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Improving the DSM-5 approach to cognitive impairment: Developmental prosopagnosia reveals the need for tailored diagnoses

Edwin Burns Orcid Logo

Behavior Research Methods

Swansea University Author: Edwin Burns Orcid Logo

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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...

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Published in: Behavior Research Methods
ISSN: 1554-3528
Published: Springer Science and Business Media LLC 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa66634
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last_indexed 2024-06-10T08:23:25Z
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spelling v2 66634 2024-06-10 Improving the DSM-5 approach to cognitive impairment: Developmental prosopagnosia reveals the need for tailored diagnoses fd2ee0c494abf5744c49ab6dd1f034bc 0000-0002-5938-5457 Edwin Burns Edwin Burns true false 2024-06-10 PSYS 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. Journal Article Behavior Research Methods 0 Springer Science and Business Media LLC 1554-3528 Diagnosis; Neurocognitive disorders; Prosopagnosia; Single case analysis; Mild cognitive impairment;Major; Subjective cognitive impairment; MCI; Transdiagnostic 8 7 2024 2024-07-08 10.3758/s13428-024-02459-4 COLLEGE NANME Psychology School COLLEGE CODE PSYS Swansea University SU Library paid the OA fee (TA Institutional Deal) Swansea University 2024-07-24T12:06:37.1352337 2024-06-10T09:17:12.7479859 Faculty of Medicine, Health and Life Sciences School of Psychology Edwin Burns 0000-0002-5938-5457 1 66634__30956__2a7941cc398f4d6a8692711f326a2e1e.pdf 66634.VoR.pdf 2024-07-24T12:01:21.2079745 Output 1670655 application/pdf Version of Record true © The Author(s) 2024. This article is licensed under a Creative Commons Attribution 4.0 International License. true eng http://creativecommons.org/licenses/by/4.0/ 253 true https://osf.io/3x86n/
title Improving the DSM-5 approach to cognitive impairment: Developmental prosopagnosia reveals the need for tailored diagnoses
spellingShingle Improving the DSM-5 approach to cognitive impairment: Developmental prosopagnosia reveals the need for tailored diagnoses
Edwin Burns
title_short Improving the DSM-5 approach to cognitive impairment: Developmental prosopagnosia reveals the need for tailored diagnoses
title_full Improving the DSM-5 approach to cognitive impairment: Developmental prosopagnosia reveals the need for tailored diagnoses
title_fullStr Improving the DSM-5 approach to cognitive impairment: Developmental prosopagnosia reveals the need for tailored diagnoses
title_full_unstemmed Improving the DSM-5 approach to cognitive impairment: Developmental prosopagnosia reveals the need for tailored diagnoses
title_sort Improving the DSM-5 approach to cognitive impairment: Developmental prosopagnosia reveals the need for tailored diagnoses
author_id_str_mv fd2ee0c494abf5744c49ab6dd1f034bc
author_id_fullname_str_mv fd2ee0c494abf5744c49ab6dd1f034bc_***_Edwin Burns
author Edwin Burns
author2 Edwin Burns
format Journal article
container_title Behavior Research Methods
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publishDate 2024
institution Swansea University
issn 1554-3528
doi_str_mv 10.3758/s13428-024-02459-4
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Psychology{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Psychology
document_store_str 1
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description 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.
published_date 2024-07-08T12:06:38Z
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