSM-5 approach is that neuro cognitive disorders are only diagnosed for conditions that have cognitive deficits as the core or defining feature: though psychiatric disorders should be considered in the differential diagnosis of neurocognitive disorders, distinct conditions should not be conflated.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    Delirium may result from an underlying medical condition, substance intoxication or withdrawal, toxin exposure, or a combination of these causes.

    “Delirium can be caused by an underlying medical condition, substance intoxication or withdrawal, exposure to toxins, or a combination of these factors.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The term dementia is most often used for older people, frequently as a synonym for Alzheimer disease, and is less likely to be used for younger people with severe cognitive deficits from conditions such as traumatic brain injury or HIV infection.

    “The term dementia is most commonly used to refer to older individuals-very often synonymously with AD-and is less likely to be used to describe younger people with severe cognitive deficits due to, for example, traumatic brain injury or HIV infection.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Sachdev, P. Is it time to retire the term “dementia”? J. Neuropsychiatry Clin. Neurosci. 12, 276–279 (2000). source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Mild neurocognitive disorder is not always a precursor of major neurocognitive disorder, and its diagnosis does not require further decline; the impairment may remain static or continue to decline.

    “Importantly, mild neurocognitive disorder is not always a precursor of major neurocognitive disorder, and the diagnosis has no requirement for further decline: there may be continued decline, as in the neurodegenerative disorders, or the impairment may be static, as in traumatic brain injury.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Mild neurocognitive disorder is new to DSM nomenclature, was previously included under cognitive disorder not otherwise specified, and provides a new framework for the commonly used diagnosis of MCI.

    “Mild neurocognitive disorder is a new addition to the DSM nomenclature, previously subsumed by the nonspecific category of 'cognitive disorder not otherwise specified, ' and represents a new framework for the commonly used diagnosis of MCI. 12”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Petersen, R. et al. Mild cognitive impairment: ten years later. Arch. Neurology 66, 1447–1455 (2009). source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    The independent-functioning criterion is the key distinction between mild and major neurocognitive disorders and depends on an insightful report from the individual and/or a family member and on clinician judgement.

    “The criterion of independent functioning represents the key distinction between the mild and major neurocognitive disorders, and relies on an insightful report by the individual and/ or a family member, and a level of good judgement from the clinician.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Mild and major neurocognitive disorders are categorical constructs imposed on an underlying continuum of cognitive impairment from normality to severe impairment.

  • May combine two claims.

    Premisecitation

    The Mayo Criteria correspond most closely to amnestic MCI in the IWG Criteria, and their main diagnostic objective is to identify Alzheimer disease at the predementia stage.

    “The Mayo Criteria correspond best to what is referred to as amnestic MCI in the IWG Criteria, with the main objective of the diagnosis being the identification of AD at the predementia stage.12”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Petersen, R. et al. Mild cognitive impairment: ten years later. Arch. Neurology 66, 1447–1455 (2009). source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Because mild neurocognitive disorder must be distinguished from normal cognitive ageing and major neurocognitive disorder, neuropsychological assessment is relied on more in mild than in major neurocognitive disorder.

    “because mild neurocognitive disorder needs to be distinguished from both normal cognitive ageing and major neurocognitive disorder (or dementia), even greater reliance on neuropsychological assessment is called for in mild than in major neurocognitive disorder.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    NIA-AA criteria were explicitly developed to let researchers diagnose MCI due to Alzheimer disease, but they also include a generic definition of MCI.

    “NIA-AA criteria were explicitly developed to enable researchers to diagnose MCI due to AD, but include a generic definition of MCI.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Albert, M. S. et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging–Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 7, 270–279 (2011). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Delirium involves a disturbance of attention that makes it hard for a person to direct, sustain, and shift focus.

    “This neurocognitive disorder is characterised by disturbance in attention that makes it difficult for the indi vidual to direct, sustain and shift their focus.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The Neurocognitive Disorders Work Group agreed on six principal cognitive domains: complex attention, executive function, learning and memory, language, perceptual-motor function, and social cognition.

