Table 1 Neurocognitive domains
|Cognitive domain||Examples of symptoms or
observations||Examples of assessments |
Complex attention (sustained
attention, divided attention, selective attention, processing speed)
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: 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).
attention: Maintenance of attention over time (e.g.,
pressing a button every time a tone is heard, and over a period
Selective attention: Maintenance
of attention despite competing stimuli and/or distractors: hearing
numbers and letters read and asked to count only letters.
Divided attention: Attending
to two tasks within the same time period: rapidly tapping while
learning a story being read. Processing speed can be quantified
on any task by timing it (e.g., time to put together a design of
blocks; time to match symbols with numbers; speed in responding,
such as counting speed or serial 3 speed).
Executive function (planning,
decision making, working memory, responding to feedback/error
correction, overriding habits/inhibition, mental flexibility)
complex projects. Needs to focus on one task at a time. Needs to
rely on others to plan instrumental activities of daily living or
Mild: 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.
to find the exit to a maze; interpret a sequential picture or object
Decision making: Performance
of tasks that assess process of deciding in the face of competing
alternatives (e.g., simulated gambling).
Working memory: Ability to
hold information for a brief period and to manipulate it (e.g.,
adding up a list of numbers or repeating a series of numbers or
Feedback/error utilization: Ability
to benefit from feedback to infer the rules for solving a problem.
Overriding habits/inhibition: Ability
to choose a more complex and effortful solution to be correct (e.g.,
looking away from the direction indicated by an arrow; naming the
color of a word’s font rather than naming the word).
Mental/cognitive flexibility: Ability
to shift between two concepts, tasks, or response rules (e.g., from
number to letter, from verbal to key-press response, from adding
numbers to ordering numbers, from ordering objects by size to ordering
memory (immediate memory, recent memory [including free recall,
cued recall, and recognition memory], very-long-term memory [semantic; autobiographical], implicit
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: 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
Note: Except in severe forms
of major neurocognitive disorder, semantic, autobiographical, and
implicit memory are relatively preserved, compared with recent memory.
memory span: Ability to repeat a list of words
or digits. Note: Immediate memory sometimes
subsumed under “working memory” (see “Executive Function”).
Recent memory: Assesses the
process of encoding new information (e.g., word lists, a short story,
or diagrams). The aspects of recent memory that can be tested include
1) free recall (the person is asked to recall as many words, diagrams,
or elements of a story as possible); 2) cued recall (examiner aids
recall by providing semantic cues such as “List all the food items
on the list” or “Name all of the children from the story”); and
3) recognition memory (examiner asks about specific items—e.g.,
“Was ’apple’ on the list?” or “Did you see this diagram or figure?”).
Other aspects of memory that can be assessed include semantic memory
(memory for facts), autobiographical memory (memory for personal
events or people), and implicit (procedural) learning (unconscious
learning of skills).
language [including naming, word finding, fluency, and grammar,
and syntax] and receptive language)
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: 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
language: Confrontational naming (identification
of objects or pictures); fluency (e.g., name as many items as possible
in a semantic [e.g., animals] or phonemic [e.g., words starting
with “f”] category in 1 minute).
Grammar and syntax (e.g.,
omission or incorrect use of articles, prepositions, auxiliary verbs):
Errors observed during naming and fluency tests are compared with
norms to assess frequency of errors and compare with normal slips
of the tongue.
Receptive language: Comprehension
(word definition and object-pointing tasks involving animate and
inanimate stimuli): performance of actions/activities according
to verbal command.
abilities subsumed under the terms visual perception, visuo-constructional, perceptual-motor, praxis,) and gnosis)
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: 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.
Visual perception: Line
bisection tasks can be used to detect basic visual defect or attentional
neglect. Motor-free perceptual tasks (including facial recognition)
require the identification and/or matching of figures—best when
tasks cannot be verbally mediated (e.g., figures are not objects);
some require the decision of whether a figure can be “real” or
not based on dimensionality.
of items requiring hand-eye coordination, such as drawing, copying,
and block assembly.
perception with purposeful movement (e.g., inserting blocks into
a form board without visual cues; rapidly inserting pegs into a
Praxis: Integrity of learned
movements, such as ability to imitate gestures (wave goodbye) or
pantomime use of objects to command (“Show me how you would use
Gnosis: Perceptual integrity
of awareness and recognition, such as recognition of faces and colors.
Social cognition (recognition
of emotions, theory of mind)
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: 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.
Recognition of emotions: Identification
of emotion in images of faces representing a variety of both positive
and negative emotions.
Theory of mind: Ability to
consider another person’s mental state (thoughts, desires, intentions)
or experience—story cards with questions to elicit information about
the mental state of the individuals portrayed, such as “Where will
the girl look for the lost bag?” or “Why is the boy sad?”