Neurocognitive Disorders DSM-5-TR (Internship)

Neurocognitive Domains

1. Complex attention

2. Executive function

3. Learning and memory

4. Language

5. Perceptual-motor

6. Social cognition

Social Cognition Domain

recognition of emotions, theory of mind

Perceptual-Motor Domain

abilities subsumed under the terms visual perception, visuoconstructional, perceptual-motor, praxis, and gnosis

Language Domain

language and receptive language

Learning and Memory Domain

immediate memory, recent memory, very-long-term memory, implicit learning

Executive Function Domain

planning, decision-making, working memory, responding to feedback/error connection, overriding habits/inhibition, mental flexibility

Complex attention domain

sustained attention, divided attention, selective attention, processing speed

Major symptoms/observations in Complex Attention

• Has increased difficulty in environments with multiple stimuli (TV, radio, conversation)

• is easily distracted by competing events in the environment.

• Is unable to attend unless input is restricted and simplified.

• Has difficulty holding new information in mind, such as recalling phone numbers or addresses just given, or reporting what was just said.

• Is unable to perform mental calculations.

• All thinking takes longer than usual, and components to be processed must be simplified to one or a few

Mild symptoms/observations in Complex Attention

• Normal tasks take longer than previously.

• Begins to find errors in routine tasks; finds work needs more double-checking than previously.

• Thinking is easier when not competing with other things (radio, TV, other conversations, cell phone, driving).

Major symptoms/observations in Executive Function

• Abandons complex projects.

• Needs to focus on one task at a time.

• Needs to rely on others to plan instrumental activities of daily living or make decisions.

Mild symptoms/observations in Executive Function

• Increased effort required to complete multistage projects.

• Has increased difficulty multitasking or difficulty resuming a task interrupted by a visitor or phone call.

• May complain of increased fatigue from the extra effort required to organize, plan, and make decisions.

• May report that large social gatherings are more taxing or less enjoyable because of increased effort required to follow shifting conversations.

Major symptoms/observations in Learning and Memory

• Repeats self in conversation, often within the same conversation.

• Cannot keep track of short list of items when shopping or of plans for the day.

• Requires frequent reminders to orient to task at hand.

Mild symptoms/observations in learning and memory

• Has difficulty recalling recent events, and relies increasingly on list making or calendar.

• Needs occasional reminders or re-reading to keep track of characters in a movie or novel.

• Occasionally may repeat self over a few weeks to the same person.

• Loses track of whether bills have already been paid

Major symptoms/observations in Language

• Has significant difficulties with expressive or receptive language.

• Often uses general-use phrases such as “that thing” and “you know what I mean,” and prefers general pronouns rather than names.

• With severe impairment, may not even recall names of closer friends and family.

• Idiosyncratic word usage, grammatical errors, and spontaneity of output and economy of utterances occur.

• Stereotypy of speech occurs; echolalia and automatic speech typically precede mutism.

Mild symptoms/observations in language

• Has noticeable word-finding difficulty.

• May substitute general for specific terms.

• May avoid use of specific names of acquaintances.

• Grammatical errors involve subtle omission or incorrect use of articles, prepositions, auxiliary verbs, etc.

Major symptoms/observations in perceptual-motor

• Has significant difficulties with previously familiar activities (using tools, driving motor vehicle), navigating in familiar environments;

• is often more confused at dusk, when shadows and lowering levels of light change perceptions.

Mild symptoms/observations in perceptual-motor

• May need to rely more on maps or others for directions.

• Uses notes and follows others to get to a new place.

• May find self lost or turned around when not concentrating on task.

• Is less precise in parking.

• Needs to expend greater effort for spatial tasks such as carpentry, assembly, sewing, or knitting.

Major symptoms/observations in social cognition

• Behavior clearly out of acceptable social range; shows insensitivity to social standards of modesty in dress or of political, religious, or sexual topics of conversation.

• Focuses excessively on a topic despite group’s disinterest or direct feedback.

• Behavioral intention without regard to family or friends.

• Makes decisions without regard to safety (e.g., inappropriate clothing for weather or social setting).

• Typically, has little insight into these changes.

