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A 71-year-old retired professor presents with his daughter, who has noticed increasing forgetfulness over the past year. He repeats questions during conversations, misplaces items frequently, and occasionally forgets appointments. Neuropsychological testing reveals performance 1.5 standard deviations below age-matched norms in the memory domain, with other cognitive domains intact. He continues to manage his finances, drive safely, and live independently. He scores 24/30 on the MoCA. Basic metabolic panel, TSH, vitamin B12, folate, RPR, and CBC are within normal limits.
Explanation
Mild neurocognitive disorder represents the DSM-5-TR equivalent of mild cognitive impairment (MCI). The key diagnostic criteria are: modest cognitive decline from a prior level documented by neuropsychological testing (typically 1-2 SD below norms), concern about decline corroborated by an informant, and preserved functional independence. The workup should include reversible cause screening (thyroid, B12, depression, medication effects) and neuroimaging to help identify the underlying etiology.
Key Takeaway
Mild neurocognitive disorder requires documented modest cognitive decline with preserved functional independence, and the workup should include reversible cause screening and neuroimaging to determine the underlying etiology.