SLHS 580 Unit 3 Test(final)

Three parts of the WHO model(world health organization)

impairment, disability, handicap

impairment

a problem with structure (function) of the body

disability

functional limitation with regard to an activity

handicap

an environmental factor preventing living of normal life

What does the ICIDH Model stand for?

International classification of impairment ,disability, and handicap

Three parts of the ICIDH model

structure/function

activity

participation

ICIDH model: Structure/function

functioning at the level of the body

ICIDH model: activity

functioning at the level of the individual, activity limitations they experience

ICIDH model: participation

functioning of a person as a member of society; involvement of people in all areas of life, and participation restrictions they experience

Developmental disorder

begins in childhood, lifelong impairments

Acquired disorder

develops after birth from external factors

Acute acquired disorder

sudden onset, recovery is possible with rehab

Degenerative acquired disorder

gradual onset, progressive decline

Left hemisphere

responsible for language usage, processing auditory stimuli, detail oriented and analytical

Right hemisphere

visuospatial processing, attention, pragmatics; used for slow integration of information; holistic and big picture oriented

Frontal lobe lesion

Non-fluent speech (telegraphic)

Omission errors Concomitant motor deficits

Relatively good comprehension

Temporal lobe lesion

Fluent speech maintained

Problems with open class words (nouns, verbs)/ semantic errors

Substitution errors (e.g., dog for cat)

Typically no motor deficits/but auditory deficits

Poor comprehension

What are some examples of developmental disorders?

autism, cerebral palsy, down syndrome

Accelerated aging

people with Down syndrome experience symptoms of aging at a much faster rate than people w/o Down syndrome • Symptoms begin by 40-50 years old

High prevalence of ________ in Down syndrome at earlier age

Alzheimers

30% of people with Down syndrome who are in their 50s

50% of people with Down syndrome in their 60s have Alzheimer's dementia

Developmental language disorders

can have a significant impact on participation and activity in adulthood, but limited research is available

Autism spectrum disorders

A more variable genetic basis and less available research makes it more challenging to predict patterns of aging

The first individuals were labeled with ASD in the 1940s - elders with this diagnosis are now present in the population

An estimated 1% prevalence across the lifespan

It is likely that as the elder population identified as autistic grows, more knowledge will become available.

ADHD

lifespan disorder, meaning that it does not go away, however some people do not get diagnosed until adulthood

Mild cognitive impairment

a stage between expected age-related cognitive decline and the pathological decline associated with dementia; includes issues with memory, language, thinking, and/or judgement o ADLs are not affected

Characteristics of MCI

Plaques and tangles

Small strokes or TIA

Shrinkage/atrophy of hippocampus

Enlargement of ventricles

What percent of individuals with MCI develop dementia each year?

10-15%

Pragmatics study

older adults with MCI show increased non-verbal communication strategies (e.g., pointing, gestures, increased eye contact, head nodding)

What is the greatest risk factor for dementia?

aging

Alzheimer's disease

most common form of dementia

Pathology - presence of plaques and tangles

key symptom is memory loss, also poor judgement/decision-making, planning, reasoning, changes in personality or behaviors

Vascular dementia

often co-occurs with other types of dementia

Pathology - stroke / cardiovascular disease

Dementia with Lewy bodies

Pathology - presence of Lewy bodies

Parkinson's Disease Dementia

Pathology - presence of Lewy bodies specifically in substantia nigra

Mixed dementia

more than one type of dementia pathology is present

Incidence

number of new cases in the population over a certain period of time

Increases with age

Prevalence

number of current cases at a certain point in time

Higher prevalence of women

Whole brain effects for Alzheimers disease

Cortex shrinks • Expanded ventricles • Weight decrease

Neuronal effects for Alzheimers disease

Plaques - deposit of amyloid in spaces between neurons. Interferes with neuron communication at synapses

Tangles - deposits from cell components within the neuron. Interferes with microtubules in the cell, preventing individual neuron communication and resulting in cell death

Microglia - immune cells that work to clear up plaques and tangles; can cause inflammation which exacerbates presence of plaques and tangles

Progression of Alzheimer's Disease

1) entorhinal cortex

2) hippocampus

3) inferior temporal regions, temporal pole

Braak Stages

based on brain symptoms at autopsy; tracks the development of tangles across the brain

Braak stages I and II

tangles in the entorhinal cortex

Braak stages III and IV

tangles spread to hippocampus

Braak stages V and VI

tangles spread to neocortex

Brain reserve theory

no direct relationship between amount of Alzheimer's pathology in the brain and the extent of behavioral symptoms

Plasticity

the brain's flexibility in adjusting to injury

Neurological brain reserve hypothesis

the size and structure of the brain allows some to absorb more injury before cognitive function is affected

Behavioral/cognitive brain reserve hypothesis

complex cognitive ability increases neural plasticity and ability to work around pathology

Diagnosis of Dementia: Three behavioral symptoms must be present

1) impairment in short term memory

2) impairment in another area of cognition

3) impairment in social/daily living

Diagnostic tools for diagnosing Dementia

Neuroimaging - PET Scan

Cerebrospinal fluid testing

Blood-based biomarkers

Clinical stages of Dementia

Stage 1 - no symptoms; subclinical stage

Stage 2 - encoding and storage of new memories affected; short-term memory loss; mood-related changes

Stage 3 - onset of mild dementia; difficulty with word retrieval, comprehension, recognizing people/faces; may wander and forget where they were going/get lost

Stage 4-5 - onset of moderate dementia; misinterpretation of events; paranoia/paranoid delusions

Stage 6 - onset of severe dementia; visual deficits; major changes in sleep, bladder/bowel control, personality

Stage 7 - very severe dementia; impairment of basic functions; aspiration pneumonia more likely; bedridden

Biomarkers of Dementia

Structural imaging-changes clear - no norms though!

