Classifying neurocognitive disorders: the DSM-5 approach

The fifth edition of the American Psyciatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-5) was published in 2013, and with it came new diagnostic criteria for mild cognitive impairment and dementia. In this Review, members of the working group tasked with writing the DSM-5 criteria for neurocognitive disorders present the new approach to categorization and diagnosis. Three key syndromes are recognized—delirium, mild neurocognitive disorder and major neurocognitive disorder—and each can have distinct aetiological subtypes. 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.