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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Persistent Post-Concussion Syndrome After Its Withdrawal from DSM-5 and ICD-11: Definitional Disagreement and the Neurocognitive Gap

  • Miguel A. Pappolla1
  • Remi Nader2
  • Felix Fang3,4
  • Xiang Fang1
4 affiliations
  1. 1Department of Neurology, University of Texas Medical Branch, Galveston, TX 77555, USA
  2. 2Department of Neurosurgery, University of Texas Medical Branch, Galveston, TX 77555, USA
  3. 3Department of Physical Medicine and Rehabilitation, University of North Texas Health Science Center (UNTHSC), Fort Worth, TX 76104, USA
  4. 4Texas Rehabilitation Hospital, Fort Worth, TX 76104, USA
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Abstract

A substantial minority of patients do not recover fully after mild traumatic brain injury. Persistent post-concussion syndrome includes both cognitive and non-cognitive manifestations, yet DSM-5 and ICD-11 withdrew the syndrome as a distinct diagnosis and reorganized its persistent sequelae exclusively within neurocognitive categories. While this reorganization addresses the cognitive component of the syndrome, it provides no single category for its non-cognitive consequences, including vestibular, oculomotor, headache-related, autonomic, sleep, and pain-related manifestations. In some patients, these may be the most disabling consequences of the injury. This narrative review examines the resulting diagnostic gap and other continuing disagreements. Published criteria differ in symptom count, duration, and other requirements, yielding an unacceptably wide range of prevalence estimates, from 11.4% to 38.7%. We review the current status of this syndrome and propose an approach that separates diagnosis from attribution. Finally, we discuss the interactions between cognitive and non-cognitive consequences through shared neural substrates, so abnormalities in one domain may influence function in another. Because cognitive and non-cognitive manifestations may dissociate, a patient may have normal or minimal findings in one domain and functionally significant abnormalities in the other; therefore, evaluation confined to one domain alone (as reflected in the new classifications) cannot exclude the syndrome.

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Cite

BibTeXRIS
BibTeX
@article{pappolla2026persistent,
  title = {{Persistent Post-Concussion Syndrome After Its Withdrawal from DSM-5 and ICD-11: Definitional Disagreement and the Neurocognitive Gap}},
  author = {Miguel A. Pappolla and Remi Nader and Felix Fang and Xiang Fang},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15208031},
  url = {https://www.mdpi.com/2077-0383/15/20/8031},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Persistent Post-Concussion Syndrome After Its Withdrawal from DSM-5 and ICD-11: Definitional Disagreement and the Neurocognitive Gap
AU  - Miguel A. Pappolla
AU  - Remi Nader
AU  - Felix Fang
AU  - Xiang Fang
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15208031
UR  - https://www.mdpi.com/2077-0383/15/20/8031
AB  - A substantial minority of patients do not recover fully after mild traumatic brain injury. Persistent post-concussion syndrome includes both cognitive and non-cognitive manifestations, yet DSM-5 and ICD-11 withdrew the syndrome as a distinct diagnosis and reorganized its persistent sequelae exclusively within neurocognitive categories. While this reorganization addresses the cognitive component of the syndrome, it provides no single category for its non-cognitive consequences, including vestibular, oculomotor, headache-related, autonomic, sleep, and pain-related manifestations. In some patients, these may be the most disabling consequences of the injury. This narrative review examines the resulting diagnostic gap and other continuing disagreements. Published criteria differ in symptom count, duration, and other requirements, yielding an unacceptably wide range of prevalence estimates, from 11.4% to 38.7%. We review the current status of this syndrome and propose an approach that separates diagnosis from attribution. Finally, we discuss the interactions between cognitive and non-cognitive consequences through shared neural substrates, so abnormalities in one domain may influence function in another. Because cognitive and non-cognitive manifestations may dissociate, a patient may have normal or minimal findings in one domain and functionally significant abnormalities in the other; therefore, evaluation confined to one domain alone (as reflected in the new classifications) cannot exclude the syndrome.
SN  - 2077-0383
ER  -