Dementia & MCI Flashcards
1
Q
- Syndrome with cluster of symptoms
- Has different causes
- Is characterized by acquired, persistent impairment of multiple coginitive domains
- significantly alters communication, social interaction, occupational function and ability to perform instrumental activities of daily living
A
Dementia
2
Q
- A preclinical condition that may suggest a person is at risk for developing dementia
- a transition stage or condition of intermediate symptoms between cognitive changes associated with healthy aging and salient cognitive impairments seen in Alzheimer’s disease or other dementias
A
Mild Cognitive Impairment
3
Q
Two types of Mild Cognitive Impairment (MCI) are:
A
- Amnestic MCI - initially affects memory only
- Non-amnestic MCI - other cognitive functions are initially affected (e.g. language or executive functions)
4
Q
Diagnostic Critieria for MCI
A
- Self-report of memory proglems, with corroboration from a family member or caregiver.
- Measurable memory impairment on standardized testing, outside range expected for age and education-matched healthy older adults
- No impairments in reasoning, general thinking skills, or ability to perform activities of daily living (ADLs)
5
Q
4 Types of Dementia
A
- Alzheimer’s Disease (AD)
- Vascular Dementia (VaD)
- Dementia with Lewy Bodies (DLB)
- Frontotemporal Dementia (FTD)
“AL thought VaD knew LEWY at the FRONT”
6
Q
A
7
Q
Earliest symptoms of AD
A
- episodic memory deficits
- working memory deficits
- attention and executive function impairments
- language and communication impairments
- Lexical retrieval and discourse
8
Q
Causes of AD
A
- No single cause identified
- Risk factors:
- modifiable risk factors (nurture): diet, exercise controlled cardiovascular risk
- non-modifiable risk factures (nature): older age, positive family history, carrier status for the e4 allele of APOE gene
9
Q
Abilities in early Alzheimer’s Disease
(AD)
A
- Language & communication aspects affected earliest
- Lexical retrieval
- Discourse
- Abilities spared in early dementia
- Orientation to self and other persons
- Semantic memory
- ability to produce fluent sentences
- engage in conversation
- frequently follow 2-3 step commands
10
Q
Abilities in middle-stage AD
A
- Have ability to follow 1&2 step commands
- Can sustain attention for some time
- Can make relevant on topic statemetns or comments about tangible stimuli during conversation
11
Q
Abilities in later stage AD
A
- Can still attend to pleasant stimuli (e.g. music, sensory stimulation) for brief periods of time.
12
Q
- Second most common cause of dementia
- Affects Cortical (cerebrum) & subcortical (e.g. basal ganglia)
- Caused by ischemic or hemorrhagic cerebrovascular disease, cardiovascular disease, or circulatory disturbances that damage brain areas vital for cognitive functions
A
Vascular Dementia
13
Q
Causes & risk factors of Vascular Dementia
A
- Ischemic or hemorrhagic cerebrovascular disease
- cardiovascular disease
- circulatory disturbances that damage brain areas vital for cognitive function
- Risk factors:
- hypertension
- hypercholesterolemia
- Type II diabetes mellitus
- Prior history of stroke
- smoking
14
Q
- Dementia related to Parkinson’s Disease
- Shares pathological hallmark with PD of presence of Lewy Bodies
A
Dementia with Lewy Bodies
15
Q
When motor deficits precede cognitive impairment, it may be….
a. PD
b. DLB
A
Parkinson’s Disease (PD)
16
Q
When cognitive impairment precedes motor deficits, it may be..
- PD
- DLB
A
Dementia with Lewy Bodies (DLB)
17
Q
What are abnormal clumps of alpha-synuclein protein?