    “the Neurocognitive Work Group agreed on six principal domains of cognitive f unction-complex attention, executive function, learning and memory, language, perceptual-motor function, and social cognition (Figure 2)-each with subdomains.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    The aetiological subtype criteria are identical for mild and major neurocognitive disorders, but establishing aetiology in mild neurocognitive disorder is more difficult and may remain unspecified in many patients.

    “The aetiological subtype criteria are the same for both mild and major neurocognitive disorders, although establishing aetiology in mild neurocognitive disorder is more difficult and may, therefore, have to remain unspecified in many patients.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Patients for whom neuropsychological testing is not feasible or appropriate norms are unavailable can receive a brief bedside assessment to provide the objective data needed for diagnosis.

    “As in mild neurocognitive disorder, patients for whom neuro psycho logical testing is not feasible, or appropriate norms are not available, can undergo a brief bedside assessment by the clinician to supply the objective data necessary for diagnosis.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The final DSM-5 neurocognitive criteria were reached by consensus of the Work Group members after considerable input from expert advisers.

    “The final criteria, designed to reflect the latest advances in scientific knowledge in this field, were reached by consensus of the members after considerable input from expert advisers.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisenone given

    Substantial decline in only one cognitive domain is sufficient for a diagnosis of major neurocognitive disorder if the other criteria are met.

    “First, substantial decline in only one cognitive domain is sufficient for the diagnosis if the other criteria are met.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Risk factors are generally independent of aetiology and should not be conflated with underlying pathology.

    “It is useful to consider some risk factors when attempting to determine aetiology, but such factors are generally independent of aetiology and should not be conflated with the underlying pathology.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    The term dementia has acquired a pejorative connotation, and although changing terminology alone cannot eliminate stigma, it might be a necessary first step.

    “The term has also acquired a pejorative connotation, and although a mere change in terminology is not sufficient to eliminate stigma, it might be a necessary first step.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The final criteria were reviewed by several DSM-5 panels, including a scientific review committee, a clinical and public health review committee, the Task Force, and a summit body, before approval by the APA Board of Trustees.

    “The final cri teria were reviewed by several overarching DSM-5 panels, including a scientific review committee, a clinical and public health review committee, the Task Force, and a summit body, before final approval was granted by the APA Board of Trustees.5”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Ganguli, M. et al. Classification of neurocognitive disorders in DSM-5: a work in progress. Am. J. Geriatr. Psychiatry 19, 205–210 (2011). source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The exclusionary requirement reflects the nonspecificity of clinical features, so diagnosis involves considering and systematically excluding all possible aetiologies to arrive at the most likely cause.

    “This requirement reflects the nonspecificity of the clinical features; thus, the diagnostic process involves the consideration of all possible aetiologies and their systematic exclusion to arrive at the most likely cause.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Public comment was solicited on draft DSM-5 criteria posted on the DSM-5 website.

    “Public comment was solicited on draft criteria posted on the DSM-5 website.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    DSM-5 criteria were designed primarily for clinicians.

    “The DSM-5 criteria were designed primarily for the clin ician.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    When formal neuropsychological assessment is available, performance typically falls at least 2 SD below the normative mean, or below the third percentile, on the test given.

    “If such an assessment is available, the performance typically falls at least 2 SD below the normative mean (or below the third percentile) on the test administered.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisereasoning

    The DSM-5 classification uses a two-step diagnostic process: first a syndromal diagnosis, then examination of causative factors to attribute aetiology.

    “The DSM-5 classification was designed to complement the clinical process in which a diagnosis is made in two steps: a syndromal diagnosis is made first, and then potential causative factors are examined to attribute aetiology.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The requirement for an objective measure is best met by formal neuropsychological assessment, with performance compared to normative data appropriate for the patient's age, education, and cultural-linguistic background.

