CSD 523- MIDTERM

Adult Cognitive Disorders

what is RHD?

what is RHD?

right hemisphere disorder

cognitive communication impairments resulting from damage to the right hemisphere

symptoms of RHD- cognition

attentional deficits

short attention span/ difficulty learning new things

orientation

poor decision making, lack of insight

immediate and short term memory deficits

decreased problem solving skills

organizational deficits

reasoning difficulties

assessments for RHD

SCCAN

MoCA

CLQT

RIPA-2

hierarchy of cognition

attention

orientation

reasoning/awareness

organization/memory

executive function

name the 5 types of attention

focused

sustained

selective

alternating

divided

what is cognition?

one small word that conveys a host of multifaceted abilities. Having adequate ___ lets us get through the day without having to “think” about automatic activities such as brushing our teeth or getting dressed

definition of cognitive communication disorder

difficulty with any aspect of communication that is affected by disruption of cognition

attention

Ability to focus, sustain, alternate, and divide mental resources. Stay focused and filter out irrelevant information. To be alert/aroused

orientation

Understanding of “where” and “who” you are or direct attention toward a stimulus. Ex. Understanding surroundings, date, month, year

reasoning/awareness

Rational thinking. Basic awareness of how they are impaired ant that they are in therapy to get better

organization

Being able to engage in basic thought organization. Demonstrate the ability to engage in basic conversation while maintaining topic. Able to sequence simple steps (brushing teeth)

executive functioning

The cognitive processes that underlie goal directed behaviors such as: planning, organizing, initiation and stopping behaviors, sequencing steps

memory

ability to encode, store, and retrieve information for later use. Retain, recall and manipulate information

problem solving

Generate solutions for given situations

what part of the brain controls memory?

hippocampus

what part of the brain is responsible for short term memory?

prefrontal cortex of the frontal lobe

name the types of memory

immediate

working/short term

long term

non-declarative long term memory

knowing HOW

aka knowing how to drive a car

declarative long term memory

knowing WHAT

aka memory of the first time you drove a car

name 2 types of declarative long term memory

episodic

semantic

episodic memory

linked with particular times and places, and could be considered personal memories, such as experiences of certain events (Special trip)

semantic memory

the memory concerned with the storage of factual information which is not linked to a particular experience. (General information, facts, rules)

focused attention

to respond discretely to specific visual, auditory or tactile stimulation. BASIC. Disturbed in early stages of coma

selective attention

The ability to hold attention on a single stimuli. Maintenance of attention over time during continuous and repetitive activity (assembly line workers)

sustained attention

refers to the ability to focus on important information while ignoring irrelevant information/distractions

alternating attention

refers to capacity of mental flexibility that allows individuals to move between tasks with different cognitive requirements

divided attention

Ability to focus to two tasks simultaneously

aspects of executive functioning (ROSTA)

reasoning

organization

self monitoring and control

tasks initiation

aspects of memory and problem solving

what does AOROME stand for?

attention/arousal

orientation

reasoning/awareness

organization

memory

executive functioning

etiologies of RHD

stroke

TBI

tumor

surgery

infection

illness

RHD impairments

increased falls

difficulty judging object distance

left hemiplegia

RHD can cause:

impulsivity

left sided visual neglect

anosognosia

• lack of awareness of disease

symptoms of RHD- speech

diminished speech prosody

use of more words, but produce less information

oblivious to social conventions

rambling of speech

monotonous speech, lack of emotion

etc

RIPA- 2

ages 15-90

60 minutes to administer the whole thing

6 subtests that can be normed and completed within 10 minutes each

normed for: RHD, TBI, and tumors

what does the RIPA-2 test?

immediate memory

recent memory

problem solving and abstract reasoning

auditory comprehension

recall of general information

orientation- temporal and spatial

organizational skills

damage in the right frontal lobe would be impaired what?

impaired social behavior

damage in the right fronto-temporal lobe would be impaired what?

impaired impulse control

damage to the right temporal lobe would be impaired what?

impaired sense of familiar and unfamiliar

damage to the right parietal lobe would be impaired what?

impaired body image

damage to the right parieto-temporal lobe would be impaired what?

impaired topographic orientation

MoCA

this is a SCREENING

intended for clients with memory impairments complaints

must be certified to give it

pros of using the MoCA

multiple versions

only takes 10 minutes

available in 46 languages

no materials needed

what does the MoCA assess?

attention and concentration

executive functions

memory

language

visual constructional skills

conceptual thinking

calculations

orientation

who can the MoCA be used on?

patients with stroke

individuals with dementia

others

SCCAN

provides overview across 8 cognitive scales

takes 34 minutes to administer

ages 18-95

what does the SCCAN test?

speech comprehension

oral expression

reading

writing

orientation

attention

memory

problem solving

who is the SCCAN normed for?

left and right hemisphere stroke

Alzheimer’s disease

TBI

CLQT

ages 18-95

takes 15-30 minutes to administer

assesses 5 cognitive domains

what does the CLQT test?

attention

memory

language

executive functioning

visuospatial skills

who is the CLQT normed for?

left/right brain

TBI

dementia

what is primary progressive aphasia?

