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Table 2 Operationalization of DSM-5 mild NCD and IWG MCI within the algorithm

From: Evaluation of a research diagnostic algorithm for DSM-5 neurocognitive disorders in a population-based cohort of older adults

DSM-5 mild neurocognitive disorder IWG MCI
Criteria Algorithm Criteria Algorithm
A. Both of the following:
A1 Concern of self or informant of significant cognitive decline in one or more cognitive domains MAC-Q >24 or IQCODE >3.31 or recent doctor’s consultation about cognitive change or informant reported worsening of everyday cognitive functiona 1 Participant is not normal and not demented Does not meet criteria for DSM-IV dementia or DSM-5 major NCD and all cognitive domains not in normal range (z score ≤ –1.0)
A2 Modest impairment in cognitive performance in one or more cognitive domains Mean z score for one or more of the following domains is > –2.0 to ≤ –1.0: complex attention, executive function, learning and memory, language, perceptual/motor, social cognition, or mean decline in performance between waves 3 and 4 that is > –2.0 to ≤ –1.0 SD below norms on select testsb 2. Either or both of the following (2a and/or 2b):
2a Self and/or informant report of cognitive decline and Impairment on objective cognitive tasks MAC-Q >24 or IQCODE >3.31 or recent doctor’s consultation about cognitive change or informant reported worsening in everyday cognition. And mean z score ≥ –2.0 and ≤ –1.0 for one or more of: memory, complex attention, executive function, language, and perceptual/motor
B A1 and A2 do not interfere with capacity for independence in everyday life No HRS-IADLc problems due to memory, or self-reported need for household/personal care help, or Bayer IADL <3.12, and (if A2 social cognition impaired, then no informant-reportedd change in social behaviors or emotion recognition) 2b Evidence of decline over time on objective cognitive tasks Mean decline in performance between waves 3 and 4 that is > –2.0 to ≤ –1.0 SD below norms on select testsb
C The cognitive deficits do not occur exclusively in the context of a delirium Informant reports deficits started 6 months or more ago, or informant-reported delirium signs present for less than duration of cognitive change 3 Preserved basic activities of daily living or minimal impairment on complex IADLs No difficulty with Bayer IADL items 2, 4, and 11 or no self-reported need for personal care help, or Bayer IADL <3.12
D The cognitive deficits are not better explained by another mental disorder PHQ-9 < 10 and no informant-reported history of schizophrenia or other psychosis
  1. aPraxis: ideomotor praxis z score ≤ –2.0; gnosis: BNT-15 z score ≤ –2.0, and COWAT > –2.0
  2. bTests available for determining objective decline over time: CVLT immediate and delayed recall, Digits back, SDMT, Purdue Pegboard, COWAT and Trails B, simple and complex RT
  3. cHRS-IADL are self-report questions [40]
  4. dInformant endorses any of DEX-Q items 9, 11, 13 or 20 with frequency of ‘sometimes’ or more, or endorses any of the following: “Behave out of character or inappropriately”; “Unconcerned or unaware of how others feel”; “Less participation in social functions for reasons other than physical”, “Lost special skills interests or hobbies”
  5. DSM Diagnostic and Statistical Manual of Mental Disorders, IADL instrumental activities of daily living, IQCODE Informant Questionnaire of Cognitive Decline in the Elderly, IWG International Working Group, MAC-Q Memory and Cognitive Questionnaire, MCI mild cognitive impairment, NCD neurocognitive disorder, PHQ Patient Health Questionnaire