    “The requirement of an objective measure is best met by formal neuropsychological assessment, with the performance being compared to normative data appropriate for the patient's age, educational attainment and cultural-linguistic background.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    CSF amyloid-β42 and phosphorylated tau are research biomarkers for Alzheimer disease and are not yet ready for clinical use.

    “Other biomarkers for AD diagnosis, 23 such as levels of amyloid-β 42 and phosphorylated tau in cerebrospinal fluid, are in the research arena and not yet ready for the clinic.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Dubois, B. et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS–ADRDA criteria. Lancet Neurol. 6, 734–746 (2007). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Competent interpretation of test performance is essential and can be helped by administering the same test previously so that decline can be assessed.

    “Competent interpretation of test performance is essential, and can be aided by prior administration of the same test so that decline can be assessed.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Because the behavioural features of frontotemporal neurocognitive disorder commonly occur in isolation in various neuropsychiatric syndromes, at least three features are necessary for diagnosis.

    “In various neuropsychiatric syndromes, these features are commonly present in isolation, and so the presence of at least three features is necessary for the diagnosis of frontotemporal neurocognitive disorder.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Frontotemporal neurocognitive disorder comprises a number of syndromal variants with insidious onset and gradually progressive impairment of behaviour, personality, and/or language.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Development or worsening of cognitive deficits following a cerebrovascular event increases the certainty of the diagnosis of vascular neurocognitive disorder.

    “The development or worsening of cognitive deficits following a cerebrovascular event increases the certainty of the diagnosis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Alzheimer disease biomarkers are appropriate for research studies, but their availability varies in clinical settings and they have generally not been fully validated for clinical use.

    “Although these biomarkers are appropriate for research studies, 20,23 their availability varies in clinical settings, and they have, in general, not been fully validated for clinical use.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [20] Albert, M. S. et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging–Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 7, 270–279 (2011). source

      Not checked in the free run.

    • cites [23] Dubois, B. et al. Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS–ADRDA criteria. Lancet Neurol. 6, 734–746 (2007). source

      Not checked in the free run.

    • Rests on an assumption: Alzheimer disease biomarkers include amyloid deposition on PET, reduced CSF amyloid-β42, elevated phosphorylated and total tau, hippocampal and temporoparietal atrophy on MRI, and temporoparietal hypometabolism on FDG PET.

  • May combine two claims.

    Premisereasoning

    These frontotemporal criteria are consistent with external expert groups, but identification of frontotemporal degeneration as the aetiology for mild neurocognitive disorder without genetic or neuroimaging evidence is not yet established.

    “These criteria are consistent with those published by external expert groups, 28,29 but it must be pointed out that the identification of frontotemporal degeneration as the aetiology for mild neurocognitive disorder in the absence of genetic and/or neuroimaging evidence is not yet established.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [28] Gorno-Tempini, M. L. et al. Classification of primary progressive aphasia and its variants. Neurology 76, 1006–1014 (2011). source

      Not checked in the free run.

    • cites [29] Rascovsky, K. et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain 134, 2456–2477 (2011). source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The DSM-5 approach is consistent with the NIA-AA criteria for dementia and MCI.

    “The approach taken by DSM-5 is consistent with the one adopted by the NIA-AA criteria for dementia 25 and MCI.20”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [25] Román, G. C. et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS–AIREN International Workshop. Neurology 43, 250–260 (1993). source

      Not checked in the free run.

    • cites [20] Albert, M. S. et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging–Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 7, 270–279 (2011). source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Vascular risk factors should raise the index of suspicion but should not be used as diagnostic criteria.

    “A number of vascular risk factors that should raise the index of suspicion have been recognized, 34 but these factors should not be used as diagnostic criteria.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Gorelick, P. B. et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42, 2672–2713 (2011). source

      Not checked in the free run.

    • Rests on an assumption: Hypertension, diabetes, obesity, and metabolic syndrome are risk factors for vascular neurocognitive disorder but also increase Alzheimer disease risk and are consistent with other aetiologies.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationcitation

    DSM-5 attempts to disentangle cause from consequence and recognizes that multiple and nonexclusive factors may cause a given disorder.

