Minor Neurocognitive Disorder

A. Evidence of minor 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 minor levels of decline in specific abilities as outlined for the specific domains above. Typically these will involve greater difficulty performing these tasks, or the use of compensatory strategies.

     AND

2.  Mild deficits on objective cognitive assessment (typically 1 to 2.0 SD below the mean [or in the 2.5th to 16th percentile] of an appropriate reference population (i.e., age, gender, education, premorbid intellect, and culturally adjusted). When serial measurements are available, a significant (e.g., 0.5 SD) decline from the patient’s own baseline would serve as more definitive evidence of decline.

B. The cognitive deficits are not sufficient to interfere with independence (Instrumental Activities of Daily Living are preserved), but greater effort and compensatory strategies may be required to maintain independence.

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.

Minor Neurocognitive Disorder has been added to recognize the substantial clinical needs of individuals who have mild cognitive deficits in one or more of the same domains but can function independently (i.e., have intact instrumental activities of daily living), often through increased effort or compensatory strategies. This syndrome, known in many settings as Mild Cognitive Impairment may be particularly critical, as it may be a focus of early intervention.  Early intervention efforts may enable the use of treatments that are not effective at more severe levels of impairment and/or neuronal damage, and, in the case of neurodegenerative disease, may enable a clinical trial to prevent or slow progression.

• Minor Neurocognitive Disorder is added to account for individuals with minor levels of cognitive impairment who may require assessment and treatment, but are not sufficiently impaired the Major diagnosis. To some extent, this entity will take care of individuals currently coded as Cognitive Disorder NOS without specific criteria. This change is driven by the need of such individuals for care, and by clinical; epidemiological; and radiological, pathological and biomarker research data suggesting that such a syndrome is a valid clinical entity with prognostic and potentially therapeutic implications. Prime examples are the prevalent neurocognitive disorders associated with various neuromedical conditions such as traumatic brain injury, HIV, substance-use-related brain disorders, diabetes, and early/mild stages of neurodegenerative disorders like Alzheimer’s disease and of cerebrovascular disease. As these conditions are increasingly seen in clinical practice, clinicians have a pressing need for reliable and valid diagnostic criteria in order to assess them and provide services including treatment of associated mood symptoms, further investigation of brain function, identification of treatable causes, and, for progressive disorders, appropriate early interventions.
• The Neurocognitive Disorders Work Group is aware that the specific term “minor” can be challenged on the grounds that it implies lack of need for services and are open to alternative suggestions. They chose "minor" rather than "mild" to be parallel with "major" and to be able to maintain the mild, moderate, and severe distinction within Major NCD.
• The combination of symptoms/observations and objective assessment is critical in Minor Neurocognitive Disorder to maintain specificity: a report of a change in abilities protects against overcalling the disorder in those with lifelong poor performance (since decline can only be inferred from a single observation), and objective assessment protects against overcalling the disorder in "the worried well."
• NOTE: The Neurocognitive Disorders Work Group is in the process of refining these criteria to achieve a balance between preferred formal neuropsychological assessment and what may be feasible in some clinical settings. The issue is particularly difficult for Minor Neurocognitive Disorder because at lesser levels of cognitive impairment symptom reports may be unavailable or unreliable, observation may be less informative, the interpretation of objective assessments is complicated by variable premorbid abilities, and simpler assessments are likely to be insensitive. They welcome input on this issue.
• NOTE: The Neurocognitive Disorders Work Group is still refining criterion D and discussing to what extent Minor Neurocognitive Disorder should be diagnosed in the setting of disorders like schizophrenia and depression. 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.

This disorder is not listed in DSM-IV; therefore, DSM-IV criteria for this disorder do not exist.

Some individuals meeting criteria for  Cognitive Disorder Not Otherwise Specified would meet criteria for Minor Neurocognitive Disorder.