Observations on DSM-5 Mild Neurocognitive Disorder vs. its predecessor, Mild Cognitive Impairment

Introduction: The syndromes of mild cognitive impairment (MCI) or mild neurocognitive disorder (MiND), often prodromal to dementia (Major Neurocognitive Disorder), are characterized by acquired clinically significant changes in one or more cognitive domains despite preserved independence. Mild impairment has significant medicolegal consequences for an affected person and their care system. We review the more common etiologies of MiND and provide a systematic review of its medicolegal implications. Methods: We conducted a systematic review of the peer-reviewed English literature on medicolegal aspects of MCI or MiND using comprehensive search terms and expanding our review to include sources cited by these reports. Results: Impairment of memory, executive function, social cognition, judgment, insight or abstraction can alter an individual’s abilities in a variety of areas that include decision making, informed consent, designation of a surrogate decision-maker such as a health care proxy, understanding and management of financial affairs, execution of a will, or safe driving. Conclusion: Even mild cognitive impairment can have significant behavioral consequences. Clinicians can assist care partners and persons with MCI or MiND by alerting them to the medicolegal concerns that often accompany cognitive decline. Early recognition and discussion can help a care system manage medicolegal risk more effectively and promote thoughtful advance planning.

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Mild Cognitive Impairment

10.1093/med/9780199374656.003.0032 ◽

2017 ◽

Author(s):

David C. Hsu ◽

James M. Ellison

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Aging ◽

Forensic Psychiatry ◽

Neurocognitive Disorder ◽

Competence To Stand Trial ◽

Legal Proceedings ◽

Dsm 5 ◽

The Past ◽

Clinical Phenomenon

Mild cognitive impairment (MCI), and the newly described DSM-5 diagnosis of mild neurocognitive disorder, often lie at the intersection of geriatric and forensic psychiatry. The concept of MCI as a distinct syndrome between normal cognitive aging and major neurocognitive disorder (dementia) has continued to evolve over the past decade. Given MCI’s range of potential etiologies, as well as its increasing prevalence in an aging population, its evaluation and management can perplex the seasoned clinician and complicate legal proceedings. This chapter describes the clinical phenomenon of MCI, as well as its corresponding forensic implications. Capacity assessments, risk management, competence to stand trial, and cognitive malingering are covered.

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A patient with Korsakoff syndrome of psychiatric and alcoholic etiology presenting as DSM-5 mild neurocognitive disorder

Neuropsychiatric Disease and Treatment ◽

10.2147/ndt.s203513 ◽

2019 ◽

Vol Volume 15 ◽

pp. 1311-1320

Author(s):

Georgios Nikolakaros ◽

Timo Kurki ◽

Arttu Myllymäki ◽

Tuula Ilonen

Keyword(s):

Neurocognitive Disorder ◽

Dsm 5 ◽

Mild Neurocognitive Disorder ◽

Korsakoff Syndrome

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Prevalence Rates of Dementia and Mild Cognitive Impairment Are Affected by the Diagnostic Parameter Changes for Neurocognitive Disorders in the DSM-5 in a Korean Population

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000458408 ◽

2017 ◽

Vol 43 (3-4) ◽

pp. 193-203 ◽

Cited By ~ 7

Author(s):

Ji Won Han ◽

Yoonseop So ◽

Tae Hui Kim ◽

Dong Young Lee ◽

Seung-Ho Ryu ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Nationwide Survey ◽

Neurocognitive Disorders ◽

Performance Criteria ◽

Prevalence Rates ◽

Diagnostic And Statistical Manual ◽

Dsm 5 ◽

Gender Education ◽

The Impact

Aim: To examine the impact of the revised diagnostic criteria for neurocognitive disorders (NCDs) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) on the prevalence of dementia and mild cognitive impairment (MCI). Methods: A total of 755 participants aged 65 years or older in the Nationwide Survey on Dementia Epidemiology in Korea 2012 were rediagnosed according to the DSM-5 criteria. Results: The estimated age-, gender-, education-, and urbanicity-standardized prevalence rates of major and mild NCDs were 8.35 and 11.10%, respectively, and those of dementia and MCI were 8.74 and 31.85%, respectively. Cohen's κ for dementia and major NCD was 0.988, and that for MCI and mild NCD was 0.273. Conclusion: Diagnostic discrepancies between major/mild NCDs and dementia/MCI might depend on the operationalization of neuropsychological performance criteria.