Mild symptoms/observations in social cognition

• Has subtle changes in behavior or attitude, often described as a change in personality, such as less ability to recognize social cues or read facial expressions, decreased empathy, increased extraversion or introversion, decreased inhibition, or subtle or episodic apathy or restlessness.

Delirium Criteria

A. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) accompanied by reduced awareness of the environment.

B. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.

C. An additional disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).

D. The disturbances in Criteria A and C are not better explained by another preexisting, established, or evolving neurocognitive disorder and do not occur in the context of a severely reduced level of arousal, such as coma.

E. There is evidence from the history, physical examination, or laboratory findings that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal (i.e., due to a drug of abuse or to a medication), or exposure to a toxin, or is due to multiple etiologies.

Delirium Specifiers

• Acute

  • lasting a few hours or days

• Persistent

  • lasting weeks or months

• Hyperactive

  • 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

  • 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 though attention and awareness are disturbed. Also includes individuals whose activity level rapidly fluctuates.

• Substance intoxication delirium

  • This diagnosis should be made instead of substance intoxication when the symptoms in Criteria A and C predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.

• Substance withdrawal delirium

  • This diagnosis should be made instead of substance withdrawal when the symptoms in Criteria A and C predominate in the clinical picture and when they are sufficiently severe to warrant clinical attention.

• Medication-inducted delirium

  • This diagnosis applies when the symptoms in Criteria A and C arise as a side effect of a medication taken as prescribed.

• Delirium due to another medical condition

  • There is evidence from the history, physical examination, or laboratory findings that the disturbance is attributable to the physiological consequences of another medical condition.

• Delirium due to multiple etiologies

  • There is evidence from the history, physical examination, or laboratory findings that the delirium has more than one etiology (e.g., more than one etiological medical condition; another medical condition plus substance intoxication or medication side effect)

Other Specified Delirium

• This category applies to presentations in which symptoms characteristic of delirium that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for delirium or any of the disorders in the neurocognitive disorders diagnostic class. The other specified delirium category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for delirium or any specific neurocognitive disorder. This is done by recording “other specified delirium” followed by the specific reason (e.g., “subsyndromal delirium”).

• An example of a presentation that can be specified using the “other specified” designation is the following:

  • Subsyndromal delirium: A delirium-like presentation involving disturbances in attention, higher-level thought, and circadian rhythm, in which the severity of cognitive impairment falls short of that required for the diagnosis of delirium.

Unspecified Delirium

This category applies to presentations in which symptoms characteristic of delirium that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for delirium or any of the disorders in the neurocognitive disorders diagnostic class. The unspecified delirium category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for delirium, and includes presentations for which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).

Major Neurocognitive Disorder

A. Evidence of significant cognitive decline from a previous level of performance in one 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.

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).

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

D> The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

Major Neurocognitive Disorder Specify Due to:

• Alzheimer’s disease

• Frontotemporal degeneration

• Lewy body disease

• Vascular disease

• Traumatic brain injury

• Substance/medication use

• HIV infection

• Prion disease

• Parkinson’s disease

• Huntington’s disease

• Another medical condition

• Multiple etiologies

• Unspecified etiology

Major Neurocognitive Disorder Specifiers

• 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 (e.g., psychotic symptoms, mood disturbance, agitation, apathy, or other behavioral symptoms).

• 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

Mild Neurocognitive Disorder Criteria

A. Evidence of modest cognitive decline from a previous level of performance in one or more cognitive domains (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition) based on:

1. Concern of the individual, a knowledgeable informant, or the clinician that there has been a mild decline in cognitive function; and

2. A modest impairment in cognitive performance, preferably documented by standardized neuropsychological testing or, in its absence, another quantified clinical assessment.

B. The cognitive deficits do not interfere with capacity for independence in everyday activities (i.e., complex instrumental activities of daily living such as paying bills or managing medications are preserved, but greater effort, compensatory strategies, or accommodation may be required).

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

D. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).

Mild Neurocognitive Disorder Due to

• Alzheimer’s disease

• Frontotemporal degeneration

• Lewy body disease

• Vascular disease

• Traumatic brain injury

• Substance/medication use

• HIV infection

• Prion disease

• Parkinson’s disease

• Huntington’s disease

• Another medical condition

• Multiple etiologies

• Unspecified etiology

Mild Neurocognitive Disorder Specifiers

• 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 (e.g., psychotic symptoms, mood disturbance, agitation, apathy, or other behavioral symptoms).