a clinical dementia syndrome characterized by the gradual dissolution of language without impairment of other cognitive domains for at least the first two years of illness

demographics of PPA

2:1 male to female ratio

average age of onset= 60 years old

it changes over time

starts with WORD FINDING and progresses to other language function

what are the 3 types of PPA?

progressive nonfluent

fluent semantic

mixed/ logopenic progressive aphasia

characteristics of progressive non-fluent aphasia

labored or halting speech production and agrammatical language

word understanding is preserved

sentence comprehension may suffer if the sentences are long

what is progressive non-fluent aphasia caused by?

left frontal lobe degeneration

key characteristic in progressive non-fluent aphasia

more difficulty naming verbs than nouns

sentences become shorter

apraxia is common

sometimes gives impression of stammering or stuttering

example sentence of progressive non-fluent aphasia

woke up. eat… food. wash up. walk dog. that’s it.

characteristics of semantic dementia

fluent type language

what causes semantic dementia?

left temporal lobe degeneration, including the hippocampus

key characteristics of semantic dementia

talk like someone with anomic aphasia

difficulty with noun comprehension

do worse at naming objects vs. verbs

degraded semantic memory- both impaired noun naming and single word comprehension

example of semantic dementia

me: “bring me an orange”

person with SA: “what is an orange?”

characteristics of logopenic progressive aphasia

syntactical comprehension and naming are impaired

sentence repetition is impaired with phonological errors

what causes logopenic progressive aphasia?

cortical atrophy in the posterior temporal and inferior parietal lobe

key characteristic of logopenic progressive aphasia

mixture of progressive non-fluent and semantic dementia

example of logopenic progressive aphasia

insert fillers such as “the thing that you use for it”, “you know what I mean”, etc.

spelling errors are common

how to diagnosis PPA

history

medical history

family interview

CLQT or PASS

aphasia testing (WAB)

oral motor/swallowing

goal setting with person with aphasia at center

what is important to not forget in an informal evaluation for PPA?

determine what skills remain intact!

best model of treatment with PPA

asses

treat

assess

treat

treatment goal of PPA

communication, not perfection

prevalence of TBI

60:40, more males than females

penetrating brain injury (open)

Perforated skull, penetration of the meninges, and brain tissue damage

• Ex: bullets, nail guns, lawn darts, knives, arrows, etc

non-penetrating brain injury (closed)

Brain tissue damage with intact meninges, may or may not include a fractured skull

• Ex: industrial, domestic, or sports-related accidents, car accidents, falls, etc

name the mechanisms of brain injury

mechanical force

acceleration-deceleration

vascular injury

diffuse axonal injury (DAI)

mechanical force

struck by forceful contact

acceleration-deceleration

Head suddenly stops but the brain does not stop

• Ex: car accidents, sports injuries, shaken baby, domestic violence cases

vascular injury

Small and widespread ruptures of the blood vessels, may result in multiple hemorrhages

diffuse axonal injury (DAI)

Stretching and tearing of nerve fibers in widespread areas of the brain

primary injuries

at the time of trauma

• lacerations/ fractures

• DAI

• vascular injury

• focal cortical lesions

• cranial nerve damage

secondary injuries

as a result of primary injuries

• Hemorrhage: epidural, subdural, intracerebral

• Increased intracranial pressure, edema, swelling

• Cardiac or respiratory arrest, ischemic brain injury

• Hypotension (low blood pressure)

• Seizures

• Infection

signs/symptoms of TBI

Altered consciousness

Headache

Dizziness

Changes in behaviors, personality, irritability

Vomiting

• If someone bumps their head and starts to vomit within 6-8 hours, something is wrong!! This is one of the clear cut signs that the brain has gone through some kind of insult

Depression

Sleep disturbances

Memory deficits

Diminished attention span

what is the lowest score you can get on the glasgow coma scale?

3

score of 3-8 on the GCS would mean?

severe

score of 9-12 on the GCS would mean?

moderate

score of 13-15 on the GCS would mean?

mild

prognostic variables in TBI

duration of coma

time post-injury

age at injury

premorbid intelligence and education

premorbid or current drug and alcohol abuse

severity of injury

type of injury

secondary injuries

level of consciousness

assessment after TBI

case history

interview

observation and systematic analysis

assessment of:

• consciousness

• cognition

• communication

• dysphagia

GCS eye opening

4- spontaneous

3- to voice

2- to pain

1- none

GCS verbal response

5- normal conversation

4- disoriented conversation

3- words, but not coherent

2- no words, only sounds

1- none

GCS motor response

6- normal

5- localized pain

4- withdraws to pain

3- decorticate posture

2- decerebrate posture

1- none

rancho level I

no response- total assistance

rancho level II

generalized response- total assistance

rancho level III

localized response- total assistance

rancho level IV

confused and agitated- maximal assistance

rancho level V

confused and inappropriate- maximal assistance

rancho level VI

confused and appropriate- moderate assistance

rancho level VII

automatic and appropriate- minimal cues for ADL’s

rancho level VIII

purposeful and appropriate- stand by assistance

rancho level IX

purposeful and appropriate- stand by assistance by request

rancho level X

purposeful and appropriate- modified independence

what allows a patient to move from ranchos level V to ranchos level VI?

PTA (orientation) clearance