    “The DSM-5 also attempts to disentangle cause from consequence, 21 and is written in the recognition that multiple and nonexclusive factors may cause a given disorder.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Ganguli, M. Can the DSM-5 framework enhance the diagnosis of MCI? Neurology 81, 2045–2050 (2013). source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationnone given

    Adoption of these criteria by an international group of clinicians with a broad range of specialties should foster greater consistency in diagnosis and bring cohesion to the field.

    “The adoption of these criteria by an international group of clinicians with a broad range of specialties should foster greater consistency in the diagnosis of neurocognitive disorders and bring cohesion to this diverse field.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    DSM-5 makes explicit that neurocognitive disorders lie on a continuum, with many individuals having a milder form not severe enough to be called dementia.

    “It makes explicit the fact that neurocogni tive disorders lie on a continuum, and many individuals have a milder form of the disorder that is not severe enough to be called dementia.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The validity of the DSM-5 criteria has had only limited testing in clinical practice.

    “The validity of these criteria has had only limited testing in clinical practice.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Parkinsonism in neurocognitive disorder with Lewy bodies must be distinguished from drug-induced extrapyramidal signs because individuals with this disorder can be very sensitive to neuroleptic drugs.

    “The parkinsonism must be distinguished from drug-induced extrapyramidal signs, as individuals with neurocognitive disorder with Lewy bodies can be very sensitive to neuroleptic drugs that are often used to treat their hallucinations and delusions.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Neurocognitive disorder with Lewy bodies presents with insidious onset and gradual progression, but early changes are in complex attention and executive function rather than learning and memory.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The criteria were field-tested for reliability, revised multiple times, and scrutinized by several DSM-5 panels before finalization.

    “The criteria were fieldtested for reliability, revised multiple times, and scrutinized by several overarching DSM-5 panels before being finalized.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The DSM-5 criteria were arrived at by expert consensus.

    “The DSM-5 criteria were arrived at by expert consensus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    DSM-5 does not imply that mild neurocognitive disorder will necessarily progress to major neurocognitive disorder.

    “The DSM-5 does not imply that mild neurocognitive disorder will necessarily progress to major neurocognitive disorder.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    DSM-5 uses a clinical approach to diagnosis and recognizes that neurocognitive disorders are a heterogeneous group occurring throughout the lifespan.

    “The DSM-5 uses a clinical approach to diagnosis, and recognizes that the neurocognitive cluster is a heterogeneous group of disorders occurring throughout the life span.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    DSM-5 is the first major attempt to classify neurocognitive disorders with internally consistent criteria and common terminology.

    “DSM-5 is the first major attempt to classify the various neurocognitive disorders with sets of criteria that are internally consistent and use common terminology.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Providing a parallel format across the various disorders simplifies the approach to differential diagnosis.

    “Providing a parallel format across the various disorders simplifies the approach to differential diagnosis.”
    Quote in the paperNot a substantial claim
49 of 49

  • The authors state this as an assumption.

    Clinicians and research groups will welcome a common language for 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.”

  • The paper relies on this without support.

    Mild and major neurocognitive disorders are categorical constructs imposed on an underlying continuum of cognitive impairment from normality to severe impairment.

    “Mild and major neurocognitive disorders are categorical diagnostic constructs imposed on an underlying continuum of cognitive impairment from normality to severe impairment, as seen in the clinic and the population.”

  • The paper relies on this without support.

    Mutations in APP or PSEN1/PSEN2 are causative for early-onset Alzheimer disease.

    “For example, the presence of mutations in the amyloid precursor protein gene (APP) or the presenilin genes (PSEN1 and PSEN2) is con sidered causative for AD with an early onset”

  • The paper relies on this without support.

    Neuroimaging is particularly important for determining vascular and frontotemporal degenerative aetiology.

    “Neuroimaging is particularly important in the neurocognitive disorders to determine vascular and frontotemporal degenerative aetiology.”

