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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, Volume: 56, Pages: 7872 - 7891

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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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 56 7872 7891 Springer Science and Business Media LLC 1554-3528 Diagnosis; Neurocognitive disorders; Prosopagnosia; Single case analysis; Mild cognitive impairment;Major; Subjective cognitive impairment; MCI; Transdiagnostic 1 10 2024 2024-10-01 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 2024-11-01T15:08:01.9427096 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
container_volume 56
container_start_page 7872
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 2024-10-01T15:07:59Z
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