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Nature of Disorders of Language and Communication > Dementia > Flashcards

Dementia Flashcards

1
Q

DSM-V dementia diagnostic criteria

A
  • signficant cognitive impairment in at least one of the cognitive domains
  • acquired
  • significant decline from a previous level of functioning
  • progressive
  • symptoms do not occur exclusively during delirium
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2
Q

5 cognitive domains

A
  • learning and memory
  • language
  • complex attention
  • perceptual-motor function
  • social cognition
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3
Q

dementia definition

A

progressive loss of cognitive ability resulting in a loss of functional independence

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4
Q

what does dementia affect

A
  • memory
  • thinking
  • orientation
  • comprehension
  • calculation
  • learning capacity
  • language
  • judgement
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5
Q

main risk factor of dementia

A

age

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6
Q

Dementia Model of Care (2023)

A
  • outlines care pathways and social care system
  • targets and practice recommendations for dementia care
  • recommendations for care at each stage
  • specific advice around identification, assessment, diagnosis, disclosure, care planning, post-diagnostic support
  • recommends SLT staffing requirements
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7
Q

is dementia over or underdiagnosed in Ireland

A

under

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8
Q

principles of the Dementia Model of Care (2023)

A
  • citizenship
  • person-centered approach
  • integration
  • personal outcome-focused
  • timeliness
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9
Q

Dementia Diagnostic Model

A
  • Level 1: assessment in primary care
  • Level 2: assessment in memory assessment and support service
  • Level 3: assessment in regional specialist memory clinic
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10
Q

role of SLT

A
  • involved at all stages of the person’s journey
  • access to pre and post-diagnostic care
  • facilitating communication between the person with dementia and their family, carers, and others
  • ensure the personhood is promoted and their values, will, and preference are upheld
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11
Q

cognitive communication changes in typical aging

A
  • word retrieval difficulties
  • decreased speed of information processing
  • working memory function difficulties (small details of recent events, complex questions or instructions)
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12
Q

Working Memory Model

A
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13
Q

dementia treatment

A
  • brain health programs and strategies
  • medications (cholinesterase inhibitors, memantine)
  • MDT intervention
  • future planning, decision making, care provision
  • empowering the person with dementia and their families
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14
Q

DSM-V delirium diagnosis criteria

A
  • disturbance of consciousness occurs with reduced ability to focus, sustain, or shift attention
  • change in cognition that is not accounted for by a preexisting, establish, or evolving dementia
  • disturbance develops over a short period of time (usually hours to days) and fluctuates during the day
  • caused by a direct physiologic consequence of a general medical condition, intoxicating substance, medication, or a combination
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15
Q

identifying delirium in acute care

A
  • delirium v. dementia
  • acute v. gradual
  • fluctuating v. progressive
  • delirium usually resolves once cause is treated
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16
Q

delirium v. dementia assessment

A

4A Test: screening instrument for cognitive impairment and delirium

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17
Q

mild cognitive impairment (MCI)

A
  • also known as prodromal dementia
  • modest cognitive decline in 1+ cognitive domain
  • does not affect independence
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18
Q

what distinguishes MCI from dementia

A

lack of impact on daily functioning

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19
Q

does MCI cause dementia

A
  • no
  • can revert to normal cognition, remain stable, or improve over time
  • associated with a higher risk of developing dementia in the future
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20
Q

MCI subclassifications

A
  • amnestic MCI
  • non-amnestic MCI
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21
Q

amnestic MCI

A

memory and learning difficulties

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22
Q

non-amnestic MCI

A
  • difficulties with thinking skills aside from memory
  • attention, executive ability, language, perception, social cognition, or a combination
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23
Q

communication changes in MCI

A
  • impaired auditory comprehension
  • verbal fluency deficits (semantic and phonemic)
  • confrontation naming deficits (anomia and increased response time)
  • discourse processing deficits (irrelevant information, pauses, repetition)
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24
Q

types of dementia

A
  • Alzheimer’s disease
  • Vascular dementia
  • Frontotemporal dementia
  • Lewy Body Dementia
  • Dementia in Parkinson’s disease
  • Atypical Parkinsonian syndrome (e.g. Lewy Body Dementia)
  • Huntington’s disease
  • Dementia in Intellectual Disability
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25
Q

Alzheimer’s disease definition and hallmark symptom

A

a slowly progressive degenerative disorder characterized by memory loss

26
Q

Alzheimer’s disease cause

A
  • changes in temporal and parietal lobes
  • presence of amyloid plaques and neurofibrillary tanges
  • tau and amyloid proteins build up in the nerve cell bodies in the brain causing cell death (converted to neurofibrillary tangles)
27
Q

what are amyloid plaques

A
  • aggregations of certain peptides
  • activate inflammatory processes
  • results in cell damage and death
28
Q

most common cause of dementia

A

Alzheimer’s disease

29
Q

primary feature of alzheimer’s

A

episodic memory loss

30
Q

Alzheimer’s disease diagnostic tools

A
  • lumbar puncture (examine CSF) for levels of amyloid and tau
  • MRI-B
  • PET
  • Amyloid PET
31
Q

2 atypical types of Alzheimer’s disease

A
  • Posterior Cortical Atrophy (PCA)
  • Logopenic Alzheimer’s disease
32
Q

Posterior Cortical Atrophy (PCA) hallmark

A

predominant visual disturbance

33
Q

Logopenic AD hallmark

A

predominant language difficulties

34
Q

cognitive communication in AD (impairments, unimpaired in mild to moderate stages, and not impaired)

A

impairments:
- semantic (word-finding difficulties)
- lexical-semantic (problems accessing vocabulary, extends to no storage of new vocabulary)
- progresses to abstract language
- comprehension of complex information
- verbal fluency (letter fluency > category)

unimpaired in mild to moderate stages:
- social conversation (attention, turn taking, topic maintenance)
- pragmatics
- reading
- writing
- pragmatics
- articulation/phonological/syntax
- discourse (stereotyped, automatic phrases increase)

not impaired:
- non-iteral information (emotions)
- social skills (eye gaze, non verbal skills, prosody)

35
Q

in late stages of AD, ? can become severely impaired

A

communication

36
Q

vascular dementia causes

A
  • hemorrhagic or ischemic stroke
  • cerebrovascular disorders related to hypertension, high cholesterol, diabetes, heart disease
37
Q

vascular dementia

A
  • sudden onset with fluctuations
  • physical difficulties associated with stroke
  • distinct pattern of fluctuating cognitive, psychiatric, and motor symptoms
38
Q

vascular dementia common comorbidities

A

depending on the area of atrophy:
- aphasia
- dysarthria
- other cognitive communication difficulties including executive functioning (reduced insight, apathy, delayed processing, reduced attention)

  • commonly present with Parkinsonism (rigidity, bradykinesia, tremor, and gait changes)
39
Q

lewy body dementia (LBD) cause

A
  • small proteins (Lewy Bodies) that deposit in the neuronal cell bodies
  • frontal and temporal lobes and basal ganglia
  • interfere with the acetylcholine and dopamine effect on the brain
40
Q

many people present with dual pathology of which two types of dementia

A
  • AD
  • LBD
41
Q

lewy body dementia cognitive communication

A
  • symptoms of Parkinsonism in speech (flat affect, dysphonia, hypophonia)
  • word finding difficulties
  • content of hallucinations may intrude conversations
42
Q

dementia in parkinson’s disease (cognitive communication)

