Quiz 3 Flashcards
Dementia is characterized by acquired, persistent impairment of multiple cognitive domains that significantly alters _______, social interaction, occupational function, and the ability to perform ______ activities of daily living.
communication; instrumental
What is the preclinical condition that may suggest a person is at risk for developing dementia?
Mild cognitive impairment (MCI)
Mild cognitive impairment is a ______ stage or condition of intermediate symptoms b/w the cognitive changes associated with healthy aging and the salient cognitive impairments seen in Alzheimer’s disease or other dementias.
transition
What are the two types of mild cognitive impairment?
Amnestic MCI
Non-amnestic MCI
What type of MCI affects memory only?
amnestic
Other cognitive functions are initially affected (e.g., language or executive function) is what type of MCI?
non-amnestic
What is the diagnostic criteria for MCI?
- Self-report of memory problems
- measurable memory impairment on standardized test
- No impairments in reasoning, general thinking skills, or ability to perform activities of daily living.
List the 4 types of dementia.
Alzheimer’s Disease
Vascular Dementia
Dementia with Lewy Bodies
Frontotemporal Dementia
Episodic memory deficits
Working memory deficits
Attention and executive function impairments
language and communication impairments
Are all the earliest symptoms of what type of dementia?
Alzheimer’s disease (AD)
List some modifiable risk factors of AD
diet, exercise, controlled cardiovascular risk
List some NON-modifiable risk factors of AD
older age, positive family history, carrier status for the e4 allele of APOE gene
What language and communication aspects are affected earliest in AD?
lexical retrieval
discourse
What abilities are spared in early dementia?
Orientation to self and to other persons Semantic memory Ability to produce fluent sentences Engage in conversation Frequently follow 2-step to 3-step commands
These are all abilities in what stage of AD?
ability to follow 1-2 step commands
can sustain attention for some time
can make relevant on topic statements or comments about tangible stimuli during conversation
middle-stage
What abilities are present in later-stage AD?
attend to pleasant stimuli (e.g., music, sensory stimulation) for brief periods of time
Vascular dementia is most commonly caused by ischemic or hemorrhagic cerebrovascular disease, ________ disease, or _______ disturbances that damage brain areas vital for cognitive function
cardiovascular; circulatory
What are risk factors associated with vascular dementia?
hypertension hypercholesterolemia (high cholesterol) Type II diabetes mellitus prior history of stroke smoking
Vascular is the _____ most common cause of dementia. (first, second, third)
second
Which type of dementia is related to Parkinson’s Disease? (most commonly diagnosed after age 65)
Dementia with Lewy Bodies (DLB)
What are Lewy Bodies?
abnormal clumps of alpha-synuclein protein
When motor deficits precede cognitive impairment, it may be _________?
Parkinson’s disease
When cognitive impairment precedes motor deficits, it may be _________?
Dementia with Lewy Bodies
The following symptoms are associated to which type of dementia? hallucinations visuospatial impairment sleep disturbance fluctuating attention and vigilance gain imbalances reduced speech rate and fluency executive function impairments
Dementia with Lewy Bodies
Frontotemporal Dementia accounts for 10% of dementia cases, most are diagnosed ______ the age of 65.
before
What is a nonspecific term that describes a disease or disorder of the brain?
Encephalopathy
What alters the brains functions and / or structure of the left and right hemispheres?
Encephalopathy
A higher percentage of geriatrics have what?
Encephalopathy
Approximately what percent of those with encephalopathy are in surgical ICU’s?
20-30%
What are presenting features of encephalopathy? Mark all that apply.
A. Acute change in mental state
B. Change in personality, behavior, and in cognitive functioning
C. Altered level of alertness
D. Inattentiveness, Lethargy, and Distractibility
E. All of the above
E. All of the above
Examples of encephalopathy etiologies include •Infection (bacterial, viral) •Dehydration, poor nutrition •Metabolic deficiency •Hypoglycemia •Diabetic ketoacidosis •Drug intoxication •Anoxia •Uremia •Meningitis •\_\_\_\_\_\_ \_\_\_\_\_\_\_\_
Brain Tumors
Right Hemisphere Brain Damage:
Characteristics include both: _____ and ______ deficits
Cognitive; Communication
Right Hemisphere Brain Damage: Cognitive deficits- (AEA) 1. 2. 3.
