Major Neurocognitive Disorder

Major neurocognitive disorder (and mild neurocognitive disorder) exists on a spectrum of cognitive and functional impairment. The term major neurocognitive disorder corresponds to the condition referred to what was previously referred to in the DSM-IV as dementia. The core feature of neurocognitive disorders is an acquired cognitive decline in one or more cognitive domains based on (A) both a concern about cognition on the part of the individual, a knowledgeable informant, or the clinician, and (B) performance on an objective assessment that falls below the expected level or observed decline over time.

Criterion A

Evidence of significant cognitive decline from a previous level of performance in 1 or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:

  1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and
  2. A substantial impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.
Criterion B

The cognitive deficits interfere with independence in everyday activities (i.e. - at a minimum, requiring assistance with complex instrumental activities of daily living such as paying bills or managing medications).

Criterion C

The cognitive deficits do not occur exclusively in the context of a delirium.

Criterion D

The cognitive deficits are not better explained by another mental disorder (e.g. - major depressive disorder, schizophrenia).

Etiology Specifier

Behaviour Specifier


  • Without behavioral disturbance: If the cognitive disturbance is not accompanied by any clinically significant behavioral disturbance.
  • With behavioural disturbance (specify disturbance): If the cognitive disturbance is accompanied by a clinically significant behavioural disturbance (e.g., psychotic symptoms, mood disturbance, agitation, apathy, or other behavioural symptoms).

Severity Specifier

  • Mild: Difficulties with instrumental activities of daily living (e.g. - housework, managing money)
  • Moderate: Difficulties with basic activities of daily living (e.g. - feeding, dressing)
  • Severe: Fully dependent
For Clinicians