What is the purpose of DementiaBank Grand Rounds?
The purpose of DementiaBank Grand Rounds is to provide education about cognitive aging with an emphasis on cognitive and linguistic characteristics of individuals across the spectrum.
Who is the intended audience of DementiaBank Grand Rounds?
DementiaBank Grand Rounds aims to facilitate learning for speech-language pathologists (SLPs), graduate students, and other new learners interested in cognitive aging.
What content is included?
The Grand Rounds content is separated into modules of information that can be reviewed and completed independently. Modules contain foundational information, related articles and resources, and questions for learners to practice their knowledge.
Each module will reference case studies* that represent an older adult who is (1) cognitively unimpaired, (2) has mild neurocognitive disorder, or (3) has major neurocognitive disorder. Case studies will provide opportunities for conceptual application and highlight relevant cognitive and linguistic behavioral changes.
*Disclaimer: The individuals featured in these case studies voluntarily gave permission to the researchers to use videos or photographs collected of them for educational purposes; no identifying information beyond that contained in the video recording is provided to the audience. Personal information presented in case studies has been modified to maintain the individual’s privacy. The cases do not reflect the facts or experiences of the individuals involved.
Module 1: Introduction to Neurocognitive Disorders
Learner Objectives
After completing Module 1, the learner will be able to:
Neurocognitive disorders (NCD) are a type of clinical syndrome in which the primary symptom is acquired decline in cognitive function (Guerriero Austrom et al., 2016). Broadly, a syndrome describes a group of symptoms or physical findings that suggest a specific condition (Calvo et al., 2003).
For example, Alzheimer’s disease (a medical disease) is the most common cause of major NCD (symptoms of cognitive impairment), though Alzheimer’s disease is not the only cause. When discussing these terms, it is helpful to specify both the NCD and the cause such as “major NCD due to Alzheimer’s disease” or “major NCD due to Parkinson’s disease.” This module will focus broadly on the NCD as described in the DSM-5.*
*Terminology Note: From the DSM-4 to DSM-5, the terminology to describe these clinical syndromes was updated. Mild cognitive impairment (DSM-4) became mild NCD (DSM-5), and dementia (DSM-4) became major NCD (DSM-5). The DSM-4 terms are often still used to describe mild vs. major NCDs, but we will consistently use the DSM-5 terminology in the Grand Round modules.
Who classifies neurocognitive disorders?Typically, primary care providers (PCPs) are the first providers involved in identification or care of early cognitive changes. PCPs then provide referrals to other NCD specialists such as geriatricians, neurologists, or neuropsychologists (Miller et al., 2024). We refer learners to the Appendix of Miller et al., 2024 for comprehensive descriptions of NCD expert consultants.
While SLPs do not classify mild or major NCD themselves, they may play a valuable part in a person’s care team and have important insights into aspects of the person’s function.
Click here to read about SLP’s scope of practice in this area from ASHA.
What are the DSM-5 criteria for mild neurocognitive disorder?There are four criteria for mild NCD based on the DSM-5 (American Psychiatric Association, 2013).
There are four criteria for major NCD based on the DSM-5 (American Psychiatric Association, 2013).
An individual’s risk for major NCD is made up of a unique combination of risk factors (those that increase risk) and protective factors (those that reduce) for each person. These factors may be non-modifiable (we cannot change them, such as genetics) or modifiable (we may be able to change them, such as lifestyle or habits). There are 14 modifiable risk factors for major NCD across the lifespan that may reduce up to 45% of cases (Livingston et al., 2024).
Non-modifiable risk factors include:
Modifiable risk factors across the lifespan include:
***Terminology Note: Factors may be described in terms of risk or protection. The factors presented here are described as risk factors (e.g., less education). However, a protective factor would be its inverse (e.g., more education).***
Practice your knowledge: Identify the differences in criteria requirements for mild and major neurocognitive disorders.You should have noticed that the four criteria for mild and major NCD are similar! The main differences are in Criterion 1 and 2.
For Criterion 1, the severity level of cognitive decline can help you to determine if a person has mild NCD (i.e., mild/modest decline) or major NCD (i.e., significant/substantial). We will learn how to measure cognitive decline in a future module.
For Criterion 2, the main difference is whether or not the person can complete their complex independent activities of daily living independently. If they can complete them independently (maybe with a compensatory strategy or two), that is indicative of mild NCD If they require assistance to complete the activities, that is indicative of major NCD.
Criterion 3 and criterion 4 are the same for both NCDs.
