tually represents a substantial decline in abilities, or an illness may be incorrectly diag-
nosed in individuals whose currently “low” performance does not represent a change
from their own baseline or is a result of extraneous factors li ke test conditions or a passing
illness. Alternatively, excessive focus on subj ective symptoms may fail to diagnose illness
in individuals with poor insigh t, or whose informants deny or fail to notice their symptoms,
or it may be overly sensitiv e in the so-called worried well.
A cognitive concern differs from a complaint in that it may or may not be voiced spon-
taneously. Rather, it may need to be elicited  by careful questioning about specific symp-
toms that commonly occur in individuals wi th cognitive deficits (see Table 1 in the
introduction to this chapter). For example, memory concerns include difficulty remember-
ing a short grocery list or keeping track of the plot of a television program; executive con-
cerns include difficulty resuming a task wh en interrupted, organizing tax records, or
planning a holiday meal. At the mild NCD level,  the individual is likely to describe these
tasks as being more difficult or as requiring ex tra time or effort or compensatory strategies.
At the major NCD level, such tasks may on ly be completed with assistance or may be
abandoned altogether. At the mild NCD level, individuals and their families may not no-
tice such symptoms or may view them as norm al, particularly in the elderly; thus, careful
history taking is of paramount importance. The difficulties must represent changes rather
than lifelong patterns: the individual or info rmant may clarify this i ssue, or the clinician
can infer change from prior experience with the patient or from occupational or other
clues. It is also critical to determine that the difficulties are related to cognitive loss rather