A
  • early pragmatic difficulties (processing emotional meaning)
  • reduced memory and reasoning
  • more executive functioning than language impairment
  • more fluctuations and slower processing than people with AD
  • alongside speech deficits associated with PD
43
Q

dementia in Progressive Supranuclear Palsy (PSP) cognitive communication

A
  • primary cognitive impairment is executive impairment
  • apathetic and disinhibited due to poor self-monitoring
  • delayed processing and reduced memory
  • frontal lobe dysfunction
  • alongside speech deficits associated with PSP
44
Q

dementia in Huntington’s disease

A
  • hereditary progressive neurodegenerative disorder of the basal ganglia
  • general cognitive slowing
45
Q

dementia in Huntington’s disease cognitive communication

A
  • physical and emotional deficits impact communication
  • psychosocial impact
  • attention deficits
  • memory impairment (less severe than AD)
  • problem solving, memory skills, interpreting and perceiving facial expression difficulties
  • conversation management difficulties (initiation, topic maintenance, discourse structure and coherence, comprehension of abstract concepts)
46
Q

considerations for assessment in dementia associated with intellectual disability

A
  • cognitively and emotionally functioning at an earlier developmental level
  • difficulty in using standardized assessment procedures
  • lack of experience and education of health care professionals
  • communication difficulties
  • inability to self-report feelings/difficulties
  • physical problems overshadow other difficulties (mental health)
  • no routine screening assessment
  • frequent staff changes
  • medical and environmental considerations
47
Q

frontotemporal dementia (FTD) cause

A

atrophy in the frontal and temporal brain regions

48
Q

umbrella term for Primary Progressive Aphasia (PPA)

A

frontotemporal dementia

49
Q

2 types of FTD

A
  • progressive speech and language impairment
  • progressive changes in behavior
50
Q

frontotemporal dementia cognitive communication and behavior

A
  • personality or behavioral changes
  • high distractibility

impaired:
- social cognition
- participation in communication (severe)
- engaging with a communication partner (responding appropriately, turn taking, topic maintenance)
- interest in the environment
- organizing discourse
- self-monitoring
- prosody

51
Q

primary progressive aphasia refers to a …

A

clinical presentation not a pathological cause

52
Q

types of PPA

A
  • semantic PPA
  • non-fluent PPA
  • logopenic PPA
53
Q

primary progressive aphasia diagnostic requirements

A
  • language processes are affected first
  • no significant cognitive difficulties
  • must be no focal lesion that caused the language problem
  • onset is progressive
54
Q

non-fluent PPA language profile

A
  • similar to Broca’s aphasia
  • effortful, halting speech, agrammatism
  • speech sound errors and distortions
  • poor sentence construction, short phrases
  • letter fluency more impaired than in semantic PPA variant
  • comprehension may be spared at first
55
Q

semantic PPA language profile

A
  • selective impairment of semantic memory
  • naming and single word comprehension (severely impaired)
  • impaired object knowledge
  • surface dyslexia and dysgraphia
  • spared repetition and motor speech
  • worse category fluency than logopenic PPA variant
56
Q

logopenic PPA language profile

A

impaired:
- single-word retrieval
- repetition of sentences and phrases
- speech errors (in spontaneous speech and naming)
- worse letter fluency than category

not impaired:
- motor speech
- single-word comprehension

57
Q

non-fluent PPA clinical diagnosis requirements

A

1+
- agrammatism in speech
- effortful, halting speech with inconsistent speech sound errors and distortions (apraxic)

2+
- impaired comprehension of syntactically complex sentences
- spared single word knowledge
- spared object knowledge

58
Q

semantic PPA clinical diagnosis requirements

A

both
- impaired confrontation naming
- impaired single word comprehension

3+
- impaired object knowledge
- surface dyslexia or dysgraphia
- spared repetition
- spared speech production (motor speech and grammar)

59
Q

logopenic PPA clinical diagnosis requirements

A

both
- impaired single word retrieval in spontaneous speech and naming
- impaired repetition of sentences and phrases

3+
- speech (phonological) errors in spontaneous speech and naming
- spared single word comprehension and object knowledge
- spared motor speech
- absence of frank agrammatism

60
Q

factors to consider with FTD

A
  • younger onset (50s/60s)
  • average 7-10 year prognosis from diagnosis
  • usually quite distressing changes in communication, behavior, personality, and social cognition

Nature of Disorders of Language and Communication (9 decks)

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