Decomposing diagnostic criteria in neurology: a scoping review of components and structure to inform criteria development
Abstract
Diagnostic criteria are critical for the accurate diagnosis of neurological diseases, which are among the most challenging to define. They help to standardize global efforts in healthcare delivery and scientific investigation. Despite their importance, no standardised methodology or preferred framework exists for developing these criteria. This scoping review aims to evaluate the structure, components and development process of existing diagnostic criteria across neurological disorders in order to identify common features that may inform the development of diagnostic criteria for neurological disorders. Neurological disorders were identified using the International Classification of Diseases, 11th Revision (ICD-11) and Lerner’s monograph entitled Diagnostic Criteria in Neurology. PubMed was searched for guideline-based diagnostic criteria published within the last ten years. Neuropsychiatric conditions were retrieved from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Extracted variables for qualitative analysis included clinical manifestations, neurological examination, imaging, laboratory parameters, neurophysiology, disease course, development methodology and structure. A sensitivity analysis was conducted to account for large clustered data. A total of 332 diagnostic criteria were identified across multiple neurological subspecialties. “Typical clinical manifestations” ( n = 317/332, 95.5%) – largely referring to clinical symptoms and not examination findings – were the most frequently included diagnostic component. Structurally, checklists ( n = 232/332, 70%) were the most used methodological framework. Most criteria were developed through consensus statements (35.8%, n = 119/332). Across neurological disorders, diagnostic criteria consistently prioritize clinical manifestations supported by examination findings and ancillary investigations. Future criteria should remain adaptable to advances in diagnostic technologies while ensuring accessibility across diverse clinical settings.