Cog Com Final

Stages of Global Deterioration Scale (GDS)

overview of progressive cognitive deterioration through stages 1-7

useful for caregivers, families, & healthcare staff to predict & smoothly transition through stages

GDS Stage 1

no cog decline // age associated memory impairment

no symptoms observed, person is independent w/ normal behavior, memory, communication, mobility, ADLs

GDS Stage 2

very mild cog decline

Subjective complaints of memory deficit (misplacing items, forgetting names)

No objective evidence of memory deficit affecting employment or social situations

GDS Stage 3

mild cognitive decline (MCI)

getting lost in unfamiliar areas, coworkers notice poor work performance, can't remember new names, misplacing items, poor word finding, decreased social skills, can't read & remember after

objective concentration, memory deficits

denial, mild-moderate anxiety

GDS Stage 4

moderate cognitive decline

challenges w/ current events knowledge, personal history memory, complex tasks, finances or travel

NO deficits in orientation, recognition of familiar faces, ability to travel to familiar places

Denial, social isolation

GDS Stage 5

moderately severe cognitive decline

require 24hr care, but still eating/toileting independently

trouble recalling personal history memory (phone number/address of many years, names of grandchildren), counting backwards, orientating time & place

DO know their own names, spouse's name, kids' names, major facts about themselves

GDS Stage 6

severe cognitive decline

professional level care w/ ADLs

may forget spouse's name, unaware of recent events in life/their current surroundings, wandering at night

DO remember their own name & some vague personal info, distinguish b/w familiar & unfamiliar faces,

Personality & emotional changes: delusions, anxiety/agitation/violence, obsessive patterns, loss of willpower

GDS Stage 7

very severe cognitive decline

professional level care w/ ADLs & constant monitoring

No speech (only some unintelligible utterances & rare habit words), no walking, rigid muscles & slow reflexes

The brain appears to no longer be able to tell the body
what to do

dementia

syndrome w/ many different causes

Altered cognition, social skills, occupational functioning, memory, attention, language, visuospatial functioning, executive functioning

Acquired, persistent impairment → deterioration through 7 stages, comorbid capability

types: MCI, AD, VaD, DLB, FTLD

mild cognitive impairment (MCI)

Stage 3 → may or not may progress fully into dementia

Most common cause: Alzheimer’s dementia

10-20% of people 65+ years old have MCI, more common in less educated men w/ gene APOE

Risk factors: diabetes, high cholesterol, hypertension, hyperlipidemia, lack of exercise, high alcohol consumption, low social interactions, poor diet

Criteria for Diagnosis:
Self-report
Quantified memory impairment
No issues w/ logic, thinking, ADLs

Alzheimer's disease (AD)

60-80% of dementia diagnoses, mostly affecting women

Deficits in working (short-term) & episodic memory (personal recall of info & experiences) within medial temporal lobe

Attention & executive functioning deficits → inability to dress, feed self, drive

EARLY STAGE
Impaired: lexical retrieval, discourse
Intact: orientation, semantic memory, fluent speech, conversations, following 2-3 step commands

MID STAGE
Intact: following 1-2 step commands, sustain attention, appropriate conversation

LATE STAGE
Intact: attend to music/pleasant stimuli for a brief time

vascular dementia (VaD)

2nd most common cause of dementia

Caused by cardiovascular, cerebrovascular, or circulatory disease --> ischemic or hemorrhagic disease
Subcortical or cortical accumulation of proteins

Slowed gait, other physical neurological signs

Impairments in judgment, planning, decision making, organizing first

Risk factors: diabetes, hypertension, smoking, hypercholesterolemia

Criteria for Diagnosis:
Subcortical lesions presenting as ischemic, hemorrhagic, or white matter lesions on CT or MRI scans
Evidence of cerebrovascular/cardiac disease

dementia with Lewy Bodies (DLB)

Biologically related to Parkinson’s, both have Lewy bodies present

Lewy bodies = abnormal clumps of alpha-synuclein proteins

Symptoms: visuospatial impairment, sleep disturbance, visual/sensory hallucinations, Parkinsonian gait/imbalance, reduced speech rate/fluency

Cognitive decline → motor decline (vice versa w/ PD)

frontotemporal lobar degernation (FTLD)

overarching group of rare disorders w/ neurodegeneration (including PPA)

10% of dementia cases, 60% are diagnosed b/w 45-65 years old


Neuropathology: abnormal tau protein levels, spongiform cortex changes, focal atrophy of frontal & anterior temporal regions

Marked changes in personality, behavior, speech, & pragmatics

Primary Progressive Aphasia (PPA)

neurodegenerative disorder characterized by gradual deterioration of speech & language w/ relatively spared cognition

Cognitive & motor (apraxia, dysarthria) impairment emerge over time

NO pharmacological interventions available

3 subtypes

semantic variant PPA

Losing word knowledge --> SOUNDS LIKE WERNICKES

impaired object knowledge, surface dyslexia/dysgraphia, relatively preserved repetition, reading & writing, ADLs, receptive language

intact grammar motor speech, memory, repetition

Damage to anterior temporal lobe, greater in language dominant hemisphere

logopenic variant PPA

Losing phonological knowledge (how sounds fit together to make words) --> SOUNDS LIKE CONDUCTION APHASIA

impaired single word retrieval in spontaneous speech/picture naming, phrase/sentence repetition (phonemic paraphasias)

intact comprehension of single words, object knowledge, motor speech, syntactic processing

some jargon but comprehension deficits & episodic memory impairment

Atrophy related to brain volume loss in left posterior temporal & inferior parietal regions --> eventually frontal lobe

