Major and Mild Neurocognitive Disorders 607
Apathy is common in mild and mild major NCD. It is observed particularly in NCD due
to Alzheimer’s disease and ma y be a prominent feature of NCD due to frontotemporal
lobar degeneration. Apathy is typically char acterized by diminished motivation and re-
duced goal-directed behavior  accompanied by decreased emotional responsiveness.
Symptoms of apathy may manifest early in the course of NCDs when a loss of motivation
to pursue daily activities or hobbies may be observed.
Other important behavioral symptoms include wandering, disinhibition, hyperpha-
gia, and hoarding. Some of these symptoms are characteristic of specific disorders, as dis-
cussed in the relevant sections. When more th an one behavioral disturbance is observed,
each type should be noted in writing with the specifier “with behavioral symptoms.” 
Diagnostic Features
Major and mild NCDs exist on a spectrum of cognitive and functional impairment. Major
NCD corresponds to the conditio n referred to in DSM-IV as dementia,  retained as an alter-
native in this volume. The co re feature of NCDs is acquir ed cognitive decline in one or
more cognitive domains (Criterion A) based on  both 1) a concern about cognition on the
part of the individual, a knowledgeable informant, or the clinician, and 2) performance on
an objective assessment that falls below the expected level or that has been observed to de-
cline over time. Both a concer n and objective evidence are re quired because they are com-
plementary. When there is an  exclusive focus on objectiv e testing, a disorder may go
undiagnosed in high-functioning individuals whose currently “normal” performance ac-
tually represents a substantial decline in abilities, or an illness may be incorrectly diag-