2)    The disorders examined by this group will be those that are ‘acquired’ - i.e., there is evidence of decline from a previous level of neurocognitive function (reported by patient, significant other, evidence from longitudinal data, or based on cross-sectional assessment of prior function).  Developmental neurocognitive disorders will be covered by a separate work group.  Cognitive dysfunction is a feature of a number of mental disorders (e.g., schizophrenia, depression, OCD, etc.), but is not the most prominent or the defining feature, and is not ‘necessary’ for these diagnoses.

3)    For our deliberations, we have broadly divided the neurocognitive disorders into Delirium (with alteration in consciousness) and disorders with unimpaired level of consciousness.  The disorders in the second group have seen notable scientific progress during the past 15 years, with implications for revisions in DSM-V. 

4)    The work group is considering the roles of both functional and neurocognitive impairments in the disorders without altered level of consciousness.  This may be a basis for defining and distinguishing two broad categories of minor neurocognitive disorder (often called Mild Cognitive Impairment or MCI) and major neurocognitive disorder or Dementia.

Issues Being Discussed

1)    Should the severity of impairment for diagnosing and differentiating minor from major neurocognitive disorders be based on neuropsychological tests and/or functional impairment?

2)    Which neurocognitive domains should be included for this purpose (e.g., Memory – verbal/non-verbal, Attention/working memory, Language, etc.), and what tests would be optimal for assessing them?

3)    Could the necessary neurocognitive impairment be in only one, as opposed to multiple, domains for diagnosing minor or major neurocognitive disorders, and must it involve memory? 

4)    How should the cut-offs to be used for minor versus major neurocognitive disturbance be developed and operationalized? 

5)    How can functional impairment be reliably measured to make a diagnosis of  Neurocognitive Disorder, and to differentiate minor versus major Disorder?  

6)    What other specifiers should be used to better define the clinical condition in a given patient – e.g., Course (transient, remitting, persistent but stable, persistent and worsening, persistent with fluctuations), Age of onset (<65, ≥65), Associated behavioral disturbances (e.g., psychosis, depression, agitation), etc.?

Plans for Further Work

1)    Literature reviews

2)    Assessing secondary data analysis results, including existing longitudinal data sets.

3)    Preparing draft criteria that can then lead to field tests or additional data analysis to support revision options. 

4)    Field testing of neurocognitive and functional measures.