Lecture 1 Flashcards
How is language affected during normal aging?
Language abilities are well preserved, vocabulary may increase BUT retrieval declines.
Richer narrative BUT decreased active naming
How does normal aging affect abilities that aren’t language?
Slower processing
Decreased ability to switch attention
LT memory declines, WM declines less
Decrease in abstraction and mental flexibiility
Decline in visuo-spatial skills
Presbyopia and presbycusis
Preserved crystallized intelligence but decreased fluid intelligence
Stable verbal IQ but decline in performance IQ
Define Dementia:
Dementia is a loss of mental function. Dementia is an acquired persistent impairment in multiple areas of intellectual function. Deficits beyond MCI.
Define Mild Cognitive Impairment (MCI):
Greater than age-expected cognitive decline, but not significant enough to result in marked loss of functional independence. 80% go on to develop Dementia.
List the two classes of Mild Cognitive Impairment (MCI)
Amnestic MCI (single or multiple domain) Non-Amnestic MCI (single or multiple domain)
List the 4 requirements for a diagnosis of Mild Cognitive Impairment:
- self or informant report of cognitive complaint
- objective cognitive impairment on testing
- Generally intact functional abilities
- Not dementia
Dementia involves cognitive/ behavioural symptoms that :
- interferes with the ability to function
- decline from previous levels of functioning and performance
- Not explained by delirium or a psychiatric disorder
- Diagnosed through a) history-taking b) cognitive assessment
- Impairment in at least two of following domains: Memory, Reasoning and Judgment, Visuo-spatial function, Language, Personality/ behaviour
T or F: There is a 45% greater risk of developing dementia if you smoke
True
___ of those diagnosed with dementia over the age of 65 are women.
65%
Over 50% of dementia cases are caused by _______
Alzheimer’s disease
____ of dementia is caused by vascular disease
15%
____ of dementia is caused by Lewy body disease
15%
____ of dementia is caused by Frontotemporal disorders
10%
What is the criteria for Alzheimer’s Disease Dementia?
- Criteria for all cause dementia
- Insidious onset
- No evidence of: comcommitant CV disease, Lewy bodies, fronto-temporal dementia, PPA, concurrent neurologial disease or medication
What is the only sure way to diagnose dementia?
Autopsy
Autopsy in a person with Alzheimer’s Disease would reveal:
severe atrophy, cortical cell loss, amyloid plaques and neurofibrillary tangles
What is the average age of onset of AD?
65yo
T or F: AD is twice as common in men as in women
False - twice as common in women as in men
The duration of AD is on average ____ with a range of _____
on average 6-12 years
range of 1-20 years
Describe the language impairment in AD:
Naming difficulties, paraphasias, impaired comprehension
List the ways of diagnosing Dementia:
- Autopsy
- Lab Tests (B12, Thyroxine lvl)
- Brain Imaging (can sometimes be normal even with clinical diagnosis)
- Family History
- Physical Examination (look for other events)
- Pharmacological assessment (not med mixtures)
- Neurological examination
- Neuropsychology
- SLP
AD tissue has fewer _______ than a healthy brain. This is due to
________ build up between nerve cells and _________ made up of twisted strands of protein.
nerve cells
Amyloid plaque
neurofibrillary tangles
A healthy brain has a volume of 1200-1500cm^3. A brain with advanced alzheimer’s has a brain volume of _______cm^3.
less than 1000cm^3
Brain scans of patients with Alzheimer’s disease show reduced activation of the entire brain but especially in ________ areas
temporo-parietal
Which 3 chromosomes are proposed to be involved with Alzheimer’s?
14, 19, 21
List the 7 proposed causative mechanisms for AD:
Cerebrovascular amyloidosis Aluminum Head trauma Acute phase reactants Decreased metabolism Atypical Virus-like Agents Chromosome 14, 21, 19
What is the first type of memory impaired in AD?
Episodic
Describe the oral language of someone in AD Stage 1:
- Word finding difficulties
- “Empty speech”
- Semantic naming errors
- Sentence fragments
- Repetition
Describe the comprehension of someone in AD Stage 1:
- Trouble following directions
- Decrease in receptive vocabulary
- Trouble understanding jokes
Describe the oral language of someone in AD Stage 2:
- Obvious Anomia
- Slower speech
- Fewer nouns than verbs
- Difficulty defining words and repeating phrases
Describe the comprehension of someone in AD Stage 2:
- Diminished Comp.
