Dementia & MCI

Question 1

• 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

Answer 1

Dementia

Question 2

• 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

Answer 2

Mild Cognitive Impairment

Question 3

Two types of Mild Cognitive Impairment (MCI) are:

Answer 3

1. Amnestic MCI - initially affects memory only
2. Non-amnestic MCI - other cognitive functions are initially affected (e.g. language or executive functions)

Question 4

Diagnostic Critieria for MCI

Answer 4

1. Self-report of memory proglems, with corroboration from a family member or caregiver.
2. Measurable memory impairment on standardized testing, outside range expected for age and education-matched healthy older adults
3. No impairments in reasoning, general thinking skills, or ability to perform activities of daily living (ADLs)

Question 5

4 Types of Dementia

Answer 5

• Alzheimer’s Disease (AD)
• Vascular Dementia (VaD)
• Dementia with Lewy Bodies (DLB)
• Frontotemporal Dementia (FTD)

“AL thought VaD knew LEWY at the FRONT”

Question 7

Earliest symptoms of AD

Answer 7

• episodic memory deficits
• working memory deficits
• attention and executive function impairments
• language and communication impairments
  
  • Lexical retrieval and discourse

Question 8

Causes of AD

Answer 8

• 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

Question 9

Abilities in early Alzheimer’s Disease

(AD)

Answer 9

• 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

Question 10

Abilities in middle-stage AD

Answer 10

• 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

Question 11

Abilities in later stage AD

Answer 11

• Can still attend to pleasant stimuli (e.g. music, sensory stimulation) for brief periods of time.

Question 12

• 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

Answer 12

Vascular Dementia

Question 13

Causes & risk factors of Vascular Dementia

Answer 13

• 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

Question 14

• Dementia related to Parkinson’s Disease
• Shares pathological hallmark with PD of presence of Lewy Bodies

Answer 14

Dementia with Lewy Bodies

Question 15

When motor deficits precede cognitive impairment, it may be….

a. PD
b. DLB

Answer 15

Parkinson’s Disease (PD)

Question 16

When cognitive impairment precedes motor deficits, it may be..

1. PD
2. DLB

Answer 16

Dementia with Lewy Bodies (DLB)

Question 17

What are abnormal clumps of alpha-synuclein protein?

Answer 17

Lewy bodies

Question 18

Symptoms of DLB

Answer 18

• 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

Question 19

• 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

Answer 19

Frontotemporal Dementia (FTD)

Question 20

SLP’s role in MCI/Dementia

Answer 20

SLP’s key role in

• screening,
• assessment
• diagnosis
• treatment
• research

of dementia based communication disorders

Question 21

• Mini-Mental State Examination (MMSE)
• Clock Drawing Test-CDT
• Montreal Cognitive Assessment (MoCA)
• Saint Louis University Mental Status (SLUMS) Exam

are examples of…

Answer 21

most widely used screening tools for cognitive impairment

Question 22

Assessment Considerations for Cognitive Impairment/Dementia

Answer 22

• review of prior & current medical history (e.g. comorbidities, medications)
• hearing impairment
• vision impairment
• speech/language/ communication
• depression
• global cognitive function
• mobility/balance impairments

Question 24

Goals of assessment for cognitive impairment

Answer 24

• 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

Question 25

• Repeatable Battery for the Assessment of Neuropsychological Status - RBANS
• Dementia Rating Scale (DRS-2)
• Cognitive Linguistic Quick Test (CLQT)

are examples of…

Answer 25

Measures to assess dementia across cognitive domains

Question 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..

Answer 26

same measures for functional assessment in select cognitive domains

Question 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…

Answer 27

samples of other measures beyond standardized assessment

Question 28

Differential diagnosis for types of dementia table

Question 29

Types of Treatment for Dementia

Answer 29

• 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.

Question 30

Core features of evidence-based treatments for persons with dementia

Answer 30

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.

Question 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)

Answer 31

Spaced retrieval

Question 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

Answer 32

Memory books/wallets

Question 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.

Answer 33

Reading Roundtable