Exam 2: Alzheimer's Presentation Flashcards
Anatomical & Physiological Changes
Neurological Level
-Neurodegenerative: Neuron-loss
-Hallmarks of AD, Amyloid-beta (Aβ) and Tau [1]
-Plaques and tangles
-Interferes with neuron function
-As neurons die, the brain atrophies
-Gyri narrow, sulci widen, ventricles enlarge
Etiology
● Underlying cause of AD is still unknown, and there is no one accepted theory
● Several hypotheses proposed, but two are
mainly accepted
1. Cholinergic
2. Amyloid (most popular)
● Several risk factors: increasing age, genetic
factors, head injuries, vascular diseases,
infections, environmental factors, life-style
Etiology Continued.
Amyloid: most accepted theory
➔ Alteration in amyloid
production/processing
➔ Degradation of
amyloid plaques leads
to neuronal cell death
and
neurodegeneration
Cholinergic: impairment in function
➔ Relating to or denoting
nerve cells in which
acetylcholine acts as a
neurotransmitter
➔ Failure of our brain to
synthesize Acetylcholine
(ACh), which is essential for
cognitive function (memory,
attention, sensory info,
learning)
➔ Reduced presynaptic
cholinergic markers in the
cerebral cortex, severe
neurodegeneration of
nucleus basalis of Meynert
(NBM) in basal forebrain
Risk Factors:
● Aging
- Reduction in brain volume/weight, loss of
synapses, ventricles’ enlargement; glucose
hypometabolism, cholesterol dyshomeostasis,
mitochondrial dysfunction, depression
● Genetics: 70% of cases
- Mutations in dominant genes
- Mutation in variations of ApoE gene increases
AD risk in women compared to men
● Environmental factors
- Air pollution, diet, metals, infections to the CNS
● Medical factors
- Cardiovascular disease, obesity, diabetes
Characteristics of AD: 10 Signs
- Memory loss the disrupts daily living
- Challenges in making plans or solving problems
- Difficulty completing familiar tasks
- Confusion with time and/or place
- Trouble with understanding visual images and relationships
- New problems with words in speaking or writing
- Misplacing things and losing the ability to retrace steps
- Decreased or poor judgment
- Withdrawal from work or social activities
- Changes in mood and personality
Characteristics of AD: Stages
Preclinical, Mild (Early), Moderate, Severe
Characteristics of AD: The 5 A’s of Alzheimer’s
● Amnesia→ the most common sign of Alzheimer’s disease,
refers to loss of memory.
● Aphasia→ loss of ability to express or understand speech, has
two forms: expressive and receptive. Expressive aphasia occurs
when someone can’t find the right words or may say them
incorrectly. Receptive aphasia indicates an inability to understand,
receive and interpret language.
● Apraxia→ represents a loss in voluntary motor skills, eventually
preventing the body from physically functioning.
● Agnosia→ occurs when the five senses can’t receive or
correctly process information.
● Anomia→ loss of ability to identify names of everyday objects
Characteristics of AD: Dysphagia
● Persons with AD experience a high occurrence of dysphagia, estimates vary
from 32%-84%
● Dysphagia can result in social isolation and decreased quality of life
● Can lead to malnutrition, dehydration, pneumonia, and mortality
● Dysphagia related aspiration pneumonia is the most common cause of
mortality for those with AD
● Common at the end of life in AD Patients, but swallowing changes have been
found to begin before they are seen as clinical symptoms
● Early involvement of an SLP and regular evaluations for dysphagia are crucial
Assessment of speech/language/cognition and swallowing:
Assessments measure
● Production
● Comprehension
● Repetition
● Cognitive function
● Functional communication
Speech-language pathologists must gather information on their client’s medical history, their personal history, the support they receive
from family and/or caregivers, and the level at which they are functioning.
Questionnaires and/or interviews will give the clinician information about the client’s medical and personal history.
