8d. Neurologically Based Communication Disorders and Dysphagia -- DEMENTIA

Question 1

Definition and Classification of Dementia

Answer 1

*Primarily found in people 65+
*Acquired neurological syndrome associated with persistent or progressive deterioration in intellectual functions (cognition, visuospatial skills), language memory, emotion and personality
*Typically progressive; reversible in 20% of cases
*Can be classified as reversible and progressive
*Can be classified as cortical, subcortical, and mixed
[cortical: intellectual deficits precedes motor deficits; subcortical: motor deficits precede intellectual deterioration]

Question 2

Dementia of the Alzheimer Type

Answer 2

• Form of cortical dementia
• ~50% of irreversible dementia is due to Alzheimer’s
• Onset usually when pt is in 70s or 80s
• More women vs men are affected
• Associated w/ fam hx of Down syndrome and hx of brain injury
• Neuropathology involves: neurofibrillary tangles, neuritic plaques, neuronal loss, and neurochemical changes

Question 3

Frontotemporal Dementia (Incl. Pick’s Disease)

Answer 3

• FTD is a group of heterogenous diseases
• ~12% of dementia cases diagnosed in people under 65
• Typically diagnosed bet. age 40 and 60
• Neuropathology includes degeneration of nerve cells in L and R frontal lobe, temporal lobe, or both lobes in the two hemispheres
• In Pick’s, atrophy may be focal, involving anterior frontal and temporal lobes, the orbital frontal lobe, and the medial frontal lobe

Question 4

Dementia Associated with Parkinson’s Disease

Answer 4

• Form of SUBCORTICAL dementia
• Only ~35-55% of pts with PD have dementia
• PD is more common in males vs females
• PD onset is usu. bet. 50 and 56 y/o
• Neuropathology of PD include: BS degeneration, prescence of abnormal structures called Lewy bodies in substantia nigra, frontal lobe atrophy resulting in widened sulci, reduced inhibitory dopamine due to loss of cells in substantia nigra, neurofibrillary tangles and plaques of the kind found in Alzheimer’s

Question 5

Parkinson’s Disease: Neurologic Symptoms

Answer 5

• Slow voluntary movement (bradykinesia)
• Tremors in resting muscles
• Muscle rigidity (increased tone and resistance to movement)
• Masklike face
• Reduced eye-blinking, festinating gait, disturbed posture, frequent falls, and freezing during movement
• Swallowing disorders
• Sleep disturbances

Question 6

Parkinson’s Disease: Speech, Language, and Related Problems

Answer 6

• Reduced speech volume
• Voice probs that incl. monopitch and monoloudness
• Long and frequent pauses in speech
• Slow, fast, or festinating speech rate
• Dysarthric speech
• Serious memory probs, probs in abstract reasoning, and prob solving
• Impaired visuospatial perception
• Impaired word-list generation
• Severe naming and language comprehension probs in later stages
• Apathy, confusion, hallucination, and delirium
• Micrographia

Question 7

Dementia Associated with Huntington’s Disease

Answer 7

• Form of SUBCORTICAL dementia
• Typical age of onset is 35-40 y/o
• Affects males and females equally
• Genetic etiology
• A malformed protein calling huntingtin kills brain cells that control movement
• Neuropathology of HD includes: a loss of neurons in BG; Atrophy may be found in prefrontal and parietal lobes; Reduced levels of inhibitory neurotransmitters, esp. GABA and acetylcholine

Question 8

Symptoms of Huntington’s Disease

Answer 8

• Chorea (irregular, spasmodic, involuntary movement of neck, head, and face)
• Increasingly uncontrolled tic-like movement disorders
• Gait disturbances and progressively reduced voluntary movements
• Slow movement in the advanced stages of the disease, leading to little or no voluntary movement
• Behavioral disorders that incl. excessive complaining, nagging, eccentricity, irritability, emotional outbursts, false sense of superiority, depression and euphoria, schizophrenic-like behaviors (delusions and hallucinations) and suicide attempts

Question 9

Infectious Dementia

Answer 9

• Several infectious diseases lead to dementia
• Dementia due to immunodeficiency virus (HIV) infection or Creutzfeldt-Jakob disease is well known
• Dementia due to HIV infection is subcortical

Question 10

Other Forms of Dementia

Answer 10

• Vascular dementia: bilateral cortical, subcortical or mixed; more common in men vs women; associated with chronic hypertension; blacks>whites; sudden onset
• Dementia associated with multiple cerebrovascular accidents: …atrophy of subcortical white matter…
• Dementia associated with TBI: can be cortical, subcortical or mixed