Neurocognitive Disorders DSM V TR

Delirium

Disturbance in attention and awareness (reduced ability to focus, sustain, and shift attention)

The disturbance develops over short period of time, represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.

Additional disturbance in cognition (memory deficit, language, perception, visuo-spatial, disorientation, etc.)

Criteria A & C is not better explained by another pre-existing, established or evolving neurocognitive disorder and does not occur in the context of a severely reduced level of arousal, such as coma.

Evidence that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal, or exposure to a toxin due to multiple etiologies

Active

Delirium lasts for a few hours or days

Persistent

Delirium lasts for weeks or months

Hyperactive Delirium

The individual has a hyperactive level of psychomotor activity that may be accompanied by mood lability, agitation, and/or refusal to cooperate with medical care.

Hypoactive Delirium

The individual has a hypoactive level of psychomotor activity that may be accompanied by sluggishness and lethargy that approaches stupor.

Mixed level of activity

The individual has a normal level of psychomotor activity even with attention and awareness being disturbed. Includes individuals whose activity rapidly fluctuates.

Hypoactive Presentation

Decreased alertness, catatonia, depressed mood

Hyperactive Presentation

Increased alertness, withdrawals from substances produces hyperactive symptoms, autonomic signs (profuse sweating, fever, vomiting, dilated pupils)

I WATCH DEATH

Infections

Withdrawal

Acute metabolic

Trauma

CNS pathology

Hypoxia

Deficiencies

Endocrinopathies

Acute vascular

Toxins or drugs

Heavy metals

Major Neurocognitive Disorder

Significant cognitive decline from previous level of performance in one or more cognitive domains (complex attention, executive functioning, learning and memory, language, perceptual-motor, or social cognition) based on 1.) Concern of the individual, a knowledgeable informant, or the clinician there has a been significant decline and 2.) Substantial impairment that is preferably documented by standardized neuropsychological testing or another quantified clinical assessment.

Interference with independence in everyday activities

Do not occur exclusively in the context of a delirium.

Not better explained by another mental disorder

Without behavioral disturbance

If the cognitive disturbance is not accompanied by any clinically significant behavioral disturbance

With behavioral disturbance

If the cognitive disturbance is accompanied by a clinically significant behavioral disturbance

Mild Neurocognitive Disorder

Evidence of a modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive functioning, learning and memory, language, perceptual motor, or social cognition) based on the concern of the individual, informant, or clinician that there has been a mild decline in cognitive function and a modest impairment in cognitive performance.

The cognitive deficits do not interfere with the capacity for independence in everyday activities

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

The cognitive deficits are not better explained by another mental disorder.

Complex Attention

Includes Sustained attention (maintenance of attention over time) and selective attention (maintenance of attention despite competing stimuli and/or distractors)

Executive Functioning

Includes planning (Finding solutions and interpreting information), working memory (Ability to hold information for a brief period and to manipulate it), and decision-making (Performance of tasks that assess process of deciding in the face of competing alternatives)

Major or Mild Neurocognitive Disorder due to Traumatic Brain Injury

The criteria are met for major or mild neurocognitive disorder.

There is evidence of TBI- that is, an impact to the head or other mechanisms of rapid movement or displacement of the brain within the skull with one or more of the following: loss of consciousness, posttraumatic amnesia, disorientation and confusion, and neurological signs (e.g., neuroimaging demonstrating injury, a new onset of seizures, worsening of preexisting seizure disorder, visual field cuts, anosmia, hemiparesis)

Presents immediately after the occurrence of the traumatic brain injury or immediately after recovery of consciousness and persists past the acute post-injury period.

Substance/Medication Induced Major or Mild Neurocognitive Disorder

Persists beyond the usual duration of intoxication and acute withdrawal.

Not related to delirium

The deficits remain stable or improve after a period of abstinence.

Amnestic Syndrome

The development of memory impairments marked by the inability to learn new information or the inability to recall previously learned information.