The Neurocognitive Disorders Work Group of the American Psychiatric Association's (APA) DSM-5 Task Force began work in April 2008 on their task of proposing revisions to the criteria for the disorders referred to in DSM-IV as Delirium, Dementia, Amnestic and Other Cognitive Disorders. (1) Over the past two years we have, among ourselves and with input from outside consultants and advisors, worked to develop a working draft that was posted on the APA's website www.dsm5.org in February 2010. This draft contained both an overview/rationale for the approach we have taken to date and preliminary criteria for the broadly defined disorders. Without reiterating here all the material posted on the website, we will provide below our approach to the challenges we faced and some rationale for that approach. We are also pleased to have this opportunity to respond publicly both to the many comments directed to the Work Group on and off the website, and to the very thoughtful and constructive commentary provided by Drs. Rabins and Lyketsos in this issue.(2) Finally, while this response is directed to the readership of the American Journal of Geriatric Psychiatry, we emphasize that the neurocognitive disorders are by no means restricted to older adults. We continue our efforts to refine and expand these criteria, working towards the final DSM-5 publication date of May 2013.
By way of background, the Task Force began its work mindful of two guiding principles. The first was to propose changes based on advances both in scientific knowledge and in current views and clinical practices, in full awareness of the controversies and challenges within our field. The second was to avoid making changes for the sake of change, bearing in mind that all change is disruptive and potentially expensive. We are fortunate that most of the disorders we address have been the focus of intense and productive scientific research since DSM-IV was published. We also recognized that ours was a category unique within DSM-5 in that, for most disorders within our purview, the underlying pathology is known, and sometimes the etiology as well.