Attention
Executive function
Awareness of deficits (anosognosia)
Right Hemisphere Brain Damage: Communication deficits- (PCPP) 1. 2. 3. 4.
Prosody (aprosodia)
Comprehension
Production
Pragmatics
Right Hemisphere Brain Damage: Attention difficulty with- (SAUS) 1. 2. 3. 4.
Sustained
Alternating
Unilateral neglect
Selective
Right Hemisphere Brain Damage:
Unilateral neglect is ____ a visual deficit
NOT
Right Hemisphere Brain Damage:
Unilateral neglect can occur following damage to _____ henisphere.
Either
Right Hemisphere Brain Damage:
Types of neglect:
1.
2.
Left (due to RHD)
Right (due to LHD)
Right Hemisphere Brain Damage:
Types of neglect-
____ neglect is most common, more severe, and lasts longer. ____ neglect is less common, less severe, and resolves more quickly.
Left
Right
Right Hemisphere Brain Damage: Types of neglect- Can affect various modalities: (MAT) 1. 2. 3.
- Motor
- Auditory
- Tactile
Right Hemisphere Brain Damage:
Types of neglect-
______ (UVN) affects one’s ability to attend to visual information from the left visual field or left side of an object
Unilateral visuospatial
Right Hemisphere Brain Damage: Types of Unilateral Neglect- 1. 2. 3.
Viewer centered
Object centered
Combinaiton
Right Hemisphere Brain Damage: Region of space- \_\_\_\_\_\_ space: one's own body \_\_-\_\_\_\_ space: within reaching distance \_\_\_\_-\_\_\_\_ space: beyond arm's reach
Personal
Peri-personal
Extra-personal
Right Hemisphere Brain Damage:
Neglect & Language-
Can affect _____ & _____.
Reading; writing
Right Hemisphere Brain Damage:
Neglect dyslexia: omit, substitute letters on the ____ side of words/sentences
left
Right Hemisphere Brain Damage:
Neglect dysgraphia: begin ____ in the middle or on the right side of the page.
writing
Right Hemisphere Brain Damage:
Executive Function deficits caused by ___ are well-documented. data specific to RHD vs stroke is ____.
Stroke; limited
Right Hemisphere Brain Damage:
Awareness-
_______- reduced awareness of deficits, often a hallmark of RHD.
Anosognosia
Right Hemisphere Brain Damage: Patients may be unaware of: (UPCC) 1. 2. 3. 4.
Unilateral neglect physical deficits (hemiparesis) communication deficits consequences of deficits
Right Hemisphere Brain Damage: Outcomes of anosognosia: 1. \_\_\_\_ participation 2. Longer \_\_\_\_\_ 3. \_\_\_\_\_ functional status upon discharge 4. \_\_\_\_\_ outcomes with employment 5. Greater \_\_\_\_ on caregivers.
Poorer Treatment Poorer Poorer Stress
Right Hemisphere Brain Damage: Prosody- 1. Linguistic: \_\_\_\_ and Grammatical 2. \_\_\_\_: conveys mood or emotion 3. Indexical: idiosyncratic speech \_\_\_\_\_
Pragmatic
Affective
Patterns
Right Hemisphere Brain Damage:
Prosody-
_____ reduced use of pitch, duration, loudness, and pause time to convey or interpret meaning
Aprosodia
Right Hemisphere Brain Damage: Comprehension- Types of non-literal language: 1. 2. 3.
Metaphors/similes
Idioms
Indirect requests
Right Hemisphere Brain Damage: Comprehension- Types of inferences: 1. 2.
Bridging
Elaborative
Right Hemisphere Brain Damage:
RHD is associated with difficulty interpreting __-___ ____ and _____
non-literal language
inferencing
Right Hemisphere Brain Damage:
Comprehension processes-
1.
2.
