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New DSM-V neurocognitive disorders criteria and their impact on diagnostic classifications of mild cognitive impairment and dementia in a memory clinic setting.
Am J Geriatr Psychiatry. 2015 Aug; 23(8):768-79.AJ

Abstract

OBJECTIVE

To examine diagnostic agreement between Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) Neurocognitive Disorders (NCDs) criteria and DSM, Fourth Edition (DSM-IV) criteria for dementia and International Working Group (IWG) criteria for mild cognitive impairment (MCI) and DSM-V's impact on diagnostic classifications of NCDs. The authors further examined clinical factors for discrepancy in diagnostic classifications between the different operational definitions.

METHODS

Using a cross-sectional study in tertiary memory clinic, the authors studied consecutive new patients aged 55 years or older who presented with cognitive symptoms. Dementia severity was scored based on the Clinical Dementia Rating scale (CDR). All patients completed neuropsychological evaluation. Agreement in diagnostic classifications between DSM-IV/IWG and DSM-V was examined using the kappa test and AC1 statistic, with multinomial logistic regression for factors contributing to MCI reclassification as major NCDs as opposed to diagnostically concordant MCI and dementia groups.

RESULTS

Of 234 patients studied, 166 patients achieved concordant diagnostic classifications, with overall kappa of 0.41. Eighty-six patients (36.7%) were diagnosed with MCI and 131 (56.0%) with DSM-IV-defined dementia. With DSM-V, 40 patients (17.1%) were classified as mild NCDs and 183 (78.2%) as major NCDs, representing a 39.7% increase in frequency of dementia diagnoses. CDR sum-of-boxes score contributed independently to differentiation of MCI patients reclassified as mild versus major NCDs (OR: 0.01; 95% CI: 0-0.09). CDR sum-of-boxes score (OR: 5.18; 95% CI: 2.04-13.15), performance in amnestic (OR: 0.14; 95% CI: 0.06-0.34) and language (Boston naming: OR: 0.52; 95% CI: 0.29-0.94) tests, were independent determinants of diagnostically concordant dementia diagnosis.

CONCLUSION

The authors observed moderate agreement between the different operational definitions and a 40% increase in dementia diagnoses with operationalization of the DSM-V criteria.

Authors+Show Affiliations

Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore. Electronic address: Laura_Tay@ttsh.com.sg.Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore.Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore.Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore.Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore.Department of Psychological Services, Tan Tock Seng Hospital, Singapore.Department of Psychological Services, Tan Tock Seng Hospital, Singapore.Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25728011

Citation

Tay, Laura, et al. "New DSM-V Neurocognitive Disorders Criteria and Their Impact On Diagnostic Classifications of Mild Cognitive Impairment and Dementia in a Memory Clinic Setting." The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, vol. 23, no. 8, 2015, pp. 768-79.
Tay L, Lim WS, Chan M, et al. New DSM-V neurocognitive disorders criteria and their impact on diagnostic classifications of mild cognitive impairment and dementia in a memory clinic setting. Am J Geriatr Psychiatry. 2015;23(8):768-79.
Tay, L., Lim, W. S., Chan, M., Ali, N., Mahanum, S., Chew, P., Lim, J., & Chong, M. S. (2015). New DSM-V neurocognitive disorders criteria and their impact on diagnostic classifications of mild cognitive impairment and dementia in a memory clinic setting. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 23(8), 768-79. https://doi.org/10.1016/j.jagp.2015.01.004
Tay L, et al. New DSM-V Neurocognitive Disorders Criteria and Their Impact On Diagnostic Classifications of Mild Cognitive Impairment and Dementia in a Memory Clinic Setting. Am J Geriatr Psychiatry. 2015;23(8):768-79. PubMed PMID: 25728011.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - New DSM-V neurocognitive disorders criteria and their impact on diagnostic classifications of mild cognitive impairment and dementia in a memory clinic setting. AU - Tay,Laura, AU - Lim,Wee Shiong, AU - Chan,Mark, AU - Ali,Noorhazlina, AU - Mahanum,Shariffah, AU - Chew,Pamela, AU - Lim,June, AU - Chong,Mei Sian, Y1 - 2015/01/29/ PY - 2014/06/28/received PY - 2015/01/26/revised PY - 2015/01/27/accepted PY - 2015/3/3/entrez PY - 2015/3/3/pubmed PY - 2016/4/19/medline KW - Dementia KW - major neurocognitive disorder KW - mild cognitive impairment KW - mild neurocognitive disorder SP - 768 EP - 79 JF - The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry JO - Am J Geriatr Psychiatry VL - 23 IS - 8 N2 - OBJECTIVE: To examine diagnostic agreement between Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) Neurocognitive Disorders (NCDs) criteria and DSM, Fourth Edition (DSM-IV) criteria for dementia and International Working Group (IWG) criteria for mild cognitive impairment (MCI) and DSM-V's impact on diagnostic classifications of NCDs. The authors further examined clinical factors for discrepancy in diagnostic classifications between the different operational definitions. METHODS: Using a cross-sectional study in tertiary memory clinic, the authors studied consecutive new patients aged 55 years or older who presented with cognitive symptoms. Dementia severity was scored based on the Clinical Dementia Rating scale (CDR). All patients completed neuropsychological evaluation. Agreement in diagnostic classifications between DSM-IV/IWG and DSM-V was examined using the kappa test and AC1 statistic, with multinomial logistic regression for factors contributing to MCI reclassification as major NCDs as opposed to diagnostically concordant MCI and dementia groups. RESULTS: Of 234 patients studied, 166 patients achieved concordant diagnostic classifications, with overall kappa of 0.41. Eighty-six patients (36.7%) were diagnosed with MCI and 131 (56.0%) with DSM-IV-defined dementia. With DSM-V, 40 patients (17.1%) were classified as mild NCDs and 183 (78.2%) as major NCDs, representing a 39.7% increase in frequency of dementia diagnoses. CDR sum-of-boxes score contributed independently to differentiation of MCI patients reclassified as mild versus major NCDs (OR: 0.01; 95% CI: 0-0.09). CDR sum-of-boxes score (OR: 5.18; 95% CI: 2.04-13.15), performance in amnestic (OR: 0.14; 95% CI: 0.06-0.34) and language (Boston naming: OR: 0.52; 95% CI: 0.29-0.94) tests, were independent determinants of diagnostically concordant dementia diagnosis. CONCLUSION: The authors observed moderate agreement between the different operational definitions and a 40% increase in dementia diagnoses with operationalization of the DSM-V criteria. SN - 1545-7214 UR - https://www.unboundmedicine.com/medline/citation/25728011/New_DSM_V_neurocognitive_disorders_criteria_and_their_impact_on_diagnostic_classifications_of_mild_cognitive_impairment_and_dementia_in_a_memory_clinic_setting_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1064-7481(15)00070-6 DB - PRIME DP - Unbound Medicine ER -