Open Access Research article

The 10/66 Dementia Research Group's fully operationalised DSM-IV dementia computerized diagnostic algorithm, compared with the 10/66 dementia algorithm and a clinician diagnosis: a population validation study

Martin J Prince1*, Juan Llibre de Rodriguez2, L Noriega3, A Lopez4, Daisy Acosta5, Emiliano Albanese1, Raul Arizaga6, John RM Copeland7, Michael Dewey1, Cleusa P Ferri1, Mariella Guerra8, Yueqin Huang9, KS Jacob10, ES Krishnamoorthy11, Paul McKeigue12, Renata Sousa13, Robert J Stewart14, Aquiles Salas15, Ana Luisa Sosa, Richard Uwakwa and the 10/66 Dementia research group

Author Affiliations

1 Section of Epidemiology, Health Services Research, King's College London, De Crespigny Park, London SE5 8AF, UK

2 Facultad de Medicina Finley-Albarran, Medical University of Havana, Cuba

3 University Policlinic "19 de Abril", Havana, Cuba

4 Community Mental Health Centre, Marianao, Havana, Cuba

5 Universidad Nacional Pedro Henriquez Ureña (UNPHU), John F Kennedy Avenue, Internal Medicine Department, Geriatric Section, Santo Domingo, Dominican Republic

6 Behavioral and Cognitive Neurology Unit, Neuraxis Institute – Neurological Foundation, Buenos Aires, Argentina

7 University of Liverpool, 6 Stanley Road, Hoylake Wirral, CH47 1HW, UK

8 Psychogeriatric Unit, National Institute of Mental Health "Honorio Delgado Hideyo Noguchi", José Galvez Barrenechea Avenue # 274. Department 401. Corpac -SAN ISIDRO Lima, Perú

9 Peking University, Institute of Mental Health. # 51 Hua Yuan Bei Road Haidian District Beijing, 100083, PR China

10 Christian Medical College, Vellore, India

11 Srinivasan Centre for Clinical Neurosciences. The Institute of Neurological Sciences, Voluntary Health Services, Taramani, Chennai, India

12 Public Health Sciences/Molecular Medicine Centre, MRC Human Genetics Unit, University of Edinburgh, UK

13 Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela

14 The Cognition and Behavior Unit, National Institute of Neurology and Neurosurgery of Mexico, Av. Insurgentes # 3877, Col. La Fama, ZIP Code 14269, Delegacion Tlalpan, Mexico City, Mexico

15 Dept. of Mental Health, Namdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria

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BMC Public Health 2008, 8:219  doi:10.1186/1471-2458-8-219

Published: 24 June 2008



The criterion for dementia implicit in DSM-IV is widely used in research but not fully operationalised. The 10/66 Dementia Research Group sought to do this using assessments from their one phase dementia diagnostic research interview, and to validate the resulting algorithm in a population-based study in Cuba.


The criterion was operationalised as a computerised algorithm, applying clinical principles, based upon the 10/66 cognitive tests, clinical interview and informant reports; the Community Screening Instrument for Dementia, the CERAD 10 word list learning and animal naming tests, the Geriatric Mental State, and the History and Aetiology Schedule – Dementia Diagnosis and Subtype. This was validated in Cuba against a local clinician DSM-IV diagnosis and the 10/66 dementia diagnosis (originally calibrated probabilistically against clinician DSM-IV diagnoses in the 10/66 pilot study).


The DSM-IV sub-criteria were plausibly distributed among clinically diagnosed dementia cases and controls. The clinician diagnoses agreed better with 10/66 dementia diagnosis than with the more conservative computerized DSM-IV algorithm. The DSM-IV algorithm was particularly likely to miss less severe dementia cases. Those with a 10/66 dementia diagnosis who did not meet the DSM-IV criterion were less cognitively and functionally impaired compared with the DSMIV confirmed cases, but still grossly impaired compared with those free of dementia.


The DSM-IV criterion, strictly applied, defines a narrow category of unambiguous dementia characterized by marked impairment. It may be specific but incompletely sensitive to clinically relevant cases. The 10/66 dementia diagnosis defines a broader category that may be more sensitive, identifying genuine cases beyond those defined by our DSM-IV algorithm, with relevance to the estimation of the population burden of this disorder.