- Loss of receptive vocab
- Degradation of conceptual knowledge
- Interpret non-literal language literally
- Poor sensitivity to context
Describe the oral language of someone in AD Stage 3:
- Form of language intact
- Meaning greatly reduced
- Jargon
- Range from mute to able to contribute to conversation
Describe the comprehension of someone in AD Stage 3:
- Auditory and reading comprehension severely impaired
List the markers of AD in Written Language:
Decrease in Vocab size Increase in lexical rep. Decrease in word specificity Fewer nouns and increase in verbs Increase in fillers Less complexity Decrease in passive voice "Get" used over "be"
_______ is a group of various dementing disorders due to cerebrovascular insufficiency.
Vascular Cognitive impairment
Vascular Cognitive Impairment is the ______ most common dementia disease and accounts for _____%
second
10-30%
T or F: Vascular Cognitive Impairment is more common in men
True
T or F: Vascular Cognitive Impairment can occur after a stroke
True - 25-30% of VCI
Language in VCI dementia will depend on the lesion location, but generally includes:
- Expressive impairments more noticeable than receptive difficulties
- Phonemic paraphasias more often than semantic
- Comp. of complex syntax may be impaired
- Dysarthric/ dysprosodic speech
- Phonemic fluency worse than semantic fluency
How do you assess phonemic fluency? Semantic fluency?
Phonemic fluency = name words that start with “f”, “a”, “s”
Semantic fluency = name as many animals as you can
Jacob-Creutzfeldt Disease is also known as . . .
Viral dementia
Describe Jacob-Creutzfeldt Disease:
- Neuropathologic changes in cortical, pyramidal and extrapyramidal systems
- Rapid progression
- Dementia develops in weeks
- Cortical and subcortical features present
- Prominent dysarthria and aphasia in midstages
- Mutism in late stages
Parkinsons disease and Huntington’s disease is a _______ dementia with _______ extrapyramidal features
subcortical
extrapyramidal
Describe Parkinson’s Disease dementia:
- Lack of initiation
- Unsuccessful problem solving
- Impaired memory
- poor visuospatial skills
- impaired set shifting
- Poor math skills
- reduced rate of processing
Describe Speech and language features of Parkinson’s Dementia
- No aphasia
- Poor word list generation
- Hypokinetic Dysarthria (first symptom)
- Depression may affect performance
T or F: All people with Parkinson’s Disease have dementia
False- only 18-40%
Describe Huntington’s Disease:
- Personality changes
- Chorea (affecting lip, tongue and diaphragm)
- Mental slowing
- Early memory impairments
- Impaired judgement and concentration
Describe speech and language features of Huntington’s Disease:
- No aphasia
- Poor word list generation (first measure)
- Hyperkinetic dysarthria, Mutism in final stage
- Failure on language tests requiring organization, sequencing and elaboration
Describe Hydrocephalic Dementia:
- Unsteady gait
- Cognitive Impairment
- Incontinence
- Great variation in severity of symptoms
- Pts are quiet, withdrawn, slow to respond, occasionally anxious or aggressive
- Language is similar to FTDbv
- Need to be engaged and stimulated to talk
Describe Pseudodementia:
Dementia caused by depression
- Memory impairments
- Slowness of responses
- Forgetfulness
- Disorientation
- Impaired attention and concentration
- Impaired abstract thinking
- Omission of details on drawing tasks
Describe speech and language features of Pseudodementia:
- freq. I don’t know responses
- Difficulty generating word lists
- Impaired comprehension of complex material
- Slow hypophonic speech
- Increased pause time in convo.
- No cortical signs
Describe Lewy Body Dementia:
- Fluctuating, alertness and cognition
- Recurrent visual hallucinations
- Spells of fainting or falling
- Disturbed sleep cycle
- Parkinson’s disease symptoms ( slowness, muscle stiffness, trembling, shuffling)
- Language pattern resemble that of AD with Parkinson like speech (hypokinetic dysarthria)
