Exam 2

What is primary progressive aphasia?

Neurodegenerative disorder characterized by a gradual deterioration of speech and language abilities and a relative sparing of non-language cognitive skills early in disease progression

What are the three PPA subtypes?

1. semantic variant

2. logopenic variant

3. nonfluent variant

Semantic Variant PPA (svPPA)

hallmark= loss of meaning of words 

behavioral symptoms include compulsions, disinhibition, personality changes, and altered eating preferences 

What are the two core clinical features of svPPA?

1. picture naming deficit 

2. single word comprehension deficit 

Logopenic Variant PPA

Jargon-like productions (paraphasias)

Impaired phonological processing

Comprehension deficits

episodic memory impairment

Underlying pathology: AD

What are the two core clinical features for lvPPA

1. difficulty with single word retrieval in both spontaneous speech and picture naming 

2. Phrase and sentence repetition deficit 

Nonfluent variant PPA

Apraxia and agrammatism

mutism 

dysphagia can develop

underlying pathology: FTLD-tau

What is relatively preserved in Nonfluent Variant PPA?

comprehension of single words and object knowledge

Mixed PPA is most often seen with what pathology?

Alzheimer’s

How to assess PPA?

Standard aphasia batteries may be used, but classifications developed for stroke-induced aphasia (e.g., Broca’s aphasia) not appropriate. 

Extralinguistic cognitive domains should also be evaluated.

svPPA and lvPPA treatment 

Lexical retrieval treatment 

practicing saying or writing a word while looking at its picture or use a cueing hierarchy 

nfvPPA treatment

• lexical retrieval treatment

• grammar treatment

• motor speech treatment

• script training

Neuromodulation

using noninvasive brain stimulation to help improve language in PPA. Two types- Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS).

Dementia definition

acquired, persistent impairment of multiple cognitive domains that significantly alters communication, social interaction, occupational function, and the ability to perform instrumental activities of daily living

Mild Cognitive Impairment (MCI)

is a preclinical condition that may suggest a person is at risk for developing dementia. aka a transition stage or condition of intermediate symptoms

3 criteria for diagnosing MCI

1. self-report of memory problem 

2. impairment on standardized assessment 

3. no impairment in reasoning, general thinking skills, or ability to perform ADLs 

2 types of MCI 

1. Amnestic (concerning memory functioning)

2. Non-amnestic (not concerning memory function)

Types of dementia

• Alzheimer’s 

• Vascular 

• Lewy Bodies 

• Frontotemporal 

• HIV associated 

• Mixed 

AD symptoms

• episodic memory deficits 

• working memory deficits 

• attention and EF impairment 

• lexical retrieval and discourse impairments 

A diagnosis of VAD requires:

• evidence of cardiac and/or other vascular conditions 

• evidence of cerebrovascular disease tied to onset of dementia symptoms 

• focal neurological s/s

• Brain imaging (ischemic, hemorrhagic, or white matter lesions)

DLB is biologically related to __

PD

Both conditions share pathological hallmark of the presence of Lewy Bodies 

DLB symptoms 

• hallucinations 

• visuospatial impairment 

• sleep disturbance 

• EF impairments 

• Gait imbalance or PD movements 

• reduced speech rate and fluency 

Early symptoms of FTD develop in one of three domains:

1. personality and behavior 

2. speech and language 

3. movement and motor skills 

FTD types

1. behavioral variant

2. language variants (PPA)

3. Motor variants (e.g. CBS, PSP)

HIV-Associated Neurocognitive Disorders (HAND) symptoms

• deficits in attention, concentration, and memory 

• slowed movements, low motivation, depression, irritability 

• does not have typical course or definitely progress to dementia 

What are some standardized tests for assessing performance in dementia?

RBANS

DRS-2

CLQT+

Functional assessments for dementia 

Communication Activities for Daily Living (CADL-3)

Functional Linguistic Communication Inventory (FLCI-2)

Rivermead Behavioral Memory Test (RBMT-3)

Dementia treatments

• spaced retrieval

• memory books

• reminiscence therapy

• music-based interventions

• Montessori-based dementia programming

Dementia treatment can be broken up into

• pharmacological vs non-pharmacological interventions

• direct vs indirect interventions

TBI definition

An acquired injury to the brain due to an applied force that results in widespread damage to cortical and subcortical structures

Glasgow Coma Scale

Provides a standardized means to measure severity of impaired consciousness via three components:

1. eye opening best response (arousal)

2. best motor response (awareness)

3. best verbal response (awareness)

Post traumatic amnesia

the time between injury and recovery of continuous memory—ability to remember events for a 24-hour period (Return of memory for day-to-day events is last stage in restoration of consciousness)

Coma

No detectable signs of awareness

No sleep-wake cycles

Lasts for a maximum of 2-3 weeks; then shift diagnosis (not necessarily status)

Vegetative state

Appearance of sleep-wake cycles

Spontaneous eye opening

No evidence of communication

Persistent vegetative state

Vegetative state has persisted for more than 1 month with no functional change

Minimally conscious state

Inconsistent control of voluntary movements or behaviors (some voluntary movement)

Visual tracking (follow person or object in room)

Inconsistent following of commands

Communication via yes/no verbal or gestural responses

T/F Individuals with TBIs usually demonstrate self-awareness and theory of mind deficits 

True

List some measures for early assessment for TBI patients

glasgow coma scale 

post traumatic amnesia 

GOAT or COAT 

Galveston orientation and amnesia test (GOAT)

Developed to standardize the evaluation of PTA and retrograde amnesia

Ten questions concerning orientation to time, person, and place; retrograde amnesia; and anterograde amnesia

Should be administered at least once daily (simple questionnaire)

Scales/checklists in TBI

• ranchos los amigos levels of cognitive functioning 

• functional independence measures (FIM)

• disability rating scale 

Self-report and QOL TBI measures

Behavior Rating Inventory of Executive Functioning (BRIEF-A)

Quality of Life after Brain Injury (QOLIBRI)

National Institute of Health Toolbox Measures

Brain Injury Screening Questionnaire (BISQ)

Mayo-Portland Adaptability Inventory (MPAI)

Motivational Interview Techniques

Functional assessment in TBI

observation

discourse analysis 

Multiple errands test or Party Planning Task