Aphasia Flashcards
Neuropathology of dementia
- Stroke and ischemic encephalopathy (multi-infarct or vascular dementia)
- Hippocampal sclerosis
- Head trauma (subdural hematomas, diffuse axonal injury, chronic traumatic encephalopathy)
- Hydrocephalus
- CNS infections (HIV encephalitis, Creutzfeldt-Jakob disease)
- Metabolic CNS disorders (lysosomal storage and peroxisomal diseases)
- Demyelinative diseases (multiple sclerosis)
- Neurodegenerative diseases (Alzheimer’s disease, Parkinson’s disease, diffuse Lewy body dementia, Huntington’s disease, and other)
- Neuropsychiatric disorders
- Severe medical illness or organ failure
- The effects of medications
Arizona Battery of Cognitive Deficits (ABCD)
for identifying and quantifying communicative deficits of persons with dementia
4 screening subtests to evaluate speech discrimination, visual perception and literacy, visual fields,and visual agnosia
14 subtests to evaluate mental status, linguistic expression, verbal memory, linguistic comprehension, and visuospatial construction
Boston Diagnostic Aphasia Examination (BDAE)/Western Aphasia Battery (WAB)
to measure general language abilities and to track change in language abilities over time
Communicative Activities in Daily Living- Second Edition (CADL-2)
test of functional communication to estimate daily life communicative ability
provide a baseline measure against which future changes in functional communication may be compared
Dementia management- early stages
People in the early stages of dementia (and their families and caregivers) need help in identifying how communication is affected by the person’s impairments, assistance in identifying the most important targets for management, help with devising strategies for working around the person’s communication impairments, and direction in putting the strategies into practice.
Dementia management
Impairments of memory and attention increase in severity and affect more dimensions of daily life. Communication becomes increasingly one-sided. The affected person no longer initiates conversations but becomes a passive conversation partner. The person’s responses consist primarily of trivialities and automatisms (e.g., you don’t say, gracious sakes).
Dementia management- late stages
Helping persons at this stage means helping their caregivers manage troublesome behaviors, ensure the person’s health and security, and maintain the person’s participation in daily life activities consistent with the person’s intellectual and psychological abilities.
Parkinson’s disease
Subcortical dementia. degenerative disease affecting nuclei in the midbrain and brainstem; disturbances of movement- rigidity, tremor, slowness, loss of balance; weak voice, speech rate increases, articulation progressively indistinct, micrographia (extremely small writing), drooling and swallowing impairments
Huntington’s disease
Subcortical dementia, loss of neurons in the caudate nucleus and the putamen, patchy loss of cortical neurons in the frontal and temporal lobes, with occasional extension of neuron loss to the cerebellum; irritability and emotional outbursts; inherited diseases, personality changes, agitation, depression, paranoia, delusions; dysarthria caused by chorea, decline in speech intelligibility, dysphagia, difficulty with sustained attention, difficulty with memory and judgment, mute in final stages
Progressive Supranuclear Palsy
Subcortical dementia, neuronal loss, neuronal abnormalities, and proliferation of glial cells throughout the brainstem and basal ganglia; rare disease that resembles Parkinson’s except for absence of tremor and rigidity of neck and trunk rather than limbs; severe dysarthria, language usually well-preserved until late stages during which they become unintelligible or mute
Human Immunodeficiency Virus Encephalopathy
Subcortical dementia,most common neurological consequence of AIDS, caused by infection of the brain with the human immunodeficiency virus which causes pathological changes in the subcortical white matter and basal ganglia; early symptoms include weakness, slowness, rigidity, dyskinesia and later symptoms include impaired perception, memory, intellect, and language; spontaneous speech becomes dysarthric and declines to a few overused words and phrases, and comprehension declines to the point of short and simple utterances
Alzheimer’s disease
Cortical dementia, microscopic changes in brain neurons including neurofibrillary tangles, neuritic plaques, and granulovacuolar degeneration; language less affected than cognition, intellect, and memory, early stages similar to anomic aphasia, late stages similar to Wernicke’s aphasia
Pick’s Disease (Frontal Lobe Dementia)
