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Classifying neurocognitive disorders: the DSM-5 approach
Open accessAbstract
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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26 Own interpretation · 16 Not checked yet · 14 No basis given · 6 Own method
In the paper
“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”
§ Classifying neurocognitive disorders: the DSM-5 approach > Introduction
What the sources say
- Not checked yetcites [4] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 5th edn (American Psychiatric Association, 2013). source
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In the paper
“Deficits in social cognition were usually referred to as personality change in previous diagnostic criteria.2”
§ Classifying neurocognitive disorders: the DSM-5 approach > The neurocognitive disorders cluster
What the sources say
- Not checked yetcites [2] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders 4th edn (American Psychiatric Association, 1994).
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Mild and major neurocognitive disorder
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In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > The neurocognitive disorders cluster
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In the paper
“Mild and major neurocognitive disorders are therefore subtyped according to aetiology.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
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In the paper
“Diagnostic criteria for most of the aetiological subtypes of neurocognitive disorders include the exclusionary criterion that the disturbance cannot be explained by another aetiology.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
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None of the sources cited for this claim have been checked yet.
In the paper
“This change was made in recognition of the fact that many individuals with dementia not due to AD can have relatively intact memory, as is seen in patients with cerebro vascular disease, 14 frontotemporal degeneration 15 and some other conditions.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Box 1 | Diagnostic criteria for delirium
What the sources say
- Not checked yetcites [14] Looi, J. C. & Sachdev, P. S. Differentiation of vascular dementia from AD on neuropsychological tests. Neurology 53, 670–678 (1999). source
- Not checked yetcites [15] Josephs, K. A. Frontotemporal dementia and related disorders: deciphering the enigma. Ann. Neurol. 64, 4–14 (2008). source
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“As a consequence, the DSM-IV category of 'amnestic disorder' is now covered by major neurocognitive disorder.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Box 1 | Diagnostic criteria for delirium
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Risk factors are therefore not included in the diagnostic criteria for the aetiological subtypes in DSM-5.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Second, memory impairment is not essential for the diagnosis.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Box 1 | Diagnostic criteria for delirium
plain- Asserted: passes — The authors put it forward as true.
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- Probably not a substantial claim. 37
- It may state two separate claims as one. 29
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Abstract
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
- The authors state this as an assumption: Clinicians and research groups will welcome a common language for neurocognitive disorders.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The DSM-5 does not specify which tests, or how many, should be administered per cognitive domain.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Mild neurocognitive disorder
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
§ Classifying neurocognitive disorders: the DSM-5 approach > Mild neurocognitive disorder
What the sources say
- Not checked yetcites [21] Ganguli, M. Can the DSM-5 framework enhance the diagnosis of MCI? Neurology 81, 2045–2050 (2013). source
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Delirium
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the objective demonstration of cognitive deficits is essential.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Mild neurocognitive disorder
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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).”
§ Classifying neurocognitive disorders: the DSM-5 approach > Mild and major neurocognitive disorder
hedgeddirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Mild and major neurocognitive disorder
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Delirium can be caused by an underlying medical condition, substance intoxication or withdrawal, exposure to toxins, or a combination of these factors.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Delirium
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Box 1 | Diagnostic criteria for delirium
What the sources say
- Not checked yetcites [13] Sachdev, P. Is it time to retire the term “dementia”? J. Neuropsychiatry Clin. Neurosci. 12, 276–279 (2000). source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Mild neurocognitive disorder
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“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”
§ Classifying neurocognitive disorders: the DSM-5 approach > Mild and major neurocognitive disorder
What the sources say
- Not checked yetcites [12] Petersen, R. et al. Mild cognitive impairment: ten years later. Arch. Neurology 66, 1447–1455 (2009). source
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Mild neurocognitive disorder
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. It may state two separate claims as one.
- 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.
In the paper
“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”
§ Classifying neurocognitive disorders: the DSM-5 approach > Mild neurocognitive disorder
What the sources say
- Not checked yetcites [12] Petersen, R. et al. Mild cognitive impairment: ten years later. Arch. Neurology 66, 1447–1455 (2009). source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Mild neurocognitive disorder
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
In the paper
“NIA-AA criteria were explicitly developed to enable researchers to diagnose MCI due to AD, but include a generic definition of MCI.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Mild neurocognitive disorder
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“This neurocognitive disorder is characterised by disturbance in attention that makes it difficult for the indi vidual to direct, sustain and shift their focus.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Delirium
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > The neurocognitive disorders cluster
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
hedgedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Box 1 | Diagnostic criteria for delirium
plain- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Introduction
plaindirect- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“First, substantial decline in only one cognitive domain is sufficient for the diagnosis if the other criteria are met.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Box 1 | Diagnostic criteria for delirium
plaindirect- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Box 1 | Diagnostic criteria for delirium
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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”
§ Classifying neurocognitive disorders: the DSM-5 approach > Introduction
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
plaindirect- Asserted: passes — The authors put it forward as true.
