1. We have adopted the term “Neurocognitive Disorders” instead of the DSM-IV terminology of “Delirium, Dementia, and Amnestic and Other Cognitive Disorders” and the ICD-10 heading of “Organic, including Symptomatic Mental Disorders”.
2. The disorders in this group will be those that are “acquired” - i.e. there is evidence of a decline from a previous level of neurocognitive function (based on report by a patient and/or a significant other, evidence from longitudinal data, or cross-sectional assessment of prior function).  Developmental neurocognitive disorders will be included in a separate category.
3. Cognitive dysfunction is a feature of a number of mental disorders (e.g., schizophrenia, depression, OCD, etc.), but it is not the most prominent or the defining feature, and is not “necessary” for these diagnoses. Therefore, those conditions will not be included in Neurocognitive Disorders.
4. The division of neurocognitive disorders into Delirium and Neurocognitive disorders, with the latter being subdivided into minor and major, was discussed. 
5. Delirium will be considered primarily as an acute or subacute disturbance of alertness, awareness, and attention with a fluctuating course. Several issues were evaluated.  The usefulness of the term “consciousness” was discussed, given the uncertainty regarding its definition. Global disturbances of cognition and sleep-wake cycle disturbances are common associated features. An etiology-based subclassification of Delirium was also considered.  Delirium can coexist with minor or major neurocognitive disorder. 
6. The division of Neurocognitive Disorders (other than delirium) into two subcategories based on severity of functional and/or neurocognitive impairment was discussed:    a) Minor Neurocognitive Disorder (often called Mild Cognitive Impairment or MCI), with the necessary neurocognitive impairment in only one domain, and b) Major Neurocognitive Disorder or Dementia, which would typically involve at least two domains.  However, memory impairment would not be necessary for diagnosing either of these conditions.
7. Both Minor and Major Neurocognitive Disorders may be further subclassified according to etiology – e.g., Alzheimer disease, vascular neurocognitive disorder, Frontotemporal degeneration, Lewy Body disease, Mixed (specify which ones), Not otherwise specified (NOS). While we hope that the NOS category will be used only infrequently for the Major Neurocognitive Disorders, it may be a common category for Minor Neurocognitive Disorders in patients who seem to have Alzheimer-type picture but the clinician does not want to prematurely label the patient as having AD without longer follow-up and/or additional lab work.
8. The criteria for non-Alzheimer dementing disorders have been and will continue to be developed independently by multiple other subspecialty groups (e.g., Lewy Body Disease group, vascular dementia groups, etc.).  Instead of reinventing the wheel, we will look at the criteria developed by these other groups, and see if we can use them, probably with some minor revisions for the sake of uniformity.
9. The use of other specifiers to better define the clinical condition in a given patient was discussed– e.g., Course (transient, remitting, persistent but stable, persistent and worsening, persistent with fluctuations), Age of onset (<65, ≥65), Associated behavioral symptoms (e.g., agitation, wandering).

Other Issues Being Discussed