Communication Disorders Associated With Dementia

Question 1

Dementia and SLP

Answer 1

• poor prognosis for recovery
• medicare and 3rd party reimbursement are not supportive of rehab services
• therapy is “embedded” in environment and training, not one on one

Question 2

dementia

Answer 2

• the loss of cognitive and intellectual function, without impairment of perception or consciousness
• characterized by:
• impaired memory
• disorientation
• impaired judgement
• impaired intellect
• impaired affect

Question 3

prevalence

Answer 3

6-20% of people in nursing homes have dementia

6-8% at 60YO and doubles every 5 years

Question 4

subcortical vs cortical

Answer 4

S: no aphasia, forgetful, dysarthria, impaired motor control and slowed speech, abnormal gait, severe exec function deficits, apathetic, HD, PD

C: early aphasia, amnesia, normal artic till late, normal gait until late, unconcerned, euphoric

Question 5

major types of dementia

Answer 5

• alzheimers (60-70%)
• vascular, multi-infarct (15-25%)
• lewy body (5-8%)
• frontotemporal lobar (3-5%)

Question 6

other types of dementia

Answer 6

• alcohol
• PD
• creutzfeldt-jakob

Question 7

reversible types of dementia

Answer 7

• depression
• drug toxicity
• long term sensory deprivation
• metabolic disorders (liver, kidney, pancreas, thyroid etc disorders)
• intracranial mass (depends on lesion)
• infection (syphillis, meningitis, etc)
• arteriosclerotic complications (blood flow to brain reduced tissues)

Question 8

2 major risk factors

Answer 8

• age

- family history

Question 9

memory impairment in dementia

Answer 9

EARLY:
-difficulty learning and retaining new info

LATE
-inability to to access distant memories, impaired judgement and executive function

Question 10

clinical features

Answer 10

• early behavior and mood changes
• dementia and depression often overlap
• agitation

Question 11

6 diagnostic criteria for dementia

Answer 11

1. multiple cog deficits
2. cog deficits impair social or occupational function, reps a significant decline from previous function
3. gradual onset and continued cog decline
4. cog deficits are not due to : CNS condition, systemic condition, substance-induced condition
5. deficits do not occur exclusively during the course of a delirium
6. disturbance is not better accounted for by another disorder (major depression, schizophrenia)

Question 12

neuropathology of AD

Answer 12

• associated with plaques and neurofibrillary tangles in the brain
• PLAQUES: abnormal clusters of protein fragments build up between nerve cells
• NEUROFIBRILLARY TANGLES: twisted strands of protein within nerve cells

= prevents cell from doing its job, causes atrophy of brain

Question 13

lewy body

Answer 13

• periods of normal cognition, alternate with abnormal cognition
• progressive often rapid course
• lewy bodies present at autopsy
• motor speech disorder w/ hypotonia

Question 14

vascular

Answer 14

• abrupt deterioration, stair-step decline
• dx includes multiple infarcts, small vessel disease, multiple lacunes, hemorrhage
• motor speech disorder is prominent
• can detect on brain imaging studys to some degree

Question 15

frontotemporal lobar dementia

Answer 15

• insidious onset, usually before 65
• progressive slow course
• wide range of symptoms, social inhibition

Question 16

primary progressive aphasia

Answer 16

slowly worsening aphasia not due to to stroke, trauma, tumor, or infection