Click this link **NEED LINK** to compare the DSM-V criteria across mild and major NCDs.**3 colored boxes in frame**NEED LINKS**
Cognitively Unimpaired: Meet Anita
**Meet Anita.mp4**NEED VIDEO**
Anita is a 77-year-old Black female with 18 years of education (Master’s degree), who recently retired from a successful career in software engineering. She is now writing a memoir about her childhood for her grandchildren. Anita remains active in her community, including church groups, book club, League of Women Voters, as well as exercise groups (e.g., yoga, pickleball). She also enjoys walking with a friend 3-5x/week. Past medical history includes diabetes and hypertension (high blood pressure). Her vision and hearing are within normal limits. She reports more memory difficulties such as forgetting why she went into a room or people’s names.
Practice your knowledge: Identify Anita’s risk and protective factors for major neurocognitive disorder.| Risk Factors | Protective Factors |
| Age | Education |
| Race | Physical activity |
| Hearing loss | Social engagement |
| High cholesterol | |
| Hypertension | |
| Diet |
**Meet Rose.mp4**NEED VIDEO**
Rose is an 83-year-old White female diagnosed with major neurocognitive disorder ~2 years ago. Her medical history includes diabetes, hypertension (high blood pressure), and hearing loss (for which she lost her hearing aids). She has never smoked, and her vision is within functional limits. Rose did not finish high school but completed a General Educational Diploma (GED). She is a retired teaching assistant and artist who previously enjoyed traveling with friends but now spends most of her time at home with her spouse who is her primary caregiver. While her social interactions are more limited, she enjoys visiting with her family and, most importantly, spending time with her dogs. Rose’s spouse reports that he manages the household activities (including finances, grocery shopping, etc.) and that she requires some cues for self-care (e.g., reminders to brush her teeth).
Practice your knowledge: Identify Rose’s risk and protective factors for major neurocognitive disorder.| Risk Factors | Protective Factors |
| Age | No history of smoking |
| Sex | Normal vision |
| Education level | |
| Diabetes | |
| Hearing loss | |
| Hypertension | |
| Social isolation |
Sachdev, P. S., Blacker, D., Blazer, D. G., Ganguli, M., Jeste, D. V., Paulsen, J. S., & Petersen, R. C. (2014). Classifying neurocognitive disorders: the DSM-5 approach. Nature Reviews Neurology, 10(11), 634-642.
More on dementia terminology from the Alzheimer’s Association
More about risk factors from the Alzheimer’s Society (UK)
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, 5th Ed.
Calvo, F., Karras, B. T., Phillips, R., Kimball, A. M., & Wolf, F. (2003). Diagnoses, syndromes, and diseases: a knowledge representation problem. AMIA ... Annual Symposium proceedings. AMIA Symposium, 2003, 802.
Fishman, E. (2017). Risk of developing dementia at older ages in the United States. Demography, 54(5), 1897-1919.
Guerriero Austrom, M., Johnson, C. B., Rexroth, D. F., & Unverzagt, F. W. (2016). Neurocognitive disorders. In J. C. Norcross, G. R. VandenBos, D. K. Freedheim, & N. Pole (Eds.), APA handbook of clinical psychology: Psychopathology and health (pp. 253–271). American Psychological Association. https://doi.org/10.1037/14862-009
Kornblith, E., Bahorik, A., Boscardin, W. J., Xia, F., Barnes, D. E., & Yaffe, K. (2022). Association of race and ethnicity with incidence of dementia among older adults. Jama, 327(15), 1488-1495.
Livingston, G., Huntley, J., Liu, K. Y., Costafreda, S. G., Selbæk, G., Alladi, S., Ames, D., Banerjee, S., Burns, A., Brayne, C., Fox, N. C., Ferri, C. P., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Nakasujja, N., Rockwood, K., … Mukadam, N. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet Standing Commission. The Lancet, S0140673624012960. https://doi.org/10.1016/S0140-6736(24)01296-0
Loy, C. T., Schofield, P. R., Turner, A. M., & Kwok, J. B. (2014). Genetics of dementia. The Lancet, 383(9919), 828-840.
Miller, M., Ward, M., Keith, C., Patel, V., Haut, M. W., Wilhelmsen, K., Navia, O., Mehta, R., Marano, G., & Kiddy, A. (2024). Managing neurocognitive disorders in the real world: optimizing collaboration between primary care providers and dementia specialists. The American Journal of Geriatric Psychiatry Open Science, Education, and Practice, 1, 17–27. https://doi.org/10.1016/j.osep.2024.04.001
Salwierz, P., Davenport, C., Sumra, V., Iulita, M. F., Ferretti, M. T., & Tartaglia, M. C. (2022). Sex and gender differences in dementia. International Review of Neurobiology, 164, 179–233. https://doi.org/10.1016/bs.irn.2022.07.002