Aphasia and Dementia

Aphasia

• acquired language disorder due to neurological damage affecting verbal expression and auditory comprehension.

• deficits in retention, visual com, orthographic & expression deficits

Aphasia is caused by damage to…

• language centers of brain

• right hand people language is in left hemisphere

• so aphasia results from damge to left hemisphere language areas (majority)

Aphasia is not…

1. Speech disorder

   • Language and speech are different.

   • Speech is the physical act of producing sounds (articulatory)

   • Speech disorders include apraxia and dysarthria

2. Cognitve disorder

   • Thought processes well preserved in aphasia

   • People with aphasia retain:

     • World knowledge

     • Personal histories

     • Ability to learn & remember

     • General intelligence

Causes of aphasia

1. Sudden Onset— cerebral vascular accident, closed head injury, tumor, anoxia, hypertension. & asteriosclerosis

2. Progressive Onset— Proressive neurological diseases like PD & infectious diseases like meningitis

T/F: Stroke is the most common cause of aphasia

true

Assessment of aphasia

1. Naming ability or presence of anomia

2. Word fluency in convo speech

   • Phonemic paraphasias: “tome” for phone

   • Semantic paraphasias: knife for spoon

   • Neologisms: timba for cup

3. Auditory comp

4. Word-sentece repetition

types of fluent aphasias:

1. wernicke

2. anomic

3. conduction

4. transcortical sensory

Wernicke’s area

comprehension of spoken, written, & signed lang

Wernicke’s aphasia

• fluent, but pauses for word retrieval / good syntax

• poor auditory and reading comp

• poor naming

• poor repetition

• semantic paraphasias common

• spontaneous speech lacks content

• jargon

• little error awarness

• location: posterior part of the left superior temporal gyrus

Anomia aphasia

• FLUENT & good syntax

• good auditory & reading comp

• good repetition

• poor naming

• NO paraphasias

• location: angular gyrus?

types of nonfluent aphasias

1. broca

2. global

3. transcortical motor

Broca’s area

Find the right words, get them ready to say before message sent to motor cortex

Broca’s aphasia

• NONFLUENT; telegraphic speech

• good auditory & reading comp

• poor naming

• agrammatic

• error awareness

• no paraphasias

• mechanically poor repitition

• writing ouput = oral output (may be )

• location: posterior inferior frontal gyrus

factors affecting recovery

• age

• general health

• physical health prior to event

• motivation

• lvl of education

• pre-stoke intelligence

What are the two key neural mechanisms for recovery of function in aphasia?

1. Restitution of function

   • Recovery happens through healing of the damaged area.

   • As the cortical area heals, neural pathways resume their function.

   • Therapy focuses on restoring lost functions by strengthening remaining connections.

2. Subsitution of function

   • Recovery occurs via functional reorganization of the brain.

   • The non-dominant hemisphere or previously uncommitted areas may take over the lost functions.

   • Therapy focuses on teaching compensatory strategies to

When to start therapy?

as soon as patient is medically stable or after spontaneous recovery has run its course

spontaneous recovery

• 3-12 month period post-injury when languag recovery occurs w/o intervention— bc brain heals & connection restored due to neural plasticity

aphasia therapy should…

• stimulate distrupted processes to promote functional reorganization

• teach use of compensatory strategies

• provide education & counseling

• promote a sutiable comm environment

Dementia

• group of symptoms of CNS degeneration resulting from progressive and persistent deterioration of intellectual functioning

• MEMORY most function affected

• hard to discern from other neurogenic lang impairments ike aphasia

Criteria for Diagnosis of dementia

1. Gradual onset & progression

2. Duration of at least 6 months or longer

3. Sustaied deterioration of memory + disturbance in at least 3 of:

   • orientation to time & place

   • judgment & problem solving

   • