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Cognitive Communication Disorders > Dementia > Flashcards

Dementia Flashcards

0
Q

What are the two types of memory?

A
  1. declarative (explicit) memory

2. non-declarative (implicit) memory

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1
Q

What is the definition of dementia?

A 
An acquired persistent impairment of intellectual function with compromise in at least three of the following spheres of mental activity:
memory
visuospacial skills
executive function
calculations
emotion
language
praxis
personality/social behaviour
semantic/conceptual knowledge
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2
Q

What is declarative memory?

A 
explicit memory
factual knowledge; conscious learning and retrieval
- semantic memory
- episodic memory
- lexical memory
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3
Q

What is non-declarative memory?

A

implicit memory
involves unconscious or incidental learning and retrieval
e.g. remembering how to ride a bike, drive a car, stoping at a red light

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4
Q

Some potentially reversible causes of Dementia?

A
  • deficiency states (eg vitamin B12 deficiency)
  • psychiatric (eg depression)
  • toxic states (eg heavy metal exposure)
  • metabolic states (eg hyper/hypothyroidism)
  • infection or fever
  • anoxic states
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5
Q

Some irreversible causes of Dementia

A
  • vascular (eg multi infarct dementia)
  • infectious (Creutzfeldt-Jacob disease)
  • degenerative (eg Hungtington’s desease, PSP, PD, DAT, Frontotemporal lobar degeneration)
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6
Q

Cortical Dementias?

A
  1. Alzheimer’s Dementia
  2. Frontotemplar degenerative dementias
    - frontotemplar
    - progressive non-fluent aphasia
    - semantic dementia
  3. Multi-infarct dementia
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7
Q

The neuropathology of Alzheimer’s Desease

A

changes associated with:

  • neurofibrillary tangles
  • senile plaques
  • cerebral atrophy (40-50% cerebral loss)
  • ventricular dilation
  • significant atrophy of hypocampus (memory hub)
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8
Q

Alzheimer’s disease characteristics

A

Primary deficit in memory
- declarative: episodic and later semantic
- anterograde memory deficits (retention of new information)
- retrograde memory deficits (recall of info acquired in the past)
- remote memory and non-declarative memory relatively preserved.
PLUS at least 2 of the following:
- language
- visuo-spatial perception
- problem solving and reasoning
- abstract thinking
- orientation

can lead to: changes in behaviour, delusions/ paranoial suspicion, agitation/ agression

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9
Q

DAT language profile

A
  • fluent verbal output (impoverished information content but preserved phrasal length, grammatical complexity and melodic line)
  • poor auditory comprehension
  • relative preservation of repetition
  • lack of completion abilities
  • anomia
  • absence of paraphasia and echolalia
  • more impaired automatic speech
  • semantic and discourse more impaired than syntax and phonology
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10
Q

Word Finding problems in DAT

A
  • among the earliest and most obvious symptoms
  • early stages: circumlocutions, semantic paraphasias, and other strategies
  • later stages: unrelated and empty words used. burden of understanding falls on the listener
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11
Q

Characteristics across all stages of dementia (mild - severe)…

A
  • few phonemic/phonological errors
  • slightly increased perceptual errors
  • increased semantic and unrelated errors significantly increase
    less severe - mostly coordinate errors (cat/dog/bird)
    more severe - mostly superordinate errors (animal)
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12
Q

Cohesive ties - 3 types of cohesive adequacy

A
  1. complete - the cohesive tie is defined with no ambiguity
  2. Incomplete - the info referred to by the cohesive marker is not provided in the text (the boys went to his house).
  3. Erroneous - the cohesive tie is linked to ambiguous information
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13
Q

Studies in narrative discourse look for appropriate:

A
  • setting information
  • completing action
  • story resolution

with:

  • structural cohesion
  • specific referents
  • semantic cohesion
  • appropriate conjunction cohesion
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14
Q

Narrative discourse difficulties:

A
  • difficulty organising and sequencing the essential elements of the scheme of the story
  • narrate less info
  • fewer core propositions
  • increase incorrect, irrelevant and ambiguous propositions
  • over use of empty speech
  • difficulty in cohesion
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15
Q

What is conversational discourse?

A

Systematic functional linguistics (SFL)

What we are going to say and how

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16
Q

CD in mild DAT

A
  • difficulty in introducing new topics
  • difficulties in sustaining and contributing to topics
  • unexpected topic shifts, due to failure to continue a topic, tendency to repeat an idea or digress
  • shorter conversational turns and call for regular prompts by the listener
  • STM problems result in repetitions of stories and other information
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17
Q

Stage 1 of Dementia (DAT)

A

Active, confused and Aware

  • an active conversational participant
  • WFD but deals with circumlocutions and semantic paraphasias
  • generally aware of memory problems (provides excuses)
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18
Q

Stage 2 of Dementia (DAT)

A

Active, confused and unaware

  • decreasing awareness of communicative needs
  • When WFD occurs, provides empty words
  • perseverates
  • more burden of the communication falls on the listener
19
Q

Stage 3 of Dementia (DAT)

A

Less active, confused and unaware

  • participation is markedly reduced
  • WFD leads to neologisms, empty words, unrelated words
  • more non-response utterances
  • perseverates
20
Q

Stage 4 of Dementia (DAT)

A

Passive

  • no lexical items produced
  • utterances confined to the set of uhuh, mmm, hmm?
  • still able to request repetition, to take conversational turns appropriatley, to indicate that she recognises personally important topics
21
Q

DAT comprehension problems

A

Early stages:

  • the ability to understand simple and concrete information is preserved
  • understanding of abstract language is poor
  • difficulty in following complex conversations and therefore appear lost

Later stages:

  • as earlier plus - more obvious trouble following directions
  • increased difficulty if word order is unexpected and more complex
22
Q

Frontotemporal Degenerative Dementias

A

“frontotemporal lobar degeneration (FTLD) is a clinical term we now use for a group of dementing neurodegenerative disorders marked by general prominence of symptoms referable to the frontal lobe”

Four clinical syndroms
- Behavioural frontotemporal dementia (character change & disordered social conduct; memory and perception generally preserved)

  • Progressive non-fluent aphasia (impaired expressive language; other cognitive areas well preserved)
  • Semantic dementia (progressive loss of conceptual knowledge about words & objects; memory relatively preserved)
  • Logopenic variant
    (last three fall under umbrella term of Primary Progressive Aphasia)
23
Q

Behavioural Frontotemporal Dementia

A
  • gross atrophy of frontal and temporal lobes
  • usually no parietal involvement
  • younger onset then DAT < 65 yrs
  • chronic progressive changes in: behaviour/personality eg emotional blunting, roaming, disinhibition, decreased social awareness, personal hygiene and grooming.
  • in early stages, usually orientated and memory problems are not prominent
  • MMSE not useful - can often perform normally
24
Q

Progressive Nonfluent Aphasia (PNFA)

A

Clinical features:
- agrammatic, effortful speech, phonemic errors
- increased frequency of AOS
PLUS 2 or more of the following
- Intact single word comprehension
- Intact object knowledge
- impaired comprehension of syntactically complex sentences

Cortical atropthy: left inferior frontal and insular
Early preservation of social skills
later behavioural changes
memory, reasoning and perception ok
For diagnosis: language only area of progressive dysfunction for first 2 years.

25
Q

Semantic Dementia

clinical features

A
  • impaired single word comprehension and naming
  • fluent but empty speech
  • semantic paraphasias
  • idiosyncratic word usage eg ‘container’ even for objects that cannot hold anything
  • impaired category fluency
    PLUS 3 or more of the following:
  • surface dyslexia - reading impairment; try to sound out irregular words eg yacht
  • impaired object knowledge (PWA cant name it but can show you how to use it, Dementia cannot do this)
  • impaired person knowledge eg show them a picture of themselves and they not know it
  • spared motor speech
  • intact word repetition
26
Q

Semantic Dementia

other features

A
  • Cerebral atrophy: anterior and ventral temporal lobe
  • good day to day memory (recent 2-5 years) impaired for more distant events
  • good orientation
  • behavioural changes only mild in early stages
  • preserved visuospacial processing, non-verbal problem solving, calculations and executive function
  • able to learn new skills
    (^ all opposite of DAT)

Often:

  • loss of sympathy and empathy
  • narrow range of interest
  • abnormal preoccupation with money; hoarding and counting
  • prosopagnosia - impaired facial recognition
27
Q

Multi-Infarct Dementia

definition and progression

A

A global cognitive loss in the presence of severe neurological lesions, none of which would be capable of causing dementia alone.
stepwise or fluctuating course or events indicated several individual strokes
- abrupt onset
- stepwise deteriation
- history of strokes
- history of hypertension
- focal neurological signs and symptoms

28
Q

Multi-Infarct Dementia

associated symptomology

A

(UMN issues)

  • pseudobulbar palsy (spastic dysarthria)
  • dysphagia
  • weakness
  • Bradykinesia (slow movement)
  • small stepped gait
  • lability
  • hyperreflexia
  • incontinence
  • Babinski signs
29
Q

Categories of Multi-infarct Dementia (MID)

A
  1. Lacunar state (deep white matter)
  2. Binswanger disease (rare - arteriosclerosis)
  3. Cortical Infarcts (small, may not show up on CT scans)
30
Q

MID Speech and Language Profile

and cognitive

A
  • did not manifest as an identifiable aphasic syndrome
  • produces grammatically simple and shorter phrases
  • decreased syntactic complexity
  • shortened utterance length
  • diminished total and unique words
  • increased sentence fragmentation
  • dysarthria evident - more motor speech abnormalities

Cognitive (similar to DAT)

  • attention
  • memory
  • perception
  • visuospacial
31
Q

Subcortical Dementias

A

Location: subcortical nuclear centres
(PD, Huntington’s Disease, Thalamic Disease)

Characteristics:

  • mental slowness
  • inertia and lack of initiative
  • forgetfulness
  • dilapidation of cognition
  • mood disturbance

Associated symptomology depends on the disease state
motor signs - extrapyramidal movement disorders

32
Q

Dementia in Parkinson’s Disease

A
  • failure to initiate activities spontaneously
  • impaired and slow memory
  • visuospacial and visuomotor defecitis
  • slow information processing
  • executive dysfunction
  • impaired problem solving, attention-set shifting, planning and regulating behaviour
  • Impaired concept formation
  • poor word list generation
33
Q

Parkinson’s Disease Speech and Language Profile

A
  • significant dysarthria - hypokinetic
  • disturbances of phrase length, melody & grammatical complexity
  • naming and comprehension disturbances evident in some PD dementia
  • nonfluent verbal output (more syntactic than semantic disturbances as opposed to DAT)
34
Q

DAT vs Aphasia

A
  • DAT distinugished by using language tasks
  • language abnormalities resemble Transcortical Sensory Aphasics BUT differ because of the lack of completion abilities, relative absence of echolalia and more impaired automatic speech
35
Q

DAT vs MID/PD

A
  • DAT significantly more impaired language than MID or PD dementia subjects
36
Q

PD vs MID

A
  • PD greater motor disability
  • PD dementia pts have shorter phrase lengths, lower voice problems, slower speech, more stuttering, poor writing mechanics
37
Q

Language Assessment Batteries for DAT patients

A 
ABCD - Arizona Battery for Communication Disorders of Dementia
DRS - Dementia Rating Scale
BNT (with error analysis)
Token Test ( AC decline in DAT)
FAS letter fluency test
Sentence construction and repetition
Narrative Analysis (cookie theft, Cinderella)
Conversational Analysis
Functional Communication Assessment
38
Q

ABCD

A

Arizona Battery of Communication Disorders of Dementia
- comprehensive test to test linguistic communication deficits
- appropriate for mild to moderate dementia
- Assess 5 domains
1 linguistic expression
2 linguistic comprehension
3 mental status
4 verbal episodic memory
5 visuospacial construct
- story retell and word learning most effective subtests
- admin time 45-90 min
- normative data available

39
Q

DRS

A 
Dementia Rating Sclaes
- brief but comprehensive test for predicting cognitive decline in older adults
5 subtests
	1 Attention
	2 Initiation and Perseveration 
	3 Construction 
	4 Conceptualisation
	5 Memory 
Time: 30 min
Max score 144
Normal cognitive function = > 123
Norms available for 55-89+ year olds
40
Q

MMSE

A 
Mini Mental State Exam 
-30 item subtest
tests: 
	orientation, 
	registration of information 
	attention and calculation 
	recall
	language
	construction 
Max score = 30 
< 17 definite cognitive deficit
41
Q

conversational difficulties in people with DAT typically defined in terms of deviance from normality…

A
  • shorter conversational turns
  • reduced coherence
  • reduced ability to introduce new topics
    unexpected topic shifts
42
Q

Management of DAT

- why implement effective communication?

A
  • to remain at home
  • difficulties in communication in a threat of personal caregivers
  • communication decline is the top stress for family
43
Q

Management of DAT

- what do we do?

A

We need to educate and provide info to partners and families

  • Need to focus on strengths, if not…. manifests disability
  • caregivers may underestimate the communication abilities of DAT and lead to minimal demand of the person, which feeds the helplessness cycle and results in further attrition of skills and routines.
44
Q

Why work closely with partners?

A
  1. they are informants of the communication difficulties

2. they are active participants in facilitating effective communication.

45
Q

Group Training Programs

A
  • MESSAGE 2011

- The focused 1996

46
Q

What does MESSAGE stand for?

A 
M - Maximise attention 
E - Expression and body language
S - keep in Simple
S - Support their converstation
A - Assist with visual aids
G - Get their message 
E - Encourage and Engage in communication

Cognitive Communication Disorders (1 decks)

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