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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Major Neurocognitive Disorder


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Diagnosis

History: History should be obtained from or at least corroborated by the family or caregivers, as the individual often lacks judgment and is unaware that anything is wrong. The individual also may be in psychological denial, unwilling to accept that what he or she fears may be happening. The diagnosis of dementia involves a deterioration in memory from baseline. Depending on the underlying cause of dementia, memory and thinking may get worse gradually or in stepwise fashion (for example, in multi-infarct dementia), or may be worst at the outset, with stability or even gradual improvement with time (for example, in traumatic brain injury). Other symptoms may include difficulty recognizing people or objects, performing skills, or organizing one's life. These impairments cause a decline in social or occupational functioning, including taking care of basic tasks of life such as bathing, dressing, and eating. Diagnosis requires the presence of memory impairment plus one or more of the following: language disturbance (aphasia); inability to carry out motor activities in spite of preserved motor function (apraxia), such as inability to use a toilet; inability to identify objects (agnosia); or inability to plan or organize activities (impaired executive functioning). History should also focus on alcohol or medication use that could be affecting cognitive function.

According to the DSM-5, individuals with major neurocognitive disorder have evidence (based on concern of the individual, an informant, or the clinician) of important cognitive decline from a previous level in at least one cognitive domain (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition); and a considerable impairment in cognitive performance, documented by standardized neuropsychological testing or other quantified clinical assessment. The cognitive deficits interfere with independence in daily activities, do not occur exclusively in the context of a delirium, and are not better explained by another mental disorder. It is necessary to specify whether The major neurocognitive disorder is due to Alzheimer's disease, frontotemporal lobar degeneration, Lewy body disease, vascular disease, traumatic brain injury, substance/medication use, HIV infection, prion disease, Parkinson's disease, Huntington's disease, another medical condition, multiple etiologies, or is unspecified. For each etiological subtype, coding may include an associated etiological medical code for major neurocognitive disorder, a major neurocognitive disorder code, or a mild neurocognitive disorder code. It is also necessary to specify if the major neurocognitive disorder courses without behavioral disturbance, or with behavioral disturbance, as well as the current severity: mild, moderate or severe (DSM-5).

Also according to the DSM-5, individuals with mild neurocognitive disorder have evidence (based on concern of the individual, an informant, or the clinician) of modest cognitive decline from a previous level in at least one cognitive domain (complex attention, executive function, learning and memory, language, perceptual-motor, or social cognition); and a modest impairment in cognitive performance, documented by standardized neuropsychological testing or other quantified clinical assessment. The cognitive deficits do not interfere with independence in daily activities, do not occur exclusively in the context of a delirium, and are not better explained by another mental disorder. It is necessary to specify the same etiological subtypes as for major neurocognitive disorder. It is also necessary to specify if the mild neurocognitive disorder courses without behavioral disturbance, or with behavioral disturbance (DSM-5).

Physical exam: The exam may show signs of an underlying disease, such as vascular disorders or vitamin deficiencies. A lack of facial expression (flat affect) might be present. On neurological examination, abnormalities might include symmetrically abnormal reflexes (frontal lobe release signs). In dementia caused by vascular disease, multiple sclerosis, or autoimmune conditions, there might be multifocal findings reflecting abnormalities in several different brain structures. These might include asymmetrical reflexes, weakness on one side, or abnormalities in the cranial nerves supplying strength and sensation to the head and neck. In dementia caused by a brain tumor, single stroke, or head trauma, the neurological examination might show abnormalities restricted to a single location in the nervous system.

Tests: Tests include mental status examinations such the Folstein Mini Mental Status Exam (MMSE) or more detailed and sensitive neuropsychological testing to document cognitive impairment. Neuroimaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), may reveal shrinking of brain substance (cerebral atrophy), strokes, tumors, or other abnormalities. Positron-emission tomography (PET) or single photon emission computed tomography (SPECT) scans, thought to be more of a research tool than CT and MRI, may show functional changes in parts of the brain involved in Alzheimer's disease or thought processing (frontal, temporal, or parietal lobes). Blood work may show treatable endocrine, metabolic, autoimmune, or infectious causes, such as hypothyroidism, vitamin B12 or folate deficiency, syphilis, or lupus. Electroencephalogram (EEG) may be helpful in those forms of dementia with specific EEG patterns, such as Creutzfeldt-Jakob disease. Spinal tap (lumbar puncture) is usually unnecessary, but may help diagnose autoimmune or infectious forms of dementia. Research suggests that certain markers in spinal fluid may be elevated in Alzheimer's disease.

Note: It must be kept in mind that just because a physical diagnosis cannot be established as the cause of the presenting symptomatology, it does not necessarily mean that the cause is a mental one. That is to say that the presence of medically unexplained symptomatology does not necessarily establish the presence of a psychiatric condition. The first step in identifying the presence of a mental disorder is excluding the presence of malingering and/or of factitious disorder. Although factitious disorder is conscious and purposeful, it is classified as a psychiatric disorder. The strong need for this step is especially true whenever there is a medicolegal context associated with the presenting problem(s). Additionally, using DSM-5 and/or ICD-9-CM or ICD-10-CM, the clinician will find that many presentations fail to fit completely within the boundaries of a single mental disorder. There are systematic ways to go about making psychiatric diagnoses, however.

Source: Medical Disability Advisor