Improving the DSM-5 Approach to Cognitive Impairment: Developmental Prosopagnosia Reveals the Need for Tailored Diagnoses

Overview

Journal Behav Res Methods

Publisher Springer

Specialty Social Sciences

Date 2024 Jul 8

PMID 38977608

Authors

Edwin J Burns

Affiliations

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Abstract

The Diagnostic Statistical Manual of Mental Disorders (DSM-5) recommends diagnosing neurocognitive disorders (i.e., cognitive impairment) when a patient scores beyond - 1 SD below neurotypical norms on two tests. I review how this approach will fail due to cognitive tests' power limitations, validity issues, imperfect reliabilities, and biases, before summarizing their resulting negative consequences. As a proof of concept, I use developmental prosopagnosia, a condition characterized by difficulties recognizing 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.

Citing Articles

Assessment of Developmental Prosopagnosia in an Individual with Tourette Syndrome and Attention Deficit Hyperactivity Disorder: A Case Report.

Emhjellen P, Starrfelt R, Raudeberg R, Hassel B Brain Sci. 2025; 15(1).

PMID: 39851424 PMC: 11764325. DOI: 10.3390/brainsci15010056.

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