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Improving the DSM-5 approach to cognitive impairment: Developmental prosopagnosia reveals the need for tailored diagnoses
Edwin Burns 
Behavior Research Methods
Swansea University Author:
Edwin Burns
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© The Author(s) 2024. This article is licensed under a Creative Commons Attribution 4.0 International License.
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DOI (Published version): 10.3758/s13428-024-02459-4
Abstract
The Diagnostic Statistical Manual of Mental Disorders 5th edition (DSM-5) approach to neurocognitive disorders recommends diagnosing cognitive impairment when a patient scores beyond -1 SD below neurotypical norms on two cognitive tests. I review how this approach will fail due to cognitive tests’ p...
| Published in: | Behavior Research Methods |
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| ISSN: | 1554-3528 |
| Published: |
Springer Science and Business Media LLC
2024
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| Online Access: |
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa66634 |
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| Abstract: |
The Diagnostic Statistical Manual of Mental Disorders 5th edition (DSM-5) approach to neurocognitive disorders recommends diagnosing cognitive impairment when a patient scores beyond -1 SD below neurotypical norms on two cognitive tests. I review how this approach will fail due to cognitive tests’ power limitations, validity issues, imperfect reliabilities, and biases, before summarising their resulting negative consequences. As a proof of concept, I use developmental prosopagnosia, a condition characterised by difficulties recognising faces, to show the DSM-5 only diagnoses 62-70% (n1 = 61, n2 = 165) versus 100% (n1 = 61) through symptoms alone. Pooling the DSM-5 missed cases confirmed the presence of group-level impairments on objective tests, which were further evidenced through meta-analyses, thus validating their highly atypical symptoms. These findings support a paradigm shift towards bespoke diagnostic approaches for distinct cognitive impairments, including a symptom-based method when validated effective. I reject dogmatic adherence to the DSM-5 approach to neurocognitive disorders, and underscore the importance of a data driven, transdiagnostic approach to understanding patients’ subjective cognitive impairments. This will ultimately benefit patients, their families, clinicians, and scientific progress. |
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| Keywords: |
Diagnosis; Neurocognitive disorders; Prosopagnosia; Single case analysis; Mild cognitive impairment;Major; Subjective cognitive impairment; MCI; Transdiagnostic |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
Swansea University |