Dementia and Language Flashcards
———————— is a syndrome characterized by the deterioration of intellectual and memory functions. All types are a results of —————————————— and the loss of communication between —————- caused by generalized atrophy of the brain.
Dementia is a syndrome characterized by the deterioration of intellectual and memory functions. All types are a results of neural death and the loss of communication between neurons caused by generalized atrophy of the brain.
Symptoms of dementia include:
- Loss of judgment and reasoning
- Changes in mood, behavior and communication abilities. Changes might interfere with the social and personal life of the affected individual.
- Problems with executive functions
- Changes in Language performance → Allows us to examine relationship between language and cognition
We divide dementias into ————– (the most common is Alzheimer’s) and ———— (the most common is Parkinson’s) dementias.
cortical and subcortical
A daughter comes with her mother and complains that her mother has difficulties finding the right word, constantly repeats the same story and often doesn’t know where she is or she confuses her surroundings. She also recently bought a very expensive car even tough she cannot drive any longer due to poor eyesight. Her daugther also explains that her mother often forgets doctor’s appointments, taking pills and recently she forgot the name of both grandchildren.
What disease is described in the passage? What is it caused by? What is the characteristic progression of this disease?
Alzheimer’s. The disease was first identified by Alois Alzheimer in 1906. He discovered diffused atrophy (enlarged ventricles, atrophy in language areas and cortical strucutres), and also plaques and tangles. With neurofibrilary tangles, they deteriorated, became twisted in the brain cell. They interfere with vital processes, eventually “choking” off the living cells. Amiloid plaques are tiny dense protein deposits scattered throughout the brain which become toxic to brain cells. We all have these proteins in the brain, but the number increases in AD. We can only definitively diagnose Alzhemier’s in autopsy (90 - 95% accurate diagnosis). A better way to talk about the disease is to talk about probably Alzheimer’s disease.
disease.
While memory is the main symptoms, most patients show language changes early in the course of the disease. Some domains get affected very early and can serve diagnostic purposes. AD has three stages: 1) mild 2) moderate 3) severe.
An Alzheimer’s patient comes. They are talking to you about chores:
*“No for goodness sake. What is you doing? Coming home from a story or playing? My parents is has a present for you…Ah, your parents has the house cleaning, Timmy. We, we, no. Running out at three, then, the car, wash, they, uh, fill, four, happy everyone, then can come back again.” *
What are some symptoms you notice?
→ lacking in cohesion, over-frequent topic shifts, repetitive & fairly empty of content.
How are nouns affected in Alzheimer’s disease? What evidence supports this?
At first, they thought patients switched biological objects (saying cat for dog) worse than non-biological ones (chair for table). However, a study by Zanino et. al also took into acount semantic distance (an index referring to the degree of semantic similarity between concepts). What they discovered was that non-living things had a greater semantic distance and this was the mediating factor between the living vs. non-living entities difference. As such, nouns are affected due to a processing problem and not a representation problem.
How is naming affected in patients with Alzheimer’s disease?
In AD patients, both spontaneous and cued (with hints, in non-pathological memory loss, you tell them B, and they know) naming are impaired. Additional impairments are:
Semantic superordinate (fruit-orange) and associative errors (juicy -orange) are present,
Over time, they make more semantic and visually-based errors
In order to tell something is a water bottle you need the perceptual stage (analysis of structural features) → semantic stage (visual percept accesses semantic knowledge) → lexical stage (phonological form accessed) → articulatory stage. Initially, anomia is due to breakdown in semantic memory (cues do not benefit them: if you tell them B, it doesn’t help to recall bottle). Later, perceptual problems also contribute.
Compare the language of someone with Alzheimer’s disease and someone with Wernicke’s aphasia
AD:
* low-frequency closed-class words
* in tasks describing actions or use of objects, dont respond,respond irrelevatly or perservate
* difficulties in communication centred on conversational skills and discourse
WA:
* avoidance of low-frequency closed-class words
* in tasks describing actions or use of objects, more likely to produce phonemic paraphasias or neologisms
* difficulties in communication centred on grammatical/lexical abilities
What language specific symptoms may occur in patients with Parkinson’s disease?
