Neuro Cognition: Aging and Dementia

What are four things we gain from aging

1. vocab expansion

2. aquired wisdom

3. better integration of information

4. increased use of abstract words

What are four main things we lose when ageing

1. more dysfluencies and fillers (um, like, etc)

2. tip of the tongue effect

3. increased use of indefinite words

4. complex grammar, short sentences, fewer passives

What are some age-related changes that may affacet communication

1. Hearing loss + vision loss (risk for developing dementia, among 12 others)

2. Reduced accuracy of articulation

3. Decreased speed of mental processes

4. Decreased ability to multitask

5. Changes in memory (not sudden, subtle to working memory)

how does language and cognition change over time

changes naturally but does not equal decline

Define Subjective Cognitive Decline (SCD)

cognitive complaint, no cognitive impairments found in objective testing. Self-report, usually part of typical aging

when someone self reports SCD what usually happens within the next 3 years

40-62% progress to MCI or AD

Define Mild Cognitive Impairment

greater than age-expected cognitive decline, but not significant enough to result in the marked loss of functional independence. Objective cognitive impairment found on testing

How does MCI get diagnosed

Self or informant report of a cognitive complaint

What are the two main types of MCI

1. memory impairments

2. no memory impairments

What are the two domains of memory impairments of MCI

1. Amnestic single-domain

2. Amnestic multiple-domain

What are the two domains of no memory impairments of MCI

1. Non-amnestic single-domain

2. Non-amnestic multiple-domain

What is dementia

loss of mention functions. An acquired, persistent impairment in multiple areas of intellectual function

If functional independence is NOT affected what is that considered

MCI

How is dementia diagnosed

(a) history-taking from the patient and an informant, + (b) an objective cognitive assessment

What are the functions that dementia may affect?

1. memory

2. executive functions

3. Visuo-spatial function

4. language

5. personality/behavior

What are some key indicators that dementia has affected memory?

• Asking the same questions

• Misplacing personal belongings

• Forgetting events or appointments

• Getting lost on familiar routes

What are some key indicators that dementia has executive functioning?

• 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

What are some key indicators that dementia has visuo-spatial functioning?

• Inability to recognize faces or common objects

• Inability to operate simple gadgets or orient clothing to the body

What are some key indicators that dementia has language functioning?

• Difficulty retrieving words, hesitations

• Spelling and writing errors

What are some key indicators that dementia has personality/behavior?

• Withdrawal

• Inappropriate jocularity/behaviours (individual laughs, jokes, or exhibits high mood at highly inappropriate, shocking, insensitive times)

• Loss of social graces

List the 9 S-LP role in dementia

1. identification

2. assessment

3. intervention

4. counselling

5. collaboration

6. case management

7. education

8. advocacy

9. research

in order to diagnose Alzheimer’s disease, you need to have no evidence of:

• (a) cerebrovascular disease (e.g. stroke) ^{AKA vascular dementia}

• (b) core features of other dementias ^{AKA behavioural abnormalities common for frontotemporal dementia}

• (c) another neurological disease or medication (combos too) that could affect cognition

describe the onset of alzehiemers

• Insidious onset (cannot define start date), gradual progression

How many domain impariments must soemone have to be dianosed with alzheimers

2

What are the langauge impainemtns like in alzheimers

• Naming difficulties

• Paraphasias

• Impaired comprehension

• Reading and writing disorders

What the duration of Alzheimers

average = 6-12y (range = 1-20y)

What is the prevelence of Alz in the ages 65-70yo

2.3%

What is the prevalence of Alz in the ages 70-80yo

3.9%

What is the prevalence of Alz in the ages 80+yo

22%

what gender is Alz more common in

women

What part of the brain is responsible for memory and learning

hippocampus

What happens if the hippocampus is dysfunctional

new information and memories cannot be sent to long term memory like normal

What does the presense of Neurofibrillary tangles indicate

no transmission of electrical signals between neurons

How is Prosody affected in Alz

mostly spared

How is phonology effected in Alz

articulate well, some errors but sound production mostly spared

How is semantic knowledge/ semantic memory affected in Alz

may be affected

How is naming/word retrieval affected in Alz

difficult

How is dicourse affected in Alz

affected; poor cohesion, sometimes poor coherence

In an expressive language picture task how may the patient present

• Fewer units of information

• Decreased cohesion

• Poor organization

• Simple or nonspecific vocab

• Paraphasias

• Word finding problems

• Repeating ideas

• Missing the central idea

In an naming task how may the patient present

• Semantic and phonemic paraphasias

• Circumlocutions

In an connected speech task how may the patient present

• Poor cohesion

• Word finding difficulties

• Paraphasias (semantic + phonemic)

• Losing train of thought

• Unfinished sentences

• Reduced rate

In an receptive langauge task how may the patient present

• Increased processing time

• Difficulty in noisy environment, problems with multi-partner conversations

• Poor comprehension of complex sentences

• Reduced receptive vocabulary

• Literal understanding of figurative language

• Poor sensitivity to context

• Trouble following conversations, movie plot, etc.