mTBI mild traumatic brain injury

Diagnostic systems for categorizing psychiatric disorders, i.e. the Diagnostic and Statistical Manual for Mental Disorders (DSM), do not adequately reflect the complex neuropsychiatric depictions of patients with a history of TBI.

Those disorders that do not cause sufficient impairment to be considered for the diagnosis of dementia are now defined as neurocognitive disorders and placed on a spectrum with the more severe diseases.

Delirium, Dementia and Amnestic and Other Cognitive Disorders

The name of the diagnostic category has been changed. The section titled Delirium, Dementia and Amnestic and Other Cognitive Disorders in the fourth issue and subsequent text revision (DSM-IV6 and DSM-IV-TR) is now “neurocognitive disorders” or NCDs.

DSM5 specifically mentions TBI only within the category of neurocognitive disorders (“mild” or “severe” neurocognitive disorder due to TBI).

Does a Severe Traumatic Brain Injury Mean You’ll Have a Serious Neurocognitive Disorder?

When a person suffers multiple mild traumatic brain injuries or a severe traumatic brain injury in a fall or suffers severe traumatic brain injuries from repetitive minor head injury or major head trauma, then the direct effects of the injury can result in long-term cognitive changes, decreased functioning, and changes in emotional health.

Mood disorder, major depression, modest cognitive decline, amnestic disorders, symptoms typically associated with age related cognitive decline, and other new onset neurocognitive disorder symptoms.

Mental Health Pros Agree

Mental health professionals agree that the cognitive impairments and neuropsychiatric symptoms may be short lived, or the neurocognitive deficits may have other mechanisms that continue and persists for several years.

tbi symptoms

Amnestic disorder and risk factors for a neurodegenerative disease may possibly be assessed by standardized neuropsychological testing.

Anyone who experiences an impact on the head and develops symptoms of traumatic brain injury should see a doctor, even if symptoms appear mild. Doctors classify traumatic brain injury as mild, moderate, or severe depending on whether the injury results in unconsciousness, how long the loss of consciousness lasts, and how severe the symptoms are.

What Is The DSM5?

DSM5 specifically mentions TBI only within the category of neurocognitive disorders (“mild” or “severe neurocognitive disorder due to TBI”).

Mild neurocognitive disorder due to traumatic brain injury

The mild neurocognitive disorder is a term used to describe a broad range of psychological disturbances that are not usually considered to be mental disorders.

Mild NCDs are not associated with major psychiatric disorders and only occur in patients who have sustained a traumatic brain injury (TBI).

As defined by the American Academy of Neurology (AAN), mild NCDs include:

  • cognitive deficits

  • functional activities deficits

  • exclusion of delirium

  • and competing for mental disorders.

They reflect an accumulation of such symptoms over time rather than a sudden deterioration. Mild NCDs may also include physical symptoms like fatigue or weakness that precede the cognitive symptoms.

Are NCDs Considered Life Threatening?

While most mild NCDs are not life-threatening, they can cause significant harm to people who are already suffering from severe TBI due to their impact on everyday functioning, which could prevent them from recovering completely.

Mild NCD is often mentioned in conjunction with cognitive impairment due to TBI because it is more common than other more severe forms of cognitive impairment caused by TBI.

What is a mild neurocognitive disorder?

Mild cognitive disorder (MCD) is a term used to describe a group of disorders that are characterized by symptoms of mild but significant impairment in mental functions and behaviors.

The term “mild” is relatively new. In the 1970s, researchers started using the term “mild” in order to describe patients who had significant mental impairment but did not meet specific criteria for dementia or Alzheimer’s disease.

However, the use of this term quickly spread across the medical community and has since taken on a more general meaning.

It is not uncommon for individuals to have MCD without being diagnosed with dementia or Alzheimer’s disease. It is possible for an individual with MCD to have elevated levels of certain neurotransmitters, such as serotonin and dopamine, which may be linked to subjective feelings of well-being and physical functions such as muscle tone and balance.

Is a TBI considered a neurocognitive disorder?

Although TBIs are neurologically similar to psychiatric disorders, the degree of cognitive dysfunction is different.

A TBI is a moderate to severe neurological disorder that may involve memory, language, attention, and executive functioning.