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What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Public comment was solicited on draft criteria posted on the DSM-5 website.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Introduction
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The DSM-5 criteria were designed primarily for the clin ician.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Box 1 | Diagnostic criteria for delirium
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Box 1 | Diagnostic criteria for delirium
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Competent interpretation of test performance is essential, and can be aided by prior administration of the same test so that decline can be assessed.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Box 1 | Diagnostic criteria for delirium
plainconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Frontotemporal neurocognitive disorder
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- 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.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The development or worsening of cognitive deficits following a cerebrovascular event increases the certainty of the diagnosis.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Vascular neurocognitive disorder
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
What the sources say
- Not checked yetcites [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 yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- 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.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Frontotemporal neurocognitive disorder
What the sources say
- Not checked yetcites [28] Gorno-Tempini, M. L. et al. Classification of primary progressive aphasia and its variants. Neurology 76, 1006–1014 (2011). source
- Not checked yetcites [29] Rascovsky, K. et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain 134, 2456–2477 (2011). source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The approach taken by DSM-5 is consistent with the one adopted by the NIA-AA criteria for dementia 25 and MCI.20”
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
What the sources say
- Not checked yetcites [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 yetcites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Vascular neurocognitive disorder
What the sources say
- Not checked yetcites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- 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.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Other subtypes
What the sources say
- Not checked yetcites [21] Ganguli, M. Can the DSM-5 framework enhance the diagnosis of MCI? Neurology 81, 2045–2050 (2013). source
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Other subtypes
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Other subtypes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The validity of these criteria has had only limited testing in clinical practice.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Other subtypes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Neurocognitive disorder with Lewy bodies
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- 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.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The criteria were fieldtested for reliability, revised multiple times, and scrutinized by several overarching DSM-5 panels before being finalized.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Review criteria
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The DSM-5 criteria were arrived at by expert consensus.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Review criteria
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The DSM-5 does not imply that mild neurocognitive disorder will necessarily progress to major neurocognitive disorder.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Other subtypes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Other subtypes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Other subtypes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Providing a parallel format across the various disorders simplifies the approach to differential diagnosis.”
§ Classifying neurocognitive disorders: the DSM-5 approach > Other subtypes
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
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.”
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?
In the citing paper
“The DSM‐5 88 does not use an age cutoff in the diagnostic criteria for schizophrenia, nor does the ICD‐11 265 .”
From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [88]
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.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Classifying neurocognitive disorders: the DSM-5 approach > Introduction
“We also describe several aetiological subtypes of minor and major neurocognitive disorder”
§ Classifying neurocognitive disorders: the DSM-5 approach > Subdividing the cluster
“The neurocognitive disorders cluster comprises three syndromes, each with a range of possible aetiologies: delirium, mild neurocognitive disorder and major neurocognitive disorder.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
“The aetiological subtype criteria are the same for both mild and major neurocognitive disorders”
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
“For the DSM-5 diagnosis of major neurocognitive disorder due to AD, decline in at least two cognitive domains is necessary, one of which should be learning and memory; for mild neurocognitive disorder due to AD, the learning and memory deficit is sufficient for diagnosis”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Classifying neurocognitive disorders: the DSM-5 approach > Aetiological subtypes
“The approach taken by DSM-5 is consistent with the one adopted by the NIA-AA criteria for dementia 25 and MCI.20”
§ Classifying neurocognitive disorders: the DSM-5 approach > References
“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).”
Citations
Cites
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“…discussions with experts from diverse fields to harmonize the DSM criteria with cri‑ teria developed by other expert groups, such as the NIA– AA, 20,27 the frontotemporal dementia expert group, 28,29 the consortium on DLB, 30 the VASCOG working group, 31 the Movement Disorder Study Task Force…”
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Cited by
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Metadata
- 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
- Published
- 2014-09-30
- Volume
- 10
- Issue
- 11
- Pages
- 634-642
- ISSN
- 1759-4758 (ISSN-L)
- 1759-4766
- 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
- bronze
- doi.org
- 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
About these checks
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.
A language model drew the claims from the paper on 2026-10-05, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-05 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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