Cortical dementia, 2 neuronal abnormalities including proliferation of enlarged neurons and the presence of Pick bodies within neurons, shrinkage of the brain with loss of neurons and proliferation of glial cells throughout the cortex; rare, language breakdown appears early, word retrieval failures, impaired confrontation naming, circumlocution, and generic words for specific words, echolalia, comprehension impairments for spoken and written, mute and profoundly demented in final stages, usually die from aspiration pneumonia or infection 6 to 12 years after diagnosis
Primary Progressive Aphasia
Cortical dementia, nonspecific degeneration of brain tissues, usually in temporoparietal region of language-dominant hemisphere; impaired programming and sequencing of speech movements; apraxia of speech is the first most prominent manifestation
Vascular dementia
Cortical dementia. presence of dementia and evidence of cerebrovascular disease; important cause of dementia in adults, often concomitant with Alzheimer’s, first symptoms abrupt in onset, most common type is multi-infarct dementia (3 etiologic subgroups include lacunar state, multiple cortical infarcts, and Binswanger’s disease); memory impairment, cognitive deficits causing impairment in social or occupational functioning, focal neurologic signs (perceptual, motor or sensory), deficits do not occur during delirium
Lewy Body Dementia
Cortical dementia, proliferation of Lewy bodies which causes loss of dopamine producing neurons in the substantia nigra and loss of acetylcholine producing neurons throughout the brain; impairments in visuospatial abilities, language, attention, working memory, and executive functions, similar to Alzheimer’s but better preserved memory
Frontotemporal dementia
Cortical dementia, validity and clinical utility as a coherent diagnosis has yet to be established
Nonpenetrating (closed) head injury
Type of traumatic brain injury in which the skull and dura mater remain intact. Closed-head injuries are the leading cause of death in children under 4 years old and the most common cause of physical disability and cognitive impairment in young people
Contusion
a bruise on the brain which can cause swelling
Shearing
When the brain is slammed back and forth inside the skull it is alternately compressed and stretched because of the gelatinous consistency. The long, fragile axons of the neurons (single nerve cells in the brain and spinal cord) are also compressed and stretched. If the impact is strong enough, axons can be stretched until they are torn. This is called axonal shearing, which causes the neurons to die. After a severe brain injury, there is massive axonal shearing and neuron death
Contra-coup injury
Occurs on the side opposite the area that was impacted
diffuse axonal injury
Characterized by extensive generalized damage to cerebral white matter producing damage to nerve cell axons. Twisting/ shearing . created by angular acceleration. Stretching/ tearing created by linear acceleration. Causes severe sudden twisting or torquing of the brain, as occurs in a sudden acceleration/deceleration - whiplash – accident, can stretch, twist, and damage delicate axonal fibers. Results in coma.
secondary brain injury
Secondary injury occurs as an indirect result of the insult. It results from processes initiated by the initial trauma and typically evolves over time
linear acceleration
when the head is struck by a blunt force on a line through the central axis. Types of linear injuries: Coup injuries- injuries occur on the opposite side of the impact. This can cause focal (localized) damage to the meninges and brain tissue. Shaken-baby syndrome- can cause diffuse brain damage to a baby’s brain tissue. And whiplash injuries- commonly caused by motor-vehicle accidents, causing the head to snap back and forth.
penetrating (open) head injury
involves an open wound to the head from a foreign object (e.g., bullet). It is typically marked by focal damage that occurs along the route the object has traveled in the brain that includes fractured/perforated skull, torn meninges, and damage to the brain tissue
Coma
a prolonged state of unconsciousness. During a coma, a person is unresponsive to his or her environment. can be induced or natural.
traumatic brain injury
Brain dysfunction caused by an outside force, usually a violent blow to the head. may cause temporary dysfunction of brain cells. More serious traumatic brain injury can result in bruising, torn tissues, bleeding and other physical damage to the brain that can result in long-term complications or death.
coup injury
occurs under the site of impact with an object
Primary brain damage
Primary injury occurs at the moment of initial trauma.