  • The paper relies on this without support.

    Subtyping neurocognitive disorders by cognitive profile is not very specific for aetiology in many settings.

    “However, the subtyping of neuro cognitive disorders by cognitive profile is not very specific for aetiology in many settings.”

  • The paper relies on this without support.

    Hypertension, diabetes, obesity, and metabolic syndrome are risk factors for vascular neurocognitive disorder but also increase Alzheimer disease risk and are consistent with other aetiologies.

    “For example, hypertension, diabetes, obesity and metabolic syndrome are risk factors for vascular neurocognitive disorder, but they also increase the risk for AD, and their presence is consistent with other aetiologies for neurocognitive disorder as well.”

  • The paper relies on this without support.

    Alzheimer disease is a neurodegenerative disorder with insidious onset and gradual progression of cognitive deficits.

    “AD is a neurodegenerative disorder with an insidious onset and gradual progression of cognitive deficits.”

  • The paper relies on this without support.

    In typical Alzheimer disease, decline in learning and memory is an early and predominant feature, and the decline is progressive without extended plateaus.

    “In a typical case, decline in learning and memory is an early and predominant feature, and the decline is progressive, without extended plateaus.”

  • The paper relies on this without support.

    The ε4 variant of apolipoprotein E is a risk factor for Alzheimer disease but not a diagnostic marker.

    “The presence of the ε4 variant of apolipoprotein E is a risk factor for AD but not a diagnostic marker.”

  • The paper relies on this without support.

    Alzheimer disease biomarkers include amyloid deposition on PET, reduced CSF amyloid-β42, elevated phosphorylated and total tau, hippocampal and temporoparietal atrophy on MRI, and temporoparietal hypometabolism on FDG PET.

    “Other markers include the demonstration of amyloid deposition in the brain using PET, reduced levels of amyloid-β 42 and elevated levels of phosphorylated tau and total tau in the cerebrospinal fluid, hippocampal and temporoparietal atrophy on MRI, and temporo parietal hypometabolism on 18 F-fluorodeoxyglucose PET.”

  • The paper relies on this without support.

    The concept of vascular neurocognitive disorder is broad and includes ischaemic and haemorrhagic lesions, as well as changes due to small vessel disease.

    “The concept of vascular neurocognitive disorder is broad and includes both ischaemic and haemorrhagic lesions, as well as changes due to small vessel disease.”

  • The paper relies on this without support.

    Structural MRI or CT has an important supportive role, and MRI can exclude clinically significant parenchymal injury due to vascular pathology.

    “Structural neuroimaging using MRI or CT has an important role as supportive evidence, and MRI can, in fact, be used to exclude the presence of clinically significant parenchymal injury due to vascular pathology.”

  • The paper relies on this without support.

    No biomarkers of vascular neurocognitive disorder other than neuroimaging have been established.

    “No biomarkers of vascular neurocognitive disorder, other than neuroimaging, have been established.”

  • The paper relies on this without support.

    Frontotemporal neurocognitive disorder comprises a number of syndromal variants with insidious onset and gradually progressive impairment of behaviour, personality, and/or language.

    “This group of neurodegenerative disorders comprises a number of syndromal variants with insidious onset and gradually progressive impairment of behaviour, personality and/or language.”

  • The paper relies on this without support.

    In familial frontotemporal cases, causative mutations have been identified in C9ORF72, MAPT, GRN, TDP-43, VCP, CHMP2B, and FUS.

    “In familial cases, a number of causative mutations have been identified in C9ORF72, and in genes coding for microtubule-associated protein tau (MAPT), granulins (GRN), TAR DNA-binding protein 43 (TDP-43), transitional endoplasmic reticulum ATPase (VCP), charged multivesicular body protein 2b (CHMP2B) and FUS protein (FUS).”

  • The paper relies on this without support.

    Frontotemporal neurocognitive disorder overlaps clinically and pathologically with progressive supranuclear palsy, corticobasal degeneration, and motor neuron disease.