TBIs are often associated with the postconcussion syndrome (PCS). Although the exact cause of PCS is unknown, it is thought that traumatic brain injury (TBI) may be a significant factor in its development.

brain frontal lobe

TBI & PCS

Because of the association between TBI and PCS, it is common for a person to have both conditions at the same time. The term “competing for mental disorder” (CMD) refers to a person experiencing both TBI and PCS at the same time.

Neurocognitive functions can be affected by many somatic or neurological conditions such as Parkinson’s disease (PD), dystonia (a rare neurological condition), Alzheimer’s disease, and schizophrenia.

Is mild neurocognitive disorder the same as dementia?

The mild neurocognitive disorder is a general term describing decreased mental function due to a medical disease other than a psychiatric illness. A TBI may cause mild NCD. Common symptoms of mild NCD: cognitive changes, functional activities, exclusion of delirium, and other mental disorders. The mild neurocognitive disorder is the same as dementia? or dementia with Lewy bodies?

The answers to these questions may be found in an article titled “Is mild neurocognitive disorder the same as dementia?,” which was published in The Journal Neurology.

The authors of this study investigated whether mild cognitive impairment (MCI) is the same as dementia and whether it is associated with Lewy bodies.

The results of this study provide clear evidence that MCI is the same thing as dementia and Lewy bodies, and that both diseases can be characterized by poor memory, confusion, and impaired executive functioning.

ICD-10 major neurocognitive disorder due to traumatic brain injury

The ICD-10 major neurocognitive disorder due to traumatic brain injury (MND) is a broad diagnostic category of disorders that includes a wide range of symptoms and behaviors.

Are MND Really Mild?

The majority of MNDs are mild, with the most common being cognitive defects, functional activities, and exclusion of delirium. There are several forms of MND.

brain scan brain damage

Major neurocognitive disorder due to traumatic brain injury with behavioral disturbance

MND of the brain is often caused by a traumatic brain injury. In rare cases, however, this disorder can develop even in people who have never experienced any trauma or had any other medical issues.

There are cases where people have tested for chronic traumatic encephalopathy and they had chronic traumatic encephalopathy, but there was not necessarily a history of repeated head trauma or traumatic brain injuries. And in some cases no neurological signs such as preexisting seizure disorder due to traumatic brain injury TBI.

And just the opposite has been documented. Meaning, the neurocognitive disorder presents immediately after a mild traumatic brain injury. The bottom line is traumatic brain injury TBI can be unpredictable.

How Do You Determine The Severity Of The Disorder due to traumatic brain injury?

The severity of the disorder varies depending on the type and extent of the injury. The acute post injury period is not always a clear indicator of whether the head injury going to fall into the category of:

  • severe traumatic brain injury

  • moderate traumatic brain injury

  • mild traumatic brain injury

How Can You Tell If There Will Be Cognitive Impairment From The mTBI?

There is not a way to know immediately the cognitive functional impairment because even if the person is showing confusion neurological signs and other neurological symptoms, it could be adrenalin or fear that is causing the cognitive function deficit. Persistent cognitive impairment evidence takes time.

When Do Neurocognitive Disorder Symptoms Show Up?

Major or mild neurocognitive disorder presents immediately in some cases. Even with mild traumatic brain injury injuries. Posttraumatic amnesia in moderate and severe TBI patients is a neurocognitive disorder that presents neurocognitive symptoms recognizable fairly easily. If marked worsening neuropsychiatric symptoms that persist past what the doctors are expecting then it is less chance that it is mild TBI.

Sometimes it is only mild, while other times it can be severe enough to lead to serious side effects such as cognitive changes and behavioral disturbances.

It is important to note that the symptoms do not necessarily indicate a severe mental disorder, but rather a more severe form of an existing cognitive disorder such as dementia.

About The Author

Tiffany Dyar

Tiffany Dyar is the former Executive Director for The Center for Health Innovation & Implementation Science, and the former Program Manager at Regenstrief Institute.Tiffany has co-authored several medical publications including The American Journal of Critical Care  Journal of General Internal Medicine Trials Journal  Best Practices in Mental Health  & The New England Journal of Medicine

Scroll to Top