- Last edited on October 27, 2023
Major Neurocognitive Disorder
Primer
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.
Epidemiology
- The prevalence of major neurocognitive disorder varies widely by age and by etiological subtype.
- The dementia subtypes contributing to major neurocognitive disorder is estimated to be 31.3% Alzheimer's dementia, 21.9% vascular dementia, 10.9% Lewy body dementia, and 7.8% frontotemporal dementia.[1]
DSM-5 Diagnostic Criteria
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:
- Concern of the individual, a knowledgeable informant, or the clinician that there has been a significant decline in cognitive function; and
- 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).
Specifiers
Etiology Specifier
- Major or Mild Neurocognitive Disorder Due to Alzheimer’s Disease
- Major or Mild Frontotemporal Neurocognitive Disorder
- Major or Mild Neurocognitive Disorder With Lewy Bodies
- Major or Mild Vascular Neurocognitive Disorder
- Major or Mild Neurocognitive Disorder Due to Traumatic Brain Injury
- Substance/Medication-Induced Major or Mild Neurocognitive Disorder
- Major or Mild Neurocognitive Disorder Due to HIV Infection
- Major or Mild Neurocognitive Disorder Due to Prion Disease
- Major or Mild Neurocognitive Disorder Due to Parkinson’s Disease
- Major or Mild Neurocognitive Disorder Due to Huntington’s Disease
- Major or Mild Neurocognitive Disorder Due to Another Medical Condition
- Major or Mild Neurocognitive Disorder Due to Multiple Etiologies
- Unspecified Neurocognitive Disorder
Behaviour Specifier
Specify:
- 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