Week 1 - Intro to Dementia

describe things gained as we age

• vocabulary expansion (although slower retrieval)

• better use of context

• better integration of information

• increased use of abstract words

• acquired ‘wisdom’

describe things we lose as we age

• more disfluency or hesitancy (umm..ehh)

• more filler words (you know…well…)

• tip-of-tongue incidents

• increased use of indefinite words (this, that, the thing)

• less complex grammar

• shorter grammar

• fewer passives

as we age there is no loss of competency in …

relaying information

what are other age-related changes that may affect communication?

• hearing loss

• vision loss

• reduced accuracy of articulation

• decreased speed of mental processes

• decreased ability to multitask

• changes in memory

describe changes in memory as a result of aging

subtle changes

particularly in working, not episodic memory

… and … change naturally throughout life

language and cognition (e.g. memory)

what is subjective cognitive decline (SCD)?

• report of a cognitive complaint (self)

• no cognitive impairments on objective testing

what % of those with SCD progress to mild cognitive impairment (MCI) or AD and within what time frame?

40-62% within 3 years

what is the definition of mild cognitive impairment (MCI)?

greater than age-expected cognitive decline, but not significant enough to result in marked loss of functional independence

describe MCI

• report of a cognitive complaint (self or informant)

• objective cognitive impairment (on testing)

• no dementia

• generally intact functional abilities (e.g. banking, driving, cooking)

what is the differentiating factor between MCI and AD?

functional independence

what is the MCI type: no memory impairment, all other factors not changed

non-amnestic single domain

what is the MCI type: no memory impairment; language and visuospatial orientation affected

non-amnestic multiple-domain

what is the MCI type: memory impacted, all other functions normal

amnestic single domain

what is the MCI type: memory impacted; personality changes, executive functioning impact and language impairment

amnestic, multiple domain

what does DAT refer to?

dementia of the Alzheimer’s type

what does aMCI refer to?

amnestic mild cognitive impairment

dementia is an “umbrella” term used to describe a range of symptoms associated with…

cognitive impairment

plus other dementias associated with various neurodegenerative conditions

e.g. Parkinsons’s, Progressive Supranuclear Palsy, Huntington’s, Corticobasal syndrome, Primary Progressive Aphasia

sort the following types of dementia by % prevalence: vascular, Alzheimer’s, frontotemporal, lewy bodies

Alzheimer’s > vascular > lewy bodies > frontotemporal

dementia is a loss of … functions. it is an acquired … impairment in … areas of … function

dementia is a loss of mental functions. it is an acquired persistent impairment in multiple areas of intellectual function

dementia is characterized by deficits beyond …

beyond mild cognitive impairment

dementia entails cognitive and/or behavioural symptoms that:

• interfere with the ability to function at work or at usual activities

• represent a decline from previous levels of functioning and performing

• are not explained by delirium or major psychiatric disorder

what other presentation can present itself as mild dementia

clinical depression — in this case, neuroimaging can be helpful

dementia is diagnosed through…

1. history-taking from the patient and an informant

2. an objective cognitive assessment

both cognitive and behavioural assessments

describe how dementia may impact memory

• asking the same questions

• misplacing personal belongings

• forgetting events or appointments

• getting lost on a familiar route

describe how dementia may impact executive functions

• errors in reasoning and judgement

• poor understanding of safety risks

• inability to manage finances

• poor decision-making ability

• inability to plan complex or sequential activities

describe how dementia may impact visuo-spatial function

• inability to recognize faces or common objects

• inability to operate simple implements

• inability to orient clothing to the body (sometimes incorrectly termed ‘dressing apraxia’)

describe how dementia may impact language

• difficulty retrieving words

• hesitations

• spelling and writing errors

describe how dementia may impact personality and behaviour

• withdrawal

• inappropriate jocularity

• loss of social graces

what ratio does dementia impact males to females

1/3 males, 2/3 females

often, revoking of one’s … is more devastating than diagnosis of dementia due to …

revoking driver’s licence

loss of independence; is an immediate change that can be seen

describe what steps can be taken to diagnose dementia

• autopsy (gold standard)

• laboratory tests

• biomarkers in blood (Tau protein)

• brain imaging

• family history (2 generations: high risk)

• physical examination (to rule out other causes)

• pharmacological assessment

• neurological examination (to rule out other causes)

• neuropsychology (cognitive status)

• speech-language pathology (language status)

SLP role in dementia

• identification

• Ax

• Tx

• counselling

• collaboration

• case management

• education

• advocacy

• research

dementia of the Alzheimer’s type has a … onset and … progression

insidious onset, gradual progression (can tell when it begins)

in dementia of Alzheimer’s type, there is no evidence of…

• cerebrovascular disease (e.g. stroke)

• core features of other dementias (e.g. frontotemporal dementia)

• another neurological disease or medication that could have effect on cognition

dementia of Alzheimer’s type has impairments in at least … cognitive domains of …

two

memory, behaviour, visuo-spatial, language, executive functions

describe characteristics of language impairments

• naming difficulties

• paraphasias (semantic - related or not - OR phonemic - sound subst. changing meaning or non-word subst.)

• impaired comprehension

• reading and writing disorder

prevalence of AD in 65-80+

65-70: 2.3%

70-80: 3.9%

80+: 22% (some sources say 50%)

AD is .. as common in women than men

twice as common (4.1% ; 1.7%)

what is the average duration of AD

average 6-12 years (range is 1-20 years)

the hippocampus is responsible for…

memory and new learning

processes and stores new memories before sending them to long-term storage

describe how the neurons for AD are different than normal neurons

normal - healthy synaptic connections

AD - amyloid plaques and neurofibrillary tangles - no transmission of electrical signals between the neurons

• Tau protein is more related to cognitive decline

Tau pathology is a more direct driver of …

cognitive decline

people with AD often have poor understanding of…

their deficits

describe expressive language in AD - picture description task

• fewer units of info

• decreased cohesion

• poor organization

• simple/nonspecific vocabulary

• semantic and phonemic paraphasias

• word-finding problems

• repeating ideas

• missing central idea

describe expressive language in AD - naming

• semantic and phonemic paraphasias

• circumlocutions

describe expressive language in AD - connected speech

• poor cohesion

• word finding problems

• paraphasias

• losing train of thought

• unfinished sentences

• reduced rate

describe receptive language in AD

• increased processing time

• difficulty in noisy environment and problems with multi-partner conversations

• poor comprehension of complex sentences

• reduced receptive vocab

• literal understanding of figurative language

• poor sensitivity to context

• trouble following conversations, movie plot

what happens to prosody in AD

overall is intact (comes from RH)

what happens to phonology in AD

articulate well, make some errors here and there

sound production relatively spapred

what happens to semantic knowledge/memory in AD

may be affected

~1/3 of people with AD have impaired semantic memory identified early

what happens to naming/word retrieval in AD

very difficult for the individual

what happens to syntax in AD

spared

able to fix grammatical errors

what happens to discourse in AD

slightly disorganized, sometimes poor coherence