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DEFINITION OF DEMENTIA Although a number of definitions exist for dementia, the Diagnostic and

Statistical Manual (DSM) definition provides a reasonable framework for the concept of dementia in
clinical practice. According to DSM-5, released in 2013, the criteria for dementia (now called major
neurocognitive disorder) include the following [1]:
Evidence from the history and clinical assessment that indicates significant cognitive impairment in
at least one of the following cognitive domains:
Learning and memory
Language
Executive function
Complex attention
Perceptual-motor function
Social cognition
The impairment must be acquired and represent a significant decline from a previous level of
functioning
The cognitive deficits must interfere with independence in everyday activities
In the case of neurodegenerative dementias such as Alzheimer disease, the disturbances are of
insidious onset and are progressive, based on evidence from the history or serial mental-status
examinations
The disturbances are not occurring exclusively during the course of delirium
The disturbances are not better accounted for by another mental disorder (eg, major depressive
disorder, schizophrenia)
Prior versions of the DSM definition have had good to very good reliability for the diagnosis of dementia
[4]. The DSM-5 definition differs substantively from prior versions in that the cognitive domains have been
renamed and expanded to include social cognition and complex attention; in addition, the centrality of
memory dysfunction as a sine qua non has been deemphasized, with all six cognitive domains given
equal weight in the criteria (table 1). All previous DSM definitions of dementia listed memory as an
essential feature for the diagnosis. The change from DSM-IV to DSM-5 presumably reflects the problem
that some individuals with dementia due to causes other than AD did not meet definitional criteria
because memory function was intact or at least relatively intact compared with norms. That being said, for
the most common forms of dementia, memory and language dysfunction are generally always present.
The performance of the DSM-5 criteria in relation to prior versions is not yet known, but it is likely that the
changes will have some impact on research and possibly clinical practice in the future

DSM-IV criteria for dementia

DSM-5 criteria for major


neurocognitive disorder
(previously dementia

A1. Memory impairment

A. Evidence of significant cognitive decline from a


previous level of performance in one or more
cognitive domains*:
- Learning and memory
- Language
- Executive function
- Complex attention
- Perceptual-motor
- Social cognition
B. The cognitive deficits interfere with
independence in everyday activities. At a
minimum, assistance should be required with
complex instrumental activities of daily living,
such as paying bills or managing medications
C. The cognitive deficits do not occur exclusively
in the context of a delirium
D. The cognitive deficits are not better explained
by another mental disorder (eg, major depressive
disorder, schizophrenia)

A2. At least one of the following:


- Aphasia
- Apraxia
- Agnosia
- Disturbance in executive functioning

B. The cognitive deficits in A1 and A2 each cause


significant impairment in social or occupational
functioning and represent a significant decline
from a previous level of functioning
C. The cognitive deficits do not occur exclusively
during the course of delirium