Provisional research diagnostic criteria for Mild Behavioral Impairment (MBI)
A. Behavioral concern reflecting a change in behavior observed by patient or informant or clinician, starting later in life (age≥50) and persisting at least intermittently for > 3 months. These represent clear change from the person’s usual behavior as evidenced by at least one of the following:
a. Decreased motivation (e.g. apathy, aspontaneity, indifference)
b. Affective lability (e.g. anxiety, dysphoria, changeability, euphoria, irritability)
c. Impulse dyscontrol (e.g. agitation, disinhibition, gambling, obsessiveness, behavioral perseveration, stimulus bound)
d. Social inappropriateness (e.g. lack of empathy, loss of insight, loss of social graces or tact)
e. Abnormal perception or thought content (e.g. delusions, hallucinations)
B. Behaviors are of sufficient severity to produce disability in at least one of the following areas:
a. Interpersonal relationships
b. Other aspects of social functioning
c. Ability to perform in the workplace
C. While co-morbid conditions may be present, the behavioral changes are not attributable to another psychiatric disorder, or vascular, traumatic or medical causes, or the physiological effects of a substance or medication.
D. The patient does not meet criteria for a dementia syndrome (e.g., Alzheimer’s dementia, frontotemporal dementia, dementia with Lewy bodies, vascular dementia, other dementia). Mild Cognitive Impairment can be concurrently diagnosed with Mild Behavioral Impairment.
I am uncertain as to the utility of introducing this new diagnostic category you propose. There's much debate in psychiatry as to whether we should be looking at disorders from a 'dimensional' or 'categorical' view point. For me a psychiatric disorder needs to have validity and utility and there is an assumption of an underlying consistent pathology of the mind-brain. Although many of our currently accepted disorders fall short of that criterion. So, if through further research this criterion can be fulfilled then mild behavioural impairment would be useful. However, my prediction is that a clinician faced with the possibility of diagnosing this condition would first try and exclude an early presentation of an already known disorder or an atypical presentation of disorders. The practical outcome for the patient may be support and close follow up. If you want to propose a 'pre-clinical' state whose trajectory may be one of a number of common neurodegenerative conditions then this would be only useful if there were biomarkers available. It would be interesting to hear other views.
After reading your question globally, I would say that if we take into consideration all of what you bring into the question, I would add another concept. The concept in the elder population is a murky hopelessness and realization of the end of the "possibles" in life, leading to generalized reconditioning. More of the constructs and articulation of the phenomenon need to be explored as a concept.
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