Major/Mild Neurocognitive Disorder Due to Alzheimer’s Disease

A. The criteria are met for major or mild neurocognitive disorder.

B. There is insidious onset and gradual progression of impairment in one or more cognitive domains (for major neurocognitive disorder, at least two domains must be impaired).

C. Criteria are met for either probable or possible Alzheimer’s disease as follows:

• For major neurocognitive disorder:

  • Probable Alzheimer’s disease is diagnosed if either of the following is present; otherwise, possible Alzheimer’s disease should be diagnosed.

    1. Evidence of a causative Alzheimer’s disease genetic mutation from family history or genetic testing.

    2. All three of the following are present:

       • Clear evidence of decline in memory and learning and at least one other cognitive domain (based on detailed history or serial neuropsychological testing).

       • Steadily progressive, gradual decline in cognition, without extended plateaus.

       • No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline).

• For mild neurocognitive disorder:

  • Probable Alzheimer’s disease is diagnosed if there is evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history.

  • Possible Alzheimer’s disease is diagnosed if there is no evidence of a causative Alzheimer’s disease genetic mutation from either genetic testing or family history, and all three of the following are present:

    1. Clear evidence of decline in memory and learning.

    2. Steadily progressive, gradual decline in cognition, without extended plateaus.

    3. No evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease, or another neurological or systemic disease or condition likely contributing to cognitive decline)

D. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.

Major/Mild Frontaltemporal Neurocognitive Disorder

A. The criteria are met for major or mild neurocognitive disorder.

B. The disturbance has insidious onset and gradual progression.

C. Either (1) or (2):

1. Behavioral variant:

   • Three or more of the following behavioral symptoms:

     • Behavioral disinhibition.

     • Apathy or inertia.

     • Loss of sympathy or empathy.

     • Perseverative, stereotyped or compulsive/ritualistic behavior.

     • Hyperorality and dietary changes.

   • Prominent decline in social cognition and/or executive abilities.

2. Language variant

   • Prominent decline in language ability, in the form of speech production, word finding, object naming, grammar, or word comprehension.

D. Relative sparing of learning and memory and perceptual-motor function.

E. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.

Probable frontotemporal neurocognitive disorder is diagnosed if either of the following is present; otherwise, possible frontotemporal neurocognitive disorder should be diagnosed:

1. Evidence of a causative frontotemporal neurocognitive disorder genetic mutation, from either family history or genetic testing.

2. Evidence of disproportionate frontal and/or temporal lobe involvement from neuroimaging.

Possible frontotemporal neurocognitive disorder is diagnosed if there is no evidence of a genetic mutation, and neuroimaging has not been performed.

Major/Mild Neurocognitive Disorder with Lewy bodies

A. The criteria are met for major or mild neurocognitive disorder.

B. The disorder has an insidious onset and gradual progression.

C. The disorder meets a combination of core diagnostic features and suggestive diagnostic features for either probable or possible neurocognitive disorder with Lewy bodies.

• For probable major or mild neurocognitive disorder with Lewy bodies, the individual has two core features, or one suggestive feature with one or more core features.

• For possible major or mild neurocognitive disorder with Lewy bodies, the individual has only one core feature, or one or more suggestive features

  1. Core diagnostic features:

     • Fluctuating cognition with pronounced variations in attention and alertness.

     • Recurrent visual hallucinations that are well formed and detailed.

     • Spontaneous features of parkinsonism, with onset subsequent to the development of cognitive decline.

  2. Suggestive diagnostic features:

     • Meets criteria for rapid eye movement sleep behavior disorder.

     • Severe neuroleptic sensitivity.

D. The disturbance is not better explained by cerebrovascular disease, another neurodegenerative disease, the effects of a substance, or another mental, neurological, or systemic disorder.