- hypophonia: soft, monotonous, poorly-intelligible speech,
- restricted pitch range,
- affected prosody (pitch, stress, timing, intensity, emotional aspects of speech)
- relevant and appropriate content, however syntactically simple
- impairments in sentence processing (comprehension)
- explicit cues (surface markers for passive voice, e.g.) and comprehension
- use of rules in comprehension BUT difficulty in producing rule-based past tense (look - looked). the problem is at the lexical level, inflectional morphology. there are no difficulties production of irregular past tense (go - went). their damage in basal ganglia creates damage in procedural memory, implicit processes (creating the past tense follows rules), errors with inflectional endings
- recognizing words, facts, events remains relatively unimpaired
- impairments in naming
Name the likely cause of symptoms
A patient presents with the following symptoms:
* Motor problems (tremor, hypertonia)
* hypophonia: soft, monotonous, poorly-intelligible speech,
* relevant and appropriate content, however syntactically simple
* affected prosody (pitch, stress, timing, intensity, emotional aspects of speech)
* impairments in naming
* difficulty in producing rule-based past tense (look - looked) but no difficulties in producing irregular past tense
Parkinson’s disease
A person with Parkinson’s disease is asked to produce the past tense for look and for bring. When asked, they state the past tense for bring without difficulty but struggle to produce the same for look. What is the reason for this?
Their damage in the basal ganglia creates damage in procedural memory, implicit processes (creating the past tense follows rules), errors with inflectional endings
A 40 year old woman has been having issues with different areas of language for over two years. Her wife says that she has been having great problems with naming things and keeping on topic. She also explains her wife has lost interest in socializing and if they do go to a social event, she has difficulties following conversation. Lately, she has been making spelling errors and becoming more and more forgetful, which has had a very negative impact on her job performance.
What is the likely cause of her symptoms? What are the subtypes of this disease? Which other can be attributed to this disease?
This is likely primary progressive aphaisa. Symptoms vary but mainly a patient must have only language related problems for at least two years. The disease is progressive and impairments often remain language specific for over a decade. Usually, the person initially has poor naming, comprehension difficulties, some trouble with articulation (which get worse), semantic or phonetic paraphasia, reduced ability to comprehend speech, …
There are three subtypes:
* PPA-G (PPA with agrammatism): non-fluent production
* PPA-L (PPA with logopenia): fluent production
* PPA-S (PPA with semantic deficit): fluent production
Patient H.S. was experiencing difficulties in finding words and was generally becoming more and more forgetful. An examiner asked him when his problem started. H.S.’s answer was fluent and grammatical but full of repetitions and empty of content. Five years after onset, he reacted to his wife selling their car in the following way:
“You must have known, partly we were faultless, partly still faultless. You must know, we go partly down there still faultlessly, right. You know, can you still remember? We really still go faultlessly down there. Don’t you know? We could, right?”
11 years after onset, H.S. became mute, swallowed inedible items, became incontitent and had increasing visual problems.
What disease does patient H.S. suffer from? What are some common symptoms?
Semantic dementia (in U.S. semantic variant of PPA). Symptoms include:
* Word finding difficulties,
* Fluent aphasia,
* Anomia,
* Impaired comprehension of word meaning
* Inability to match semantically-related pictures or objects
* Some behavioral symptoms
” “Neuropathological analysis revealed severe cortical atrophy, mainly of the anterior parts of the temporal lobes [bilaterally], with only minor involvement of the posterior parts and the frontal cortex … swollen neurons were infrequent; … the number of neurofibrillary tangles and senile plaques was in the normal age-related range.”
This autopsy finding is describing:
A) Alzheimer’s
B) Parkinson’s
C) PPA - L (PPa with logopenia)
D) PPA-S (PPA with semantic deficit)
” “Neuropathological analysis revealed severe cortical atrophy, mainly of the anterior parts of the temporal lobes [bilaterally], with only minor involvement of the posterior parts and the frontal cortex … swollen neurons were infrequent; … the number of neurofibrillary tangles and senile plaques was in the normal age-related range.”
This autopsy finding is describing:
A) Alzheimer’s
B) Parkinson’s
C) PPA - L (PPa with logopenia)
D) PPA-S (PPA with semantic deficit) /semantic dementia
Compare cortical and subcortical dementia in regard to speech, language, memory, cogniton, visuospatial function and affect.
-
Speech
Cortical: normal
Subcortical: hypopohonia, dysarthia, mutism -
Cognition
Cortical: aphasic
Subcortical: normal -
Memory
Cortical: forgetfulness
Subcortical: easily distracted -
Cognition
Cortical:Reduced judgement, calculation and abstraction
Subcortical: slowing -
Visuospatial function
Cortical:Recognition problems (agnosia)
Subcortical: Reduced recognition problems (no agnosia) -
Affect
Cortical: indifference
Subcortical: apathy
