Dementia Flashcards
DSM-V dementia diagnostic criteria
- 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
5 cognitive domains
- learning and memory
- language
- complex attention
- perceptual-motor function
- social cognition
dementia definition
progressive loss of cognitive ability resulting in a loss of functional independence
what does dementia affect
- memory
- thinking
- orientation
- comprehension
- calculation
- learning capacity
- language
- judgement
main risk factor of dementia
age
Dementia Model of Care (2023)
- 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
is dementia over or underdiagnosed in Ireland
under
principles of the Dementia Model of Care (2023)
- citizenship
- person-centered approach
- integration
- personal outcome-focused
- timeliness
Dementia Diagnostic Model
- Level 1: assessment in primary care
- Level 2: assessment in memory assessment and support service
- Level 3: assessment in regional specialist memory clinic
role of SLT
- 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
cognitive communication changes in typical aging
- word retrieval difficulties
- decreased speed of information processing
- working memory function difficulties (small details of recent events, complex questions or instructions)
Working Memory Model
dementia treatment
- 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
DSM-V delirium diagnosis criteria
- 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
identifying delirium in acute care
- delirium v. dementia
- acute v. gradual
- fluctuating v. progressive
- delirium usually resolves once cause is treated
delirium v. dementia assessment
4A Test: screening instrument for cognitive impairment and delirium
mild cognitive impairment (MCI)
- also known as prodromal dementia
- modest cognitive decline in 1+ cognitive domain
- does not affect independence
what distinguishes MCI from dementia
lack of impact on daily functioning
does MCI cause dementia
- no
- can revert to normal cognition, remain stable, or improve over time
- associated with a higher risk of developing dementia in the future
MCI subclassifications
- amnestic MCI
- non-amnestic MCI
amnestic MCI
memory and learning difficulties
non-amnestic MCI
- difficulties with thinking skills aside from memory
- attention, executive ability, language, perception, social cognition, or a combination
communication changes in MCI
- impaired auditory comprehension
- verbal fluency deficits (semantic and phonemic)
- confrontation naming deficits (anomia and increased response time)
- discourse processing deficits (irrelevant information, pauses, repetition)
types of dementia
- 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
Alzheimer’s disease definition and hallmark symptom
a slowly progressive degenerative disorder characterized by memory loss
Alzheimer’s disease cause
- 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)
what are amyloid plaques
- aggregations of certain peptides
- activate inflammatory processes
- results in cell damage and death
most common cause of dementia
Alzheimer’s disease
primary feature of alzheimer’s
episodic memory loss
Alzheimer’s disease diagnostic tools
- lumbar puncture (examine CSF) for levels of amyloid and tau
- MRI-B
- PET
- Amyloid PET
2 atypical types of Alzheimer’s disease
- Posterior Cortical Atrophy (PCA)
- Logopenic Alzheimer’s disease
Posterior Cortical Atrophy (PCA) hallmark
predominant visual disturbance
Logopenic AD hallmark
predominant language difficulties
cognitive communication in AD (impairments, unimpaired in mild to moderate stages, and not impaired)
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)
in late stages of AD, ? can become severely impaired
communication
vascular dementia causes
- hemorrhagic or ischemic stroke
- cerebrovascular disorders related to hypertension, high cholesterol, diabetes, heart disease
vascular dementia
- sudden onset with fluctuations
- physical difficulties associated with stroke
- distinct pattern of fluctuating cognitive, psychiatric, and motor symptoms
vascular dementia common comorbidities
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)
lewy body dementia (LBD) cause
- 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
many people present with dual pathology of which two types of dementia
- AD
- LBD
lewy body dementia cognitive communication
- symptoms of Parkinsonism in speech (flat affect, dysphonia, hypophonia)
- word finding difficulties
- content of hallucinations may intrude conversations
dementia in parkinson’s disease (cognitive communication)
- 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
dementia in Progressive Supranuclear Palsy (PSP) cognitive communication
- 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
dementia in Huntington’s disease
- hereditary progressive neurodegenerative disorder of the basal ganglia
- general cognitive slowing
dementia in Huntington’s disease cognitive communication
- 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)
considerations for assessment in dementia associated with intellectual disability
- 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
frontotemporal dementia (FTD) cause
atrophy in the frontal and temporal brain regions
umbrella term for Primary Progressive Aphasia (PPA)
frontotemporal dementia
2 types of FTD
- progressive speech and language impairment
- progressive changes in behavior
frontotemporal dementia cognitive communication and behavior
- 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
primary progressive aphasia refers to a …
clinical presentation not a pathological cause
types of PPA
- semantic PPA
- non-fluent PPA
- logopenic PPA
primary progressive aphasia diagnostic requirements
- language processes are affected first
- no significant cognitive difficulties
- must be no focal lesion that caused the language problem
- onset is progressive
non-fluent PPA language profile
- 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
semantic PPA language profile
- 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
logopenic PPA language profile
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
non-fluent PPA clinical diagnosis requirements
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
semantic PPA clinical diagnosis requirements
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)
logopenic PPA clinical diagnosis requirements
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
factors to consider with FTD
- younger onset (50s/60s)
- average 7-10 year prognosis from diagnosis
- usually quite distressing changes in communication, behavior, personality, and social cognition