Major/Mild Vascular Neurocognitive Disorder

A. The criteria are met for major or mild neurocognitive disorder.

B. The clinical features are consistent with a vascular etiology, as suggested by either of the following:

1. Onset of the cognitive deficits is temporally related to one or more cerebrovascular events

2. Evidence for decline is prominent in complex attention (including processing speed) and frontal-executive function.

C. There is evidence of the presence of cerebrovascular disease from history, physical examination, and/or neuroimaging considered sufficient to account for the neurocognitive deficits.

D. The symptoms are not better explained by another brain disease or systemic disorder.

• Probable vascular neurocognitive disorder is diagnosed if one of the following is present; otherwise possible vascular neurocognitive disorder should be diagnosed:

  1. Clinical criteria are supported by neuroimaging evidence of significant parenchymal injury attributed to cerebrovascular disease (neuroimaging- supported).

  2. The neurocognitive syndrome is temporally related to one or more documented cerebrovascular events.

  3. Both clinical and genetic (e.g., cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) evidence of cerebrovascular disease is present.

• Possible vascular neurocognitive disorder is diagnosed if the clinical criteria are met but neuroimaging is not available and the temporal relationship of the neurocognitive syndrome with one or more cerebrovascular events is not established.

Major/Mild Neurocognitive Disorder Due to Traumatic Brain Injury

A. The criteria are met for major or mild neurocognitive disorder.

B. There is evidence of a traumatic brain injury—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:

1. Loss of consciousness.

2. Posttraumatic amnesia.

3. Disorientation and confusion.

4. Neurological signs (e.g., neuroimaging demonstrating injury; visual field cuts; anosmia; hemiparesis; hemisensory loss; cortical blindness; aphasia; apraxia; weakness; loss of balance; other sensory loss that cannot be accounted for by peripheral or other causes).

C. The neurocognitive disorder 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/Mild Neurocognitive Disorder

A. The criteria are met for major or mild neurocognitive disorder.

B. The neurocognitive impairments do not occur exclusively during the course of a delirium and persist beyond the usual duration of intoxication and acute withdrawal.

C. The involved substance or medication and duration and extent of use are capable of producing the neurocognitive impairment.

D. The temporal course of the neurocognitive deficits is consistent with the timing of substance or medication use and abstinence (e.g., the deficits remain stable or improve after a period of abstinence).

E. The neurocognitive disorder is not attributable to another medical condition or is not better explained by another mental disorder.

Major/Mild Neurocognitive Disorder due to HIV Infection

A. The criteria are met for major or mild neurocognitive disorder.

B. There is documented infection with human immunodeficiency virus (HIV).

C. The neurocognitive disorder is not better explained by non-HIV conditions, including secondary brain diseases such as progressive multifocal leukoencephalopathy or cryptococcal meningitis.

D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by a mental disorder.

Major/Mild Neurocognitive Disorder due to Prion Disease

A. The criteria are met for major or mild neurocognitive disorder.

B. There is insidious onset, and rapid progression of impairment is common.

C. There are motor features of prion disease, such as myoclonus or ataxia, or biomarker evidence.

D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.

Major/Mild Neurocognitive Disorder due to Parkinson’s Disease

A. The criteria are met for major or mild neurocognitive disorder.

B. The disturbance occurs in the setting of established Parkinson’s disease.

C. There is insidious onset and gradual progression of impairment.

D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.

• Major or mild neurocognitive disorder probably due to Parkinson’s disease should be diagnosed if 1 and 2 are both met.

• Major or mild neurocognitive disorder possibly due to Parkinson’s disease should be diagnosed if 1 or 2 is met:

  1. There is no evidence of mixed etiology (i.e., absence of other neurodegenerative or cerebrovascular disease or another neurological, mental, or systemic disease or condition likely contributing to cognitive decline).

  2. The Parkinson’s disease clearly precedes the onset of the neurocognitive disorder.

Major/Mild Neurocognitive Disorder due to Huntington’s Disease

A. The criteria are met for major or mild neurocognitive disorder.

B. There is insidious onset and gradual progression.

C. There is clinically established Huntington’s disease, or risk for Huntington’s disease based on family history or genetic testing.

D. The neurocognitive disorder is not attributable to another medical condition and is not better explained by another mental disorder.

