dementia: speech and language changes

is dementia a normal part of aging

NO

10 warning signs of dementia

1. ________ that disrupts daily life.

2. Challenges in ______ or_________

3. Difficulty completing _______

4. Confusion with_____ or _____.

5. Trouble understanding _______ and _________

6. New problems with _____ in ______ or ______

7. ______ things and losing the ability to _________

8. Decreased or poor _______.

9. Withdrawal from ____ or _______.

10. Changes in _____ and ________

1. Memory loss

2. planning or solving problems.

3. familiar tasks.

4. time or place.

5. visual images & spatial relationships.

6. words in speaking or writing.

7. Misplacing; retrace steps.

8. judgment.

9. work or social activities.

10. mood and personality

Screening for Dementia in Primary Care

• Mini-Cog

• Memory Impairment Screen (MIS)

• 3-item recall (0-3 points)

• Clock Draw Test (0 or 2 points)

  • Negative screen: 4-5 points

  • Positive screen: 0-3 points

mini-cog

• 4-item recall (2 points each for free recall; 1 point each for cued recall)

  • Negative screen: 5-8 points

  • Positive screen: ≤4 points

memory impairment screen (MIS)

why would a short test (screener) may not be reflective of the client’s abilities?

• less opportunities/less data

• may be having a bad day- misdiagnosis/false red flag

FDA-approved treatments for AD: Address Symptoms

• acetylcholinesterase inhibitors

• n-methyl-d-aspartate (NMDA) receptor antagonists

inhibit the uptake of ACH

acetylcholinesterase inhibitors

neurotransmitter used to remember something

acetycholine

FDA-approved treatments for AD

“these treatments only delay ______

symptomatic progression

Cholinesterase Inhibitors for Mild Cognitive Impairment

9 RCTs (8 funded by pharma)

there is no convincing evidence that cholinesterase inhibitors have a …

beneficial effect on progression to dementia in patients with MCI

cholinesterase inhibitors can be used in:

• LBD

• PD

• vascular dementia

(selective seratonin reuptake inhibitors)SSRIs is commonly used in:

FTD

other related treatments

• antidepressants

• sleeping aids

• psychotropics (not FDA approved fr dementia)

language and speech changes in AD

may have word-finding difficulties along with impairment in other cognitive abilities

patients with AD respond well to ____

cues (in the early-stages; may be deeply embedded in the hippocampus)

language and speech changes in vascular dementia

acute receptive and/or expressive aphasia

language and speech changes in FTD behavioral variant: may have trouble with _______

action words

language and speech changes in FTD language variant

may initially be fluent, but becomes more effortful and halting

Tests that may help distinguish memory loss from speech problems (these need to be distinguished)

• Western Aphasia Battery – Revised (Kertesz, 2007)

• Boston Diagnostic Aphasia Examination

language changes in MCI

• __________ difficulty

• mild __________ in conversation ____ topics, questions)

• decrease or increase in __________

• abrupt _________ due to word retrieval problems

• word retrieval

• perseveration; repeat

• talkativeness

• topic shifting

language changes in AD

• difficulty comprehending _____ and ________

• _________ topics (due to disinhibition)

• tendency to interpret _____

• failure to recognize _____

• ______ comprehension problems

• production of _______ sentences (______)

• _______ and _______ errors

• _______ or _______ sentence structure

• ideas and instructions

• inappropriate

• literally

• humor

• reading

• meaningless (empty speech)

• semantic and phonemeic

• simplified or disorganized

how is language typically assessed?

• verbal fluency

• confrontation naming

• connected speech (picture)

• repetition

verbal fluency looks at ________ and _________ aspects

phonemic and semantic

“Tell me as many words as you can think of that begin with the letter “C

this is assessing…

phonemic verbal fluency

“Tell me the names of as many animals as you can think of, as quickly as possible.”

this is assessing…

semantic verbal fluency

shown black and white pictures (BNT) is used for

confrontation naming

example of connected speech task

example of traditional language tasks (naming)

While the prevalence of dementia increases with age, is it a normal part of aging?

no

Early diagnosis of dementia increases __________, reduces ________, and improves _______

access to resources; caregiver burden; quality of life

Alzheimer’s disease and related dementias are diagnosed ______; however, _______ are under investigation to aid in diagnosis

clinically; biomarkers

what can can aid in the timely diagnosis of dementia?

early identification of language and speech changes