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Conversion to dementia in mild cognitive impairment diagnosed with DSM-5 criteria and with Petersen's criteria

Acta Psychiatrica Scandinavica ◽

10.1111/acps.12543 ◽

2015 ◽

Vol 133 (5) ◽

pp. 378-385 ◽

Cited By ~ 26

Author(s):

G. Marcos ◽

J. Santabárbara ◽

R. Lopez-Anton ◽

C. De-la-Cámara ◽

P. Gracia-García ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Dsm 5

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Neuropsychiatric Symptoms in Mild Cognitive Impairment

The Canadian Journal of Psychiatry ◽

10.1177/0706743716648296 ◽

2017 ◽

Vol 62 (3) ◽

pp. 161-169 ◽

Cited By ~ 26

Author(s):

Damien Gallagher ◽

Corinne E. Fischer ◽

Andrea Iaboni

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Decline ◽

Neuropsychiatric Symptoms ◽

Later Life ◽

Neurocognitive Disorders ◽

Prognostic Indicators ◽

Neurocognitive Disorder ◽

Clinical Stages ◽

Before And After

Objective: Neuropsychiatric symptoms (NPS) may be the first manifestation of an underlying neurocognitive disorder. We undertook a review to provide an update on the epidemiology and etiological mechanisms of NPS that occur in mild cognitive impairment (MCI) and just before the onset of MCI. We discuss common clinical presentations and the implications for diagnosis and care. Method: The authors conducted a selective review of the literature regarding the emergence of NPS in late life, before and after the onset of MCI. We discuss recent publications that explore the epidemiology and etiological mechanisms of NPS in the earliest clinical stages of these disorders. Results: NPS have been reported in 35% to 85% of adults with MCI and also occur in advance of cognitive decline. The occurrence of NPS for the first time in later life should increase suspicion for an underlying neurocognitive disorder. The presenting symptom may provide a clue regarding the etiology of the underlying disorder, and the co-occurrence of NPS may herald a more accelerated cognitive decline. Conclusions: NPS are prevalent in the early clinical stages of neurocognitive disorders and can serve as both useful diagnostic and prognostic indicators. Recognition of NPS as early manifestations of neurocognitive disorders will become increasingly important as we move towards preventative strategies and disease-modifying treatments that may be most effective when deployed in the earliest stages of disease.

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Alternative perspectives on Mild Cognitive Impairment (MCI): Broadening the definition of MCI.

Revista de Neuro-Psiquiatria ◽

10.20453/rnp.v74i4.1664 ◽

2012 ◽

Vol 74 (4) ◽

pp. 295-298

Author(s):

Moises Gaviria ◽

Erin Cullnan

Keyword(s):

Alzheimer’S Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Normal Aging ◽

Dsm 5 ◽

Opportune Time ◽

The Subject ◽

Criteria For Diagnosis ◽

Definition Of ◽

The Continuum

Mild cognitive impairment (MCI) is a relatively newly described phenomenon representing a mild deficit on the continuum between normal aging and dementia. Although MCI is the source of much interest and research in the fields of neuroscience and medicine, its definition, prevalence, and criteria for diagnosis has yet to become standardized and is the subject of much controversy. While there is some consensus among American and European researchers about the construct of MCI, others argue that these researchers focus too much on MCI as a preclinical state of Alzheimer’s disease (Ad) and thus is too narrow. MCI must also be examined in the context of each individual patient, taking into account each person’s unique needs and the degree to which his or her life is affected by the cognitive impairment in question. As the upcoming DSM-5 criteria are still being decided, it is a particularly opportune time to focus on alternative perspectives and definitions of MCI to ensure the best clinical definition possible can be determined.

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