Major/Mild Neurocognitive Disorder due to Another Medical Condition

A. The criteria are met for major or mild neurocognitive disorder.

B. There is evidence from the history, physical examination, or laboratory findings that the neurocognitive disorder is the pathophysiological consequence of another medical condition (e.g., multiple sclerosis).

C. The cognitive deficits are not better explained by another mental disorder (e.g., major depressive disorder) or another specific neurocognitive disorder (e.g., major neurocognitive disorder due to Alzheimer’s disease).

Major/Mild Neurocognitive Disorder due to Multiple Etiologies

A. The criteria are met for major or mild neurocognitive disorder.

B. There is evidence from the history, physical examination, or laboratory findings that the neurocognitive disorder is the pathophysiological consequence of more than one etiological process, excluding substances (e.g., neurocognitive disorder due to Alzheimer’s disease with subsequent development of vascular neurocognitive disorder).

C. The cognitive deficits are not better explained by another mental disorder and do not occur exclusively during the course of a delirium.

Unspecified Neurocognitive Disorder

This category applies to presentations in which symptoms characteristic of a neurocognitive disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the neurocognitive disorders diagnostic class. The unspecified neurocognitive disorder category is used in situations in which the precise etiology cannot be determined with sufficient certainty to make an etiological attribution.

Neurocognitive Disorder due to Alzheimer’s Disease Core Features

• Behavioral and Psychological Symptoms

  • Apathy or lack of initiative.

  • Depression or anxiety.

  • Irritability, agitation, or aggression.

  • Paranoia or delusions (e.g., thinking someone is stealing).

  • Hallucinations (less common than in Lewy body dementia).

  • Sleep disturbances (e.g., fragmented sleep, sundowning).

• Functional Impairments

  Loss of independence in daily activities:

  • Difficulty with Instrumental Activities of Daily Living (IADLs):

    • Managing money, medications, transportation, household chores.

  • Eventually progresses to impair Basic Activities of Daily Living (ADLs):

    • Dressing, bathing, eating, toileting

• Course of Illness

  • Insidious onset and gradual progression.

  • Initial symptoms are subtle but progressively worsen over years.

  • Can be categorized in mild, moderate, and severe stages.

• Neuropathology (underlying biological features)

  • Beta-amyloid plaques and neurofibrillary tangles (tau protein).

  • Medial temporal lobe atrophy, especially hippocampus.

  • May be confirmed via CSF biomarkers or PET imaging (in research/clinical settings).

Neurocognitive Disorder due to Frontotemporal Degeneration Core Features

• Core Features:

  • Insidious onset, gradual progression.

  • Prominent changes in personality, behavior, or language.

  • Relative preservation of memory and visuospatial skills (early on).

• Two main variants:

  • Behavioral variant: disinhibition, apathy, compulsivity, loss of empathy.

  • Language variant (Primary Progressive Aphasia): decline in speech production or comprehension.

• Symptoms:

  • Profound personality and behavioral changes (e.g., disinhibition, apathy).

  • Loss of empathy, socially inappropriate behavior.

  • Language deficits (aphasia, difficulty understanding or expressing speech).

  • Compulsive or ritualistic behaviors.

  • Relative sparing of memory early in the disease.

Neurocognitive Disorder due to Lewy Body Disease Core Features

• Core Features:

  • Fluctuating cognition with pronounced variability in attention and alertness.

  • Visual hallucinations that are well-formed and detailed.

  • Parkinsonian motor symptoms (rigidity, bradykinesia).

  • REM sleep behavior disorder often precedes onset.

  • Severe sensitivity to antipsychotics.

• Symptoms:

  • Visual hallucinations (detailed and recurrent).

  • Fluctuating cognition (episodes of confusion and lucidity).

  • Parkinsonism (tremor, stiffness, slow movement).

  • REM sleep behavior disorder (acting out dreams).

  • Sensitivity to antipsychotics (can worsen symptoms).

Neurocognitive Disorder due to Vascular Disease Core Features

• Core Features:

  • Cognitive decline related temporally to a cerebrovascular event.

  • Stepwise or fluctuating progression.

  • Prominent executive function and attention deficits more than memory.

  • Focal neurological signs or evidence of stroke on neuroimaging.