Functional imaging- reduced glucose metabolism in memory areas - no norms though!

Molecular imaging - PET scan, PiB

Pittsburgh compound B (PiB)

radiotracer that binds to amyloid plaques, can only be observed through molecular imaging techniques like PET scan

Stroke is also known as ...

cerebrovascular accidents (CVA)

Risk factors for stroke

Men more at risk than women

Mexican Americans more at risk than non-Hispanic White Americans

Black Americans more at risk than White Americans

Ischemic stroke

blood clot blocks or plugs a blood vessel in the brain

Embolic stroke is a type of ...

ischemic stroke

Thrombotic stroke is a type of ...

ischemic stroke

Embolic stroke

blood clot forms and travels through the bloodstream to the brain, the clot eventually lodges in a blood vessel and blocks the blood flow

Thrombotic stroke

buildup of fatty deposits on the cell wall of the artery, impeding blood flow

Hemorrhagic stroke

a blood vessel in the brain breaks or ruptures

Transient ischemic attack (TIA)

temporary ischemia that quickly resolves

Symptoms last less than 24 hours

Potential warning sign of impending stroke

Higher likelihood of having another TIA or stroke

Symptoms of stroke

Numbness/weakness on one side of the body

Confusion

Trouble speaking and/or understanding

Sudden vision problems

Dizziness or loss of balance

Severe unexplained headache

BE FAST acronym for stroke

B = balance

E = eyes

F = face

A = arms

S = speech

T = time

Experiential / phenomenological accounts

understanding the experience of living with a disorder

Atherosclerosis

fatty deposits form on the walls of blood vessels, restricting the blood flow to the brain

Puts pressure on the heart to increase the blood pressure

Arteries widen over time, thinning the walls and increasing the risk of rupture

Can lead to thrombosis

Can cause vascular dementia

High blood pressure / hypertension

Heart works harder to pump blood faster

Related to stress, hormones, diet

Increased force of blood on the artery wall over time Increased risk of heart attack

Stroke recovery stages

acute, subacute, chronic

Acute phase: stroke recovery

(hours and days post-stroke) frequent and rapid improvement, reduction in edema, reperfusion, neural plasticity

Subacute phase: stroke recovery

(weeks after stroke) neural re-organization is occurring

Chronic phase: stroke recovery

compensatory reorganization

What is an important factor in the likelihood of stroke recovery?

age

Aphasia

Language, but not intellect, is affected

Ischemic stroke is the highest cause of aphasia

Broca's Aphasia

NONFLUENT

Production

-Slow speech rate, lots of pausing

-Omits function words, mostly produces content words (telegraphic speech), content is still relatively meaningful -----Impaired naming, writing

Comprehension

-Intact for single words and simple sentences

-Impaired for complex sentences

Repetition

-Impaired, but better than production

Wernicke's Aphasia

FLUENT

Production

-Abnormally fluent speech, word salad

Intact grammar, but semantics is impaired

Speech contains paraphasias

Comprehension

-Impaired, also may not be aware that it's impaired

Repetition

-Impaired for words and sentences

Conduction Aphasia

Production

-Speech is fluent but contains articulation errors (e.g., transpositions)

Comprehension

-Auditory comprehension is spared

-Oral reading is poor

Repetition

-Impaired ability to repeat words, especially nonwords

Anomic aphasia

Production

-Usually fluent and grammatical correct, except for word retrieval problems (tip of the tongue)

Comprehension

-Good

Repetition

-Good

What are paraphasias?

speech errors

Phonemic paraphasias

substitution of one phoneme for another

Neologistic paraphasias

substitution of a nonword that is phonetically and semantically unrelated to the target word

Semantic paraphasia

substitution of one word for another

Primary progressive aphasia

a type of dementia that affects language networks initially

Socioemotional selectivity theory

the perception of time plays a fundamental role in the selection and pursuit of social goals

Knowledge-related goals

when time feels open-ended, more likely to plan for longterm goals

Emotion-related goals

when time feels short-term, more likely to make choices to feel good in the present

Positivity effect

older adults prefer positive information over negative information in tests of memory, attention, cognitive control, etc

Self regulation

the ability to identify, plan ahead, and avoid situations that may elevate negative affect, and stress

Older adults with better self-regulation skills show healthier aging process

Increased stress long term is associated with...

greater cognitive and physical health decline

Mayo Clinic study

looked at survival rates in people classified as optimists or pessimists; optimists showed a higher survival rate than pessimists

Nun study

sisters who showed higher positive emotional content in their autobiographies showed lower mortality in late life

Social isolation is linked to...

higher mortality rates, cardiovascular disease, depression/anxiety

Open family system

bigger social network and access to resources

Closed family system

more isolated social network and fewer connections to community; tend to be more vulnerable when significant health events occur

Is depression a normal part of aging?

NO, , but the most prevalent mental health issue in older adults

Older adults with PTSD often perform _______ on tests of processing speed, learning, memory, and executive function

worse

Do older adults with PTSG have a higher or lower rate of developing dementia than non PTSD?

higher

Post-pandemic resilience

Older adults showed lower rates of anxiety and depression during the pandemic than middle/younger adults

Older adults may be more resilient due to crystallized experience/perspective

Stages of chronicity

1. Shock

2. Realization

3. Denial

4. Mourning

5. Adaptation

What are the three models of counseling?

behavioral, humanistic, existential

Behavioral model

focuses on how past experiences influence present actions; uses positive reinforcement to support attainment of goals

Humanistic model

focuses on supporting feelings here and now, providing safe space to help individual express themselves

Existential model

focuses on supporting individual through understanding four concepts of life: death, responsibility (freedom), isolation/loneliness, and meaning of life