Disorders subsumed under this overarching category would include, but would not be limited to, the following: Dementia Due to a General Medical Condition, Dementia Not Otherwise Specified, Dementia of the Alzheimer's Type, Vascular Dementia, Dementia Due to Multiple Etiologies, Amnestic Disorder Due to a General Medical Condition, and Amnestic Disorder Not Otherwise Specified. Some individuals meeting criteria for Cognitive Disorder Not Otherwise Specified may also meet criteria for this disorder. Certain specific etiologies would be coded as subtypes, such as the Alzheimer's Disease Subtype of Major and Minor Neurocognitive Disorders.

Major Neurocognitive Disorder

A. Evidence of significant cognitive decline from a previous level of performance in one or more of the domains outlined above based on:

1.  Reports by the patient or a knowledgeable informant, or observation by the clinician, of clear decline in specific abilities as outlined for specific domains in the table above.

     AND

2.  Clear deficits in objective assessment of the relevant domain (typically > 2.0 SD below the mean [or below the 2.5^th percentile] of an appropriate reference population [i.e., age, gender, education, premorbid intellect, and culturally adjusted])

B. The cognitive deficits are sufficient to interfere with independence (e.g., at a minimum requiring assistance with instrumental activities of daily living, i.e., more complex tasks such as finances or managing medications)

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

D. The cognitive deficits are not wholly or primarily attributable to another Axis I disorder (e.g., Major Depressive Disorder, Schizophrenia)

For the entire rationale, please see the Neurocognitive Disorders Proposal for DSM-5.

Major Neurocognitive Disorder (including what was formerly known as Dementia) is a disorder with greater cognitive deficits in at least one (typically two or more) of the following domains:

Complex attention (planning, decision-making, working memory, responding to feedback/error correction, over-riding habits, mental flexibility),

Executive ability (planning, decision-making, working memory, responding to feedback/error correction, overriding habits, mental flexibility),

Learning and memory(immediate memory, recent memory [including free recall, cued recall, and recognition memory])

Language(expressive language [including naming, fluency, grammar and syntax] and receptive language),

Visuoconstructional-perceptual ability (construction and visual perception),and

Social cognition (recognition of emotions, theory of mind, behavioral regulation).

The cognitive deficits must be sufficient to interfere with functional independence. Important changes from the DSM-IV criteria include: change in nomenclature (MNCD or Dementia), not necessarily requiring memory to be one of the impaired domains, allowing cognitive deficit limited to one domain. In the introductory text, we offer a table that offers more details about the assessment of each domain in the form of specific symptoms of decline that can be elicited or observed, and assessment procedures that can be used to document the cognitive impairment and quantify its severity. 

• The term “dementia” is replaced by Major Neurocognitive Disorder, which is conceptualized as including what was formerly known as dementia as well as entities like amnestic disorder. "Dementia” is an accepted term for older adults (e.g., with Alzheimer’s disease)—although even in this setting it has acquired a pejorative or stigmatizing connotation, it is less well accepted among younger adults with deficits related to e.g., HIV or head injury.
• This rewording focuses on decline (rather than deficit—consistent with the requirement in the basic definition of an acquired disorder) from a previous level of performance.
• The previous criteria for dementia used Alzheimer’s disease as their prototype and thus required memory impairment as a criterion for all dementias. There is growing recognition that, in other neurocognitive disorders (e.g., HIV-related cognitive decline, cerebrovascular disease, frontotemporal degeneration, traumatic brain injury, etc.), other domains such as language or executive functions may be impaired first, or exclusively, depending on the part of the brain affected and the natural history of the disease.
• The terminology for the cognitive domains has been updated to reflect current usage in neuropsychology and neurology.
• The new definition, consistent with DSM-wide changes, focuses first on performance rather than disability. In the introductory table, we provide for each domain examples of specific symptoms or observations consistent with the Major level of decline and objective assessments. This encourages the use of objective measures, including formal neuropsychological testing where feasible with lesser exclusive reliance on individual judgment.
• The presence of both symptoms/observations and objective assessment is included to ensure specificity. This is a larger issue for Minor Neurocognitive Disorder but included here for parallel structure of the criteria.
• NOTE: The committee is in the process of refining criteria A1 and A2 to achieve a balance between preferred formal neuropsychological assessment and what may feasible in some clinical settings. They welcome input on this issue.
• The new language preserves the traditional function-based threshold for dementia but tries to operationalize it more clearly as a loss of independence.
• NOTE: The committee is still refining criterion D and discussing to what extent Major Neurocognitive Disorder should be diagnosed in the setting of disorders like schizophrenia and depression (although this concern applies primarily to Minor Neurocognitive Disorder). They also realize that issues of this nature are being addressed at the DSM-wide level, and are awaiting input of these larger discussions, as well as public input on this issue.