The Arizona Battery for Communication Disorders of Dementia (ABCD)
● Standardized assessment
● Comprehensive language battery
● Five domains
○ Mental status
○ Episodic memory
○ Linguistic expression
○ Linguistic comprehension
○ Visuospatial construction
● 14 subtests assessing language modalities and visuospatial skills
● Strengths and weaknesses of language
● Appropriate for individuals with mild to moderate forms of Alzheimer’s Disease
● 45-60 minutes to administer
Assessments Continued
Communication Activities of Daily Living-Second Edition (CADL-2)
● Standardized assessment
● Verbal and nonverbal skills are assessed in regard to functional communication
American Speech-Language-Hearing Association Functional Assessment of Communication Skills for Adults (ASHA FACS)
● Functional communication assessment
● Four domains
○ Social communication
○ Communication of basic needs
○Reading/writing/number concepts
○ Daily Planning
Addenbrooke’s Cognitive Examination (ACE-III)
● Cognitive screening battery
● 18 subtests
● Five domains: memory, attention/orientation, language, fuency and visuospatial skills
● Assesses the modalities of language
● 15 minutes to administer
Treatment
● Unfortunately, there is no single cure for Alzheimer’s Disease. However, research does show there are treatments
that may assist in changing the progression.
● Treatment for the patient and their family should start with understanding available options to help cope with the
effects of Alzheimer’s and to improve the individual’s quality of life
Tailoring a Treatment Plan
● SLP must consider
○ Patient’s current level of functioning
○ Family and caregiver support dynamic
○ Stage of dementia
○ Level of independence
● This can all be completed through formal and informal research measures of assessments and by gathering
information from the patient and family’s perspectives (case intake)
Treatment Method 1 : Spaced Retrieval Training
● Targets the patient’s cognitive linguistic deficits pertaining to the patient’s stages of Alzheimer’s.
Essentially supporting individuals with their memory loss
● How method works = Patient repeats the stimulus at increasing time intervals to facilitate learning
(Korytkowska & Obler, 2016).
● This supports the learning of new information by having the individual repeat target information over
expanding intervals
○ → 10 seconds → 20 seconds → 30 seconds → 1 minute → 2 minutes → 4 minutes etc.
■ Identity their needs or desires
■ Develop the lead question : “When should you take your medication?”
■ Formulate the response : “In the morning
● Correct response : increase the time interval to ask the patient the repeated question … passes 2
minutes add other activities while waiting to engage and enhance their cognitive abilities (card games )
○ If patient successfully answers 3 consecutives times it is considered learned yet additional booster
practice may be necessary
● Incorrect response : do not say “that is wrong” lead the client to the correct response and use visual
cues to assist with memory retrieval and try the process again
○ When client is not targeting the right response, SLP can reformulate the lead question and try again
another time
Treatment Method 2 : Memory Aids/Memory Books
● Method is used to train memory, improving quality of individuals life
and their cognitive health
● Created by the SLP with the help of the patient and family members
input
■ Memory books contain many areas of information about the
patient including : personal information, favored memories,
activities of daily living schedule, safety strategies, etc.
■ Found to be a useful tool, improving individual memory recall,
speaking abilities, promotes independence, and increases
meaningful interaction with the patient, family, and the
clinical support team
Treatment Method 3 : Music Therapy
● Strategy that utilizes music to address the physical, emotional, cognitive, and social needs of the
patient.
○ The SLP or trained therapist creates a personalized playlist for the client including active and
receptive techniques, such as improvisation, singing, dancing, where the client listens to
music with the intent of identifying an emotional content
● Music therapy allows for the stimulation and use of individual’s cognitive abilities
○ Stimulating memories, verbalization, and encourages comfortability.
● Shown to improve categorical word fluency, autobiographical memory, and self expression
providing sense of socialization for patients who may feel isolated (Bleibel et al., 2023).
○ Musical training helps alleviate the effects of age-related cognitive impairments, creating a
positive stimulus that engages patients
● Advantages of treatment :
○ Noninvasive approach to treatment
○ Lack of side effects
○ Ability to address multiple symptoms of Alzheimer’s
○ Cost effectiveness and ease of implementation
● Disadvantages of treatment :
○ Usefulness of musical therapy training may be limited to only certain patients as it may not
be suitable for every patient with Alzheimer’s pertaining to their stage
○ Limited access to trained therapists who are knowledgeable to this form of therapy
