Mild cognitive impairment should be considered for DSM-V

Mild cognitive impairment is a topic of great activity from both clinical and research perspectives. It represents a transitional state between the cognitive changes of aging and the earliest clinical manifestations of dementia. We present a case for its inclusion in the Diagnostic and Statistical Manual of Mental Disorders (5th ed; DSM-V) based on clinical, outcome, epidemiological, neuroimaging, and pathophysiological data. The strongest case for inclusion can be made for the amnestic subtype, which is likely a clinical precursor of Alzheimer's disease. Arguments are presented as to why mild cognitive impairment can be considered as an entity distinct from normal aging and from clinically probable Alzheimer's disease and why it deserves consideration as a separate construct. In many respects, mild cognitive impairment fulfills criteria for inclusion more adequately than many other conditions currently codified in DSM-IV. Future research directions to help clarify some of the remaining uncertainties are proposed.