A
Lewy bodies
18
Q
Symptoms of DLB
A
- Persistent & complex visual hallucinations or other sensory hallucinations
- Visuospatial impairment
- Sleep disturbance
- Fluctuating attention and vigilance
- Gait imbalances or Parkinsonian movement features
- Reduced speech rate and fluency
- Executive function impairments-cognitive inflexibility
19
Q
- Accounts for 10% of dementia cases, most diagnosed before the age of 65 years
- Behavioral difficulties are usually presenting symptom
- Has variants
- Behavioral variant (bvFTD)
- Language variants (PPA)
- semantic variant (svPPA)
- nonfluent or agrammatic variant (nfvPPA)
- Logopenic variant (lvPPA)
- Motor variants that can occur with or without bvFTD and/or PPA
- ALS, CBS, PSP
A
Frontotemporal Dementia (FTD)
20
Q
SLP’s role in MCI/Dementia
A
SLP’s key role in
- screening,
- assessment
- diagnosis
- treatment
- research
of dementia based communication disorders
21
Q
- Mini-Mental State Examination (MMSE)
- Clock Drawing Test-CDT
- Montreal Cognitive Assessment (MoCA)
- Saint Louis University Mental Status (SLUMS) Exam
are examples of…
A
most widely used screening tools for cognitive impairment
22
Q
Assessment Considerations for Cognitive Impairment/Dementia
A
- review of prior & current medical history (e.g. comorbidities, medications)
- hearing impairment
- vision impairment
- speech/language/ communication
- depression
- global cognitive function
- mobility/balance impairments
23
Q
A
24
Q
Goals of assessment for cognitive impairment
A
- Identifying presence of cognitive communication disorder resulting from dementia or MCI
- Documenting impaired and spared cognitive-communicative abilities
- Establishing a baseline of cognitive-communicative functioning prior to the onset of intervention
- Assessing personal and environmental factors that influence a client or family
- providing information and resources about dementia or MCI and counseling family members about expected progression
- using dynamic assessment approaches or structured therapy trials to determine patient candidacy for particular interventions
25
* Repeatable Battery for the Assessment of Neuropsychological Status - RBANS
* Dementia Rating Scale (DRS-2)
* Cognitive Linguistic Quick Test (CLQT)
are examples of...
Measures to assess dementia across cognitive domains
26
* Communication Activities for Daily Living (CADL-3)
* Functional Linguistic Communication Inventory (FLCI)
* Rivermead Behavioral Memory Test (RBMT-3)
* Texas Functional Living Scale
are examples of..
same measures for functional assessment in select cognitive domains
27
* checklists
* rating scales
* e.g. 1 - observed emotion rating scale
* e.g. 2- environment and communication toolkit (ECAT) for dementia care
* Discourse Measures
* Behavior Tracking Tools
* Behavior logs, Observation tools
are all...
samples of other measures beyond standardized assessment
28
Differential diagnosis for types of dementia table
29
Types of Treatment for Dementia
* Medical
* Pharmacological
* Surgical
* Behavioral
* What we do! (SLPs)
2 types:
Direct - patients themselves undergo treatment
Indirect - training professional and personal caregivers, modifying environment, counseling family members, etc.
30
Core features of evidence-based treatments for persons with dementia
1. Repeated presentation of target information
2. Opportunities for learning-by-doing and for practice with generating target responses
3. Cognitive stimulation to activate experience-dependent neuroplasticity
4. Task formats that reduce likelihood of errors during initial learning and increase chance of early success
5. Ways to capitalize on relatively spared sustained attention
6. exposure to personally meaningul, tangible sensory stimuli
7. Structured cues to support information retrieval
8. opportunities for creative and symbolic activity (e.g. using art, music, gardening)
9. Experiences that offer community engagement, intergenerational programming, and sustained physcial activity.
31
What treatment is this?
* Significant published evidence
* Robust outcomes for dementia patients
* strong data from other clinical populations with language/memory impairments (e.g. TBI, aphasia)
* Fits nicely within SLPs cope of practice
* Can be used to recall:
* compensatory strategies (e.g. calendar, swallow strategy)
* Meaningful information (e.g. room number, face-name associations)
Spaced retrieval
32
What treatment is this?
* one of best validated strategies for maximizing verbal communication & retention of personal biographical information
* positive treatment outcomes when used by clinicians as well as personal and professional caregivers
* can be used to train
* improved recall of personal biographical information & independent initiation of conversation
* improved recall of compensatory techniques
* reduction in the frequency of undesirable behaviors
* improved communication between professional caregivers and persons with dementia
Memory books/wallets
33
What treatment is this?
* Montessori-based group activity, aimed at increasing positive engagement and verbal discussion
* structured reading & discussion activity that uses specifically developed stories, designed and adapted with ease of communicative access in mind for persons with dementia
* stories have a supportive sensory format (large font, high-contrast printing) and layout (e.g. single-sided printing), interesting facts, and accompanying questions to spark discussion.
* Capitalizes on spared oral reading skills in many with dementia
* Helps persons with dementia to:
* Stay on task (attention, working memory)
* have an opportunity for social engagement and interaction
* participate in conversation (turn-taking, listening, making on-topic statements)
* receive language stimulation through reading and reminiscence.
Reading Roundtable