Alzehimers is most common cause

nonfluent variant PPA

Losing motor speech control --> SOUNDS LIKE BROCAS

agrammatism, apraxia (sometimes dysarthria)

Must have 2+ of these: syntax comprehension deficit, relatively preserved comprehension of single words, relatively preserved object knowledge

FTLD-tau pathology, a protein stabilizing microtubules in skeletons of nerve cells → protein build up causing neuron breakdown --> frontoinsular atrophy

May develop behavioral problems, dysphagia, mutism

mixed PPA

Rare, showing features of 2+ PPA subtypes

Alzehimers pathology

Henry 2021:
Treatment to increase naming

lexical retrieval treatment utilizes spared cognitive–linguistic domains

helps to develop self-cueing strategies to promote naming

SFA, delayed recall, & cueing hierarchy included

Shaffer 2021:
Use of care partners to extend treatment

SLPs offer counseling & education to allow care partners to be communication facilitators & advocates

treating pt & their loved ones by proxy --> holistic Tx experience that generalizes to life outside Tx sessions

From the perspective of the ICF by the WHO, a standardized test can measure...

any component of health outcome

Functional standardized tests...

measure daily functioning

In determining if a pt has a CCD, the SLP chooses a standardized norm-referenced test. The SLP assesses concurrent validity of this tool & in doing so is assessing...

if test results are consistent with other, valid diagnostic info

A clinician may choose as a target if intervention, an area which received a low subtest score on an assessment. This is often invalid because...

factor analysis of test data doesn't support this use

AND

most tests used by SLPs are single-factor

AND

most test which report "strengths & weaknesses" don't provide statistical evidence that these components can stand alone

7 tests were found to be candidate tests for standardized assessment in appropriate contexts. All of these appeared on the list except...
a) BRIEF
b) RBANS
c) RIPA
d) ASHA-FACS

RIPA

The Cog-Com Checklist for ABI...

is a cog-com symptom checklist

AND

could improve access to speech therapy

AND

assists individuals in conveying com concerns

To evaluate face & content validity for the CCABI, a survey of experts was conducted. It included each of the following groups except...
a) multidisciplinary referral sources
b) audiologists
c) SLPs
d) ABI people

audiologists

All are barriers to com rehab for those w/ ABI except...
a) shortage of SLPs
b) premature discharge from rehab
c) delay in service provision
d) substandard referral rates to speech therapy

shortage of SLPs

70-90% of TBIs are mild. These individuals access speech therapy services...

with referral from their community physician

All are factors which impact referral patterns to speech therapy expect
a) communication need
b) funding source
c) geography
d) referral source

communication need

anterograde amnesia

impairment in ability to encode, store, or retrieve declarative info AFTER injury

consolidation

time-dependent process stabilizing a memory trace in neural connections after initial acquisition

declarative memory

conscious, internal recollection of experiences (episodic memory) & info (semantic memory)

AKA explicit memory

distributed practice

breaking up practice into a series of shorter sessions

often done in an expanded rehearsal format w/ gradual increase in time interval b/w practice trials

elaboration

process encouraging a deeper level of processing than simply rehearsing

ex:) creating a visual image or trying to remember a special feature of target info

episodic memory

memory of biographical info (events, times, places, context) that can be explicilty stated

this + semantic memory = declarative/implicit memory

errorless learning

minimization of error responses during presentation of target stimuli

explicit memory

conscious, internal recollection of experiences (episodic memory) & info (semantic memory)

AKA declarative memory

impicit memory

retrieval occurs from long-term memory through related performances of tasks rather than conscious recall

AKA non-declarative memory

ex:) priming, procedural memory

long-term memory

memories as part of durable store

short-term memories move here through processes of repetition & association

maintenance

preservation of memories or skills over time

metacognition

knowledge about one's own thinking & ability to regulate functioning

ex:) using strategies to improve memory

non-declarative memory

retrieval occurs from long-term memory through related performances of tasks rather than conscious recall

AKA implicit memory

ex:) priming, procedural memory

posttraumatic amnesia (PTA)

state of confusion & inability to form new declarative memories after injury

usually improves over time, but duration determines recovery prognosis

procedural memory

form of implicit/non-declarative memory letting you perform an action

ex:) riding a bike, tying a shoelace w/o thinking

priming

process whereby exposure to an item influences the processing of the subsequent item

ex:) if shown the word "doctor", shortly after you'll recognize the word "nurse" much quicker

prospective memory

remembering to initiate intended actions at a future time

ex:) I know I need to take out the trash today at 3pm

retrieval

process of recovering an intended memory

usually through cues which bring memory into awareness

retrograde amnesia

impairment in declarative memory for info & events BEFORE injury

semantic memory

storage of accumulated concept-based knowledge

this + episodic memory = declarative/explicit memory

working memory

processes responsible for holding info in short-term memory

AKA temporary scratch pad for declarative/explicit memory

encompasses the processes necessary for holding onto & manipulating info

What is spaced retrieval training (SRT)? Why is it successful? What can you train?

evidence-based technique utilizing procedural memory to help dementia pts recall info

successfully uses intact implicit memory & errorless to optimize learning

you can train memory targets that are personal, functional, & consistent over time