Construction phase
Integration phase
Right Hemisphere Brain Damage:
Construction phase of comprehension- ____/construct meaning of ____, ____, ____
Activate words phrases sentences (i.e. words with multiple meaning)
Right Hemisphere Brain Damage:
Integration phase of comprehension-
____ are integrated into context with less appropriate meanings supressed
Meanings
Right Hemisphere Brain Damage:
Production-
____ production: content and organization of verbal output
Discourse
Right Hemisphere Brain Damage: Pragmatics in RHD 1. \_\_\_\_ eye-contact 2. Reduced use of \_\_\_\_\_-laden words 3. \_\_\_\_\_ 4. Content of discourse may not be \_\_\_\_\_ or may be \_\_\_\_
Reduced
Emotionally
Egocentric
appropriate; insensitive
Right Hemisphere Brain Damage:
Pragmatics Theory of ____ -
One’s ability to _____ that another person has ideas, beliefs, feelings, and emotions that differ from one’s own
Mind
understand
Assessment off CCD after RHD is complicated because 1. 2. 3. 4.
- few reliable, valid assessment tools
- not obvious pattern of deficits
- wide range of norma
- cultural norms affect pragmatics
Assessment of CCD after RHD should include _______ and ________.
observation
objective measures
Many cognition/pragmatic assessments used for CCD-RHD were intended for patients with ________.
TBI
A specific attentional disorder in which the brain does not process stimuli that appear in, or originate from the side contralateral to the cerebral lesion is called _____?
unilateral neglect
Assessments of unilateral visuospatial neglect need to measure _____-centered and _______-centered neglect as well as ________, __________, and _______ neglect.
viewer object personal peri-personal extrp-personal
The Awareness Questionnaire (Shere, Hart, & NIck, 2003) as well as the Patient Competency Rating Scale (Borgaro & Prigatano, 2003) can be used to assess _______ related to cognition
anosognosia (spell it carefully!)
The most reliable assessment for prosody and affect available is the _______________.
Florida Affect Battery
The evidence-based triangle for making decisions about treatment interventions includes:
1.
2.
3.
- current best evidence
- clinical expertise
- client/patient values
Treatment for _____ has been studied more than any other deficit in RHD
Neglect
There are two general types of treatment for neglect in RHD:
1.
2.
- top down (use of cognitive strategies)
2. bottom up (manipulation of stimuli and attentional systems to increase attention)
Combinations of _________ training and ________ training may be most efficacious with RHD attention disorders.
direct; strategy
Strong evidence is available for __________which adds visualization of a beam of light to the movement of the head.
lighthouse strategy
The strategy of ‘visual scanning’ is considered a top-down attentional treatment.
True
The strategy of ‘prism adaptation’ is considered a bottom-up attentional treatment.
True
_______ training is recommended as a practice standard when treating UN ( Cicerone et al., 2011).
visual scanning
Name three ways the stimulus can be manipulated with when treating UN:
1.
2.
3.
- size of target
- number of targets
- presence of distractors
The object centered neglect of word reading can be reduced by adding ___________.
meaningless characters to the front of of the word.
Treatment for executive function & awareness come from the TBI literature and include:
1.
2.
- metacognitive strategies
2. task specific treatment
The two types of treatment for expressive aprosodia include ___________ and ________.
cognitive -linguistic
motoric-imitative treatment
List 3 examples of stimuli of contextually-based treatment of discourse and pragmatics:
1.
2.
3.
choose 3: homophone: word pairs homophones sentences ambiguous sentences common idioms
If a clinician wants to determine if a treatment for TBI is applicable to patients with RHD, six questions can help: Name 3 ________, ___________, and _____.
Is my client significantly similar the most important way?
Is the nature of the client’s cognitive impairment similar to that targeted in the research
Is is feasible it apply the intervention in this setting?
Explain the difference between mild cognitive impairment and dementia.
Dementia: a cluster of syndromes characterized by acquired persistent impairment or multiple cognitive domains.
Mild cognitive impairment (MCI): a preclinical condition that may suggest a person is at risk for developing dementia, a transition stage.
Name one cause of vascular dementia.
