Substance/Medication-Induced Major or Mild Neurocognitive Disorder 627
moderate to severe TBI is associated with older ag e (older than 40 years) and initial clinical pa-
rameters, such as low Glasgow Coma Scale score; worse motor function; pupillary nonreac-
tivity; and computed tomography (CT) evidence of brain injury (e.g., petechial hemorrhages,
subarachnoid hemorrhage, midline shift, obliteration of third ventricle).
Diagnostic Markers
Beyond neuropsycholog ical testing, CT scanning may reveal petechial hemorrhages,
subarachnoid hemorrhage, or evidence of contusion. Magn etic resonance image scanning
may also reveal hyperintensities suggestive of microhemorrhages. 
Functional Consequences of Major or Mild 
Neurocognitive Disorder Due to Traumatic Brain Injury 
With mild NCD due to TBI, individuals may re port reduced cognitive efficiency, difficulty
concentrating, and lessened abilit y to perform usual activities. With major NCD due to TBI, an
individual may have di fficulty in independent living an d self-care. Prominent neuromotor
features, such as severe incoordination, ataxia , and motor slowing, may be present in major
NCD due to TBI and may add to functional diffi culties. Individuals with TBI histories report
more depressive symptoms, and these can amp lify cognitive complaints and worsen func-
tional outcome. Additionally, loss of emotional control, including aggre ssive or inappropriate
affect and apathy, may be present after more se vere TBI with greater neurocognitive impair-
ment. These features may compound difficulti es with independent living and self-care.
Differential Diagnosis