Evaluation of a research diagnostic algorithm for DSM-5 neurocognitive disorders in a population-based cohort of older adults
Date
2017
Authors
Eramudugolla, Ranmalee
Mortby, Moyra
Sachdev, Perminder Singh
Meslin, Chantal
Kumar, Rajeev
Anstey, Kaarin
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
There is little information on the application and impact of revised criteria for diagnosing dementia and mild cognitive impairment (MCI), now termed major and mild neurocognitive disorders (NCDs) in the DSM-5. We evaluate a psychometric algorithm for diagnosing DSM-5 NCDs in a community-dwelling sample, and characterize the neuropsychological and functional profile of expert-diagnosed DSM-5 NCDs relative to DSM-IV dementia and International Working Group criteria for MCI.Methods
A population-based sample of 1644 adults aged 72–78 years was assessed. Algorithmic diagnostic criteria used detailed neuropsychological data, medical history, longitudinal cognitive performance, and informant interview. Those meeting all criteria for at least one diagnosis had data reviewed by a neurologist (expert diagnosis) who achieved consensus with a psychiatrist for complex cases.
Results
The algorithm accurately classified DSM-5 major NCD (area under the curve (AUC) = 0.95, 95% confidence interval (CI) 0.92–0.97), DSM-IV dementia (AUC = 0.91, 95% CI 0.85–0.97), DSM-5 mild NCD (AUC = 0.75, 95% CI 0.70–0.80), and MCI (AUC = 0.76, 95% CI 0.72–0.81) when compared to expert diagnosis. Expert diagnosis of dementia using DSM-5 criteria overlapped with 90% of DSM-IV dementia cases, but resulted in a 127% increase in diagnosis relative to DSM-IV. Additional cases had less severe memory, language impairment, and instrumental activities of daily living (IADL) impairments compared to cases meeting DSM-IV criteria for dementia. DSM-5 mild NCD overlapped with 83% of MCI cases and resulted in a 19% increase in diagnosis. These additional cases had a subtly different neurocognitive profile to MCI cases, including poorer social cognition.
Conclusion
DSM-5 NCD criteria can be operationalized in a psychometric algorithm in a population setting. Expert diagnosis using DSM-5 NCD criteria captured most cases with DSM-IV dementia and MCI in our sample, but included many additional cases suggesting that DSM-5 criteria are broader in their categorization.
Description
Keywords
Neurocognitive disorders, dementia, Mild cognitive impairment, Diagnostic algorithm, Longitudinal, Cognitive aging, DSM-5
Citation
Collections
Source
Alzheimer's Research and Therapy
Type
Journal article
Book Title
Entity type
Access Statement
Open Access
License Rights
Creative Commons Attribution licence