    “Frontotemporal neurocognitive disorder overlaps with progressive supranuclear palsy, corticobasal degeneration and motor neuron disease in terms of clinical and pathological profiles.”

  • The paper relies on this without support.

    Neurocognitive disorder with Lewy bodies presents with insidious onset and gradual progression, but early changes are in complex attention and executive function rather than learning and memory.

    “Like AD, this disorder presents with cognitive impairment of insidious onset and gradual progression, but the early changes are in complex attention and executive function rather than in learning and memory.”

  • The authors state this as an assumption.

    By convention, in neurocognitive disorder with Lewy bodies, major cognitive symptoms are observed at least 1 year before motor symptoms.

    “The presence of spontaneous parkinsonism is an important feature and, by convention, the major cognitive symptoms are observed at least 1 year before the motor symptoms.”
18 of 18

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • An undefined diagnostic category appears in the overview

    Minor

    The overview refers to "minor" neurocognitive disorder, but the paper identifies the corresponding syndrome as "mild" neurocognitive disorder throughout.

  • AD subtype requirements differ despite a claim that they are the same

    Minor

    The paper says aetiological subtype criteria are the same for mild and major disorders, then specifies different numbers of required cognitive domains for the AD subtype.

  • The cited dementia guideline is listed as a vascular dementia paper

    Minor

    The text identifies reference 25 as NIA-AA dementia criteria, but reference 25 is a paper on vascular dementia criteria.

3 of 3

Cites

Flagged first, then by citations

1 of the 34 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Sternberg, R. J. & Sternberg, K. Cognitive Psychology 6th edn (Cengage Learning, 2009).
  2. Lezak, M. D., Howieson, D. B. & Loring, D. W. Neuropsychological Assessment 4th edn (Oxford University Press, 2004).

Cited by

Sorted by citations

Related

Authors
Sachdev, P. S., Blacker, D., Blazer, D. G., Ganguli, M., Jeste, D. V., Paulsen, J. S., & Petersen, R. C.
Affiliations
  • UNSW Sydney (AU)
  • Harvard University (US)
  • Duke University (US)
  • University of Pittsburgh (US)
  • University of California San Diego (US)
  • University of Iowa (US)
  • Mayo Clinic (US)
Corresponding author
Sachdev, Perminder S.
ORCID
Venue
Nature Reviews Neurology
Publisher
Springer Science and Business Media LLC
Published
2014-09-30
Volume
10
Issue
11
Pages
634-642
ISSN
  • 1759-4758 (ISSN-L)
  • 1759-4766
DOI
10.1038/nrneurol.2014.181
OpenAlex
W2048512926
Cited by
1,116
References
34
Citations by year
2026: 135 · 2025: 170 · 2024: 160 · 2023: 149 · 2022: 118 · 2021: 133 · 2020: 92 · 2019: 58 · 2018: 39 · 2017: 31 · 2016: 14 · 2015: 12 · 2014: 2
FWCI
2.72
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Nature Reviews Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • UNSWorks (UNSW Sydney) (submittedVersion, cc-by-nc-nd)
  • eScholarship (California Digital Library) (submittedVersion)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
Funders
  • U.S. Department of Health and Human Services
  • National Institutes of Health
  • Medical Research Council
  • National Health and Medical Research Council (568969)
  • National Institute on Aging (P50AG005134, K07AG044395)
  • National Institute of Mental Health (MH099987, R01MH099987)
  • Sam and Rose Stein Institute for Research on Aging
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
Keywords
neurocognitive disorders, DSM-5, diagnostic criteria, delirium, mild neurocognitive disorder, major neurocognitive disorder, mild cognitive impairment, dementia, Alzheimer's disease, cerebrovascular disease, Lewy body disease, frontotemporal lobar degeneration, traumatic brain injury
MeSH terms
Delirium, Dementia, Humans, Diagnostic and Statistical Manual of Mental Disorders, Cognitive Dysfunction

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.

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