• Symptoms:

  • History of stroke or transient ischemic attacks (TIAs).

  • Sudden or stepwise decline in cognition.

  • Focal neurological signs (e.g., hemiparesis, aphasia).

  • Impairments in executive function, processing speed.

  • Gait disturbances, urinary incontinence (in some cases, e.g., multi-infarct dementia).

Neurocognitive Disorder due to Traumatic Brain Injury (TBI) Core Features

• Core Features:

  • Cognitive decline following a traumatic injury (e.g., impact, blast).

  • May include loss of consciousness, amnesia, disorientation.

  • Common symptoms: attention, executive function, memory problems.

  • Onset usually occurs immediately or shortly after injury; may improve or remain stable.

• Symptoms:

  • Loss of consciousness, post-traumatic amnesia.

  • Headaches, dizziness, difficulty concentrating.

  • Irritability, mood swings, impulsivity.

  • Problems with attention, memory, and executive function.

  • May include emotional and personality changes

Neurocognitive Disorder due to Substance/Medication Use Core Features

• Core Features:

  • Cognitive impairment related to use or withdrawal of a substance (e.g., alcohol, inhalants, sedatives).

  • Must persist beyond usual duration of intoxication or withdrawal.

  • Often involves executive function, memory, and language impairments.

  • Common in chronic alcohol use—e.g., alcohol-related dementia or Wernicke-Korsakoff syndrome.

• Symptoms:

  • Cognitive slowing, poor judgment, attention deficits.

  • Wernicke’s encephalopathy: confusion, ataxia, ophthalmoplegia.

  • Korsakoff’s syndrome: severe memory impairment, confabulation.

  • Chronic alcohol use: executive dysfunction, memory loss.

  • Drug toxicity or withdrawal: delirium-like symptoms, mood lability.

Neurocognitive Disorder due to HIV Infection Core Features

• Core Features:

  • Cognitive decline attributable to HIV not explained by other conditions.

  • Commonly affects attention, executive function, and psychomotor speed.

  • Often presents as subcortical pattern: slowed thinking, apathy, motor symptoms.

  • May be more common in advanced stages of HIV/AIDS.

• Symptoms:

  • Slowed thinking, motor dysfunction, apathy.

  • Poor concentration and executive dysfunction.

  • Depression and psychomotor slowing.

  • In advanced cases, HIV-associated dementia (more common before antiretrovirals).

Neurocognitive Disorder due to Prion Disease Core Features

• Core Features:

  • Rapid progression of cognitive decline.

  • Motor features: myoclonus, ataxia, rigidity.

  • Hallucinations or behavioral changes may occur.

  • Most common form is Creutzfeldt-Jakob Disease

• Symptoms:

  • Rapidly progressive dementia.

  • Myoclonus (sudden jerking movements).

  • Ataxia (balance and coordination problems).

  • Visual disturbances, personality changes.

  • Fatal within months to a few years.

Neurocognitive Disorder due to Parkinson’s Disease Core Features

• Core Features:

  • Established Parkinson’s disease precedes onset of NCD.

  • Gradual cognitive decline developing after motor symptoms.

  • Affects executive function, attention, memory retrieval.

  • Similar symptoms to Lewy Body Dementia but timing of motor vs. cognitive onset distinguishes them.

• Symptoms:

  • Bradykinesia, tremors, rigidity, shuffling gait.

  • Executive dysfunction, poor working memory.

  • Mood disorders (depression, anxiety).

  • Cognitive decline occurs later in the disease course.

  • Hallucinations may occur, especially in later stages

Neurocognitive Disorder due to Huntingon’s Disease Core Features

• Core Features:

  • Genetic disorder—onset typically in mid-adulthood.

  • Motor symptoms: chorea, dystonia, incoordination.

  • Cognitive decline involves executive dysfunction, processing speed, and memory.

  • Associated with psychiatric symptoms: depression, irritability, psychosis

• Symptoms:

  • Chorea (involuntary, jerky movements).

  • Executive dysfunction, impaired judgment.

  • Memory impairment.

  • Irritability, depression, anxiety, and psychosis.

  • Gradual progression with motor, cognitive, and psychiatric decline.