Ischemic or hemorrhagic cerebrovascular disease
How would you distinguish dementia with Lewy bodies from Parkinson’s disease?
DLB: cognitive impairment precedes motor deficits;
PD: motor deficits preceded cognitive impairment
Which type of dementia has an onset age before 65 years and accounts for 10% of dementia cases?
Frontotemporal Dementia (FTD)
Name one evidence-based treatment to be used with patients who have dementia.
Reading roundtable
spaced retrieval
Memory books
True or False: Unilateral neglect is a visual deficit.
true
True or False: Left neglect is more common than right?
true
Unilateral visuospatial neglect (UVN) can be viewer centered or ____________ centered.
Object
Define anosognosia
reduced awareness of deficits, hallmark of Right hemisphere damage (RHD)
Define aprosodia
a disruption in prosody; reduced use of pitch, duration, loudness and pause time to convey or interpret meaning.
Assessment of Right hemisphere damage- Cognitive communication disorder (RHD-CCD) should include ____________ as well as objective measures.
observation
Although there is a paucity of treatment efficacy research for disorders associated with RHD, the exception is _______________.
Unilateral visuospatial neglect (UVN)
Right hemisphere damage- Cognitive communication disorder (RHD-CCD) can affect both cognition and communication, including: executive function, ______________, prosody, comprehension, production, and ___________.
awareness; pragmatics
What are the 3 categories of mTBI?
sports related concussion (SRC), Mixed-mechanism (MM), Military-related concussion
You are completing a chart review on your patient who comes with cognitive complaints that have persisted 2 months following a concussion. You review imagining available which includes a CT and MRI. Both indicated normal results. Is the lack of findings on imaging important to the diagnosis?
No
How might auditory comprehension impairments in patients with mTBI impact your evaluation or treatment?
an audiologist is needed to assess for central auditory processing disorder (CAPD)
True or False: Stuttering in mTBI is likely neurogenic.
False
Why would assessment be postponed for 2 weeks to 3 months?
the assessment is specifically for persisting symptoms
Give two reasons why you would refer to a neuropsychologist in working with a patient with mTBI.
- many formal standardized assessments are not sensitive enough to postconcussive impairments and 2.neuropsychologists deal with emotional impairments of mTBI.
Regarding the emotional problems caused by mTBI, would it be best for you to treat these yourself or refer? To whom might you refer?
refer; neuropsychologist
What are the variants of FTD?
behavioral (bvFTD), language variants (PPA), and motor variants that can occur with or without bvFTD and/or PPA
Semantic variant (svPPA), nonfluent or agrammatic variant (nfvPPA) and logopenic variang (lvPPA) fall under which FTD variant?
Language (PPA)
Which diseases fall under motor variants?
ALS, CBS, PSP
According to ASHA, what role do SLPs have in MCI/dementia?
SLPs play a role in screening, assessment, diagnosis, treatment, and research of dementia-based communication disorders
What are some things we have to consider as part of the assessment?
- Thorough review of prior and current medical history (comorbidities, medication)
- Hearing impairment
- Vision impairment
- speech/language/communication
- depression
- global cognitive function
- mobility/balance impairments
What type of treatment for dementia is within our scope of practice?
Behavioral
T/F: Identifying the presence of cognitive communication disorder resulting from dementia or MCI is a treatment goal for dementia?
False; assessment goal.
T/F: Documenting impaired and spared cognitive-communicative abilities is one of the goals for assessment of dementia?
True
T/F: Establishing a baseline of cognitive-communicative functioning after the onset of intervention is one of the goals for assessment of dementia?
False; PRIOR.
T/F: A goal for dementia assessment includes assessing personal and environmental factors that influence a client or family.
True
T/F: We should not provide information and resources about dementia or MCI and counsel family members about expected progression. It should be left up to the doctor.
False
T/F: Using dynamic assessment approaches or structured therapy trials does not determine patient candidacy for particular interventions.
False; does
T/F: Indirect treatment for dementia includes patients undergoing treatment themselves.
False; direct treatment
Training professional and personal caregivers, modifying environment, counseling family members, etc. is what type of dementia treatment?
Indirect
