DSM - 5 in Vascular Dementia - Comparison with other diagnostic criteria in a retrospective study

Context: The studies comparing different diagnostic guidelines for vascular dementia (VaD) demonstrated that they differ in their requirements. The more recent guideline, Diagnostic and Statistical Manual of Mental Disorders–5th Edition (DMS-5) does not have an established comparison. This study compared DSM-5 with other diagnostic guidelines for VaD and its degree of association with them. Methods and Material: It is a retrospective analysis of the clinical case files of 91 patients who were diagnosed to have VaD between 1st April’ 2013 to 31st March’2014. Based on the information about history, clinical findings, and neuroimaging findings, the cases were diagnosed according to DSM-5, National Institute of Neurological Disorders and Stroke -Association Internationale pour la Recherche et l’Enseignement en Neurosciences (NINDS-AIREN) with and without modification for sub-cortical ischemic vascular dementia (SIVD), International Classification of Diseases, 10th Revision (ICD-10), and State of California Alzheimers Disease Diagnostic and Treatment Centers (ADDTC). The association of DSM-5 with other guidelines was measured by the concordance rate, Kendell Tau B (for effect size estimate) and Spearman correlation coefficient (for degree of convergence). Results: For only 30% (28 out of 91) cases, all diagnostic guidelines agreed to the diagnosis of same category of VaD. The total positive cases rose to 95.6% (87 out of 91) cases when it was considered even if anyone guideline gives the diagnosis of VaD. There was almost equal proportion of probable (40.6%) and possible (42.9%) The concordance rate of DSM-5 was maximum with ADDTC (67.3%) followed by with ICD-10 (53.8%), NINDS-AIREN with modification for SIVD (51%) and NINDS-AIREN without modification for SIVD (46.2%). The degree of convergence and effect size of association was of moderate level ranging from 0.29 to 0.39 and all were statistically significant. ADDTC had the highest values for all measures of its association with DSM-5. Conclusion: DSM-5 contributes to increase in total number of positive cases of VaD by using diagnostic guidelines. The moderate degree of association of DSM-5 with other guidelines indicates the incorporation of some of their criteria by DSM-5 and simultaneous consideration of the recent valid features of VaD.