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--- cl:2-major-neurocog-disorder [on September 26, 2018]
+++ cl:2-major-neurocog-disorder [on October 27, 2023] (current)
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+====== Major Neurocognitive Disorder ======
+{{INLINETOC}}
+===== Primer =====
+**Major neurocognitive disorder** (and [[cl:3-mild-neurocog-disorder|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 [[geri:dementia:home|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.
+<alert icon="fa fa-arrow-circle-right fa-lg fa-fw" type="success">
+See also: **[[geri:dementia:home|]]**
+</alert>
+== 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% [[geri:dementia:alzheimers|Alzheimer's dementia]], 21.9% [[geri:dementia:vascular|vascular dementia]], 10.9% [[geri:dementia:lewy-body|Lewy body dementia]], and 7.8% [[geri:dementia:frontotemporal|frontotemporal dementia]].[([[https://pubmed.ncbi.nlm.nih.gov/11872521/|Stevens, T. I. M., Livingston, G., Kitchen, G., Manela, M., Walker, Z., & Katona, C. (2002). Islington study of dementia subtypes in the community. The British Journal of Psychiatry, 180(3), 270-276.]])]
+===== DSM-5 Diagnostic Criteria =====
+<WRAP group>
+<WRAP half column>
+== 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.
+</WRAP>
+<WRAP half column>
+== 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. - [[mood:1-depression:home|major depressive disorder]], [[psychosis:schizophrenia-scz|schizophrenia]]).
+</WRAP></WRAP>
+==== Specifiers ====
+<WRAP group>
+<WRAP half column>
+<panel icon="fa fa-search-plus" size="xs" title="Etiology Specifier">
+  * Major or Mild Neurocognitive Disorder Due to [[geri:dementia:alzheimers|Alzheimer’s Disease]]
+  * Major or Mild [[geri:dementia:frontotemporal|Frontotemporal Neurocognitive Disorder]]
+  * Major or Mild Neurocognitive Disorder With [[geri:dementia:lewy-body|Lewy Bodies]]
+  * Major or Mild [[geri:dementia:vascular|Vascular Neurocognitive Disorder]]
+  * Major or Mild Neurocognitive Disorder Due to [[:cl:tbi|Traumatic Brain Injury]]
+  * [[cl:psychiatric-side-effects-of-medications|Substance/Medication-Induced]] Major or Mild Neurocognitive Disorder
+  * Major or Mild Neurocognitive Disorder Due to [[cl:hiv|HIV Infection]]
+  * Major or Mild Neurocognitive Disorder Due to [[geri:dementia:creutzfeldt-jakob-disease-cjd|Prion Disease]]
+  * Major or Mild Neurocognitive Disorder Due to [[geri:dementia:parkinsons|Parkinson’s Disease]]
+  * Major or Mild Neurocognitive Disorder Due to [[cl:huntingtons-disease|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
+</panel>
+</WRAP>
+<WRAP half column>
+<panel icon="fa fa-user" size="xs" title="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).
+</panel>
+<panel icon="fa fa-signal" size="xs" title="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
+</panel>
+</WRAP>
+</WRAP>
+===== Resources =====
+== For Clinicians ==
+  * [[https://www.bcmj.org/articles/twelve-tips-assessing-and-managing-mild-cognitive-impairment-and-major-neurocognitive|Balogh, K., & Wong, R. Y. (2017). Twelve tips for assessing and managing mild cognitive impairment and major neurocognitive disorder in older people. British Columbia Medical Journal, 59(3), 158-164.]]