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Table 1 Operationalization of DSM-5 major NCD and DSMIV dementia within the algorithm

From: Evaluation of a research diagnostic algorithm for DSM-5 neurocognitive disorders in a population-based cohort of older adults

DSM-5 major neurocognitive disorder DSM-IV dementia
Criteria Algorithm Criteria Algorithm
A. Both of the following:   A. Both of the following:  
A1 Concern of self or informant of significant cognitive decline in one or more cognitive domains MAC-Q >24 or IQCODE >3.31 or recent doctor’s consultation about cognitive change or informant reported worsening of everyday cognitive functiona A1 Memory impairment Mean z score for the learning and memory domain ≤ –2.0.
A2 Substantial impairment in cognitive performance in one or more cognitive domains Mean z score for one or more of the following domains is ≤ –2.0: complex attention, executive function, learning and memory, language, perceptual/motor, social cognition or mean decline in performance between waves 3 and 4 that is </=-2.0 below norms on select testsf. A2 Substantial impairment in cognitive performance in one or more cognitive domains Mean z scores ≤ –2 for one or more of: executive function, language, praxisb, gnosisb or mean decline in performance between waves 3 and 4 that is </=-2.0 below norms on select testsf.
B The cognitive deficits interfere with independence in everyday activity Any self-reported problems due to memory on HRS-IADLc, or need for household/personal care help, or Bayer IADL >3.12, and (if A2 social cognition impaired, then also informant-reportedd change in social behaviors or emotion recognition) B A1 and A2 each cause significant social/occupational dysfunction and represent a decline Any HRS-IADLc problems due to memory, or need for household/personal care help, or Bayer IADL >3.12, and (if A2 praxis or gnosis impaired then also informant-reportede difficulties in everyday praxis and object recognition)
C The cognitive deficits do not occur exclusively in the context of a delirium Informant reports deficits started 6 months or more ago, or informant reported delirium signs present for less than duration of cognitive change C The cognitive deficits do not occur exclusively in the context of a delirium Informant reports deficits started 6 months or more ago, or informant reported delirium signs present for less than duration of cognitive change
D The cognitive deficits are not better explained by another mental disorder PHQ-9 < 10 and no informant-reported history of schizophrenia or other psychosis D The cognitive deficits are not better explained by another mental disorder PHQ-9 < 10 and no informant-reported history of schizophrenia or other psychosis
  1. aInformant questions of everyday cognitive difficulties and worsening modeled on DSM-5 ‘Examples of symptoms or observations’ for neurocognitive domains
  2. bPraxis: ideomotor praxis z score ≤ –2.0; gnosis: BNT-15 z score ≤ –2.0, and COWAT > –2.0
  3. cHRS-IADL are self-report questions [40]
  4. dInformant endorses any of Dysexecutive Questionnaire (DEX-Q) items 9, 11, 13 or 20 with frequency of ‘sometimes’ or more, or endorses any of the following: “Behave out of character or inappropriately”; “Unconcerned or unaware of how others feel”; “Less participation in social functions for reasons other than physical”, “Lost special skills interests or hobbies”
  5. eInformant endorses any of following: “Difficulty with familiar tasks like parking a car, assembling objects, sewing etc.” “Difficulty using familiar tools or equipment”, “Get lost in familiar places”
  6. fTests available for determining objective decline over time: CVLT immediate and delayed recall, Digits back, SDMT, Purdue Pegboard, COWAT and Trails B, simple and complex RT
  7. DSM Diagnostic and Statistical Manual of Mental Disorders, IADL instrumental activities of daily living, IQCODE Informant Questionnaire of Cognitive Decline in the Elderly, MAC-Q Memory and Cognitive Questionnaire, MCI mild cognitive impairment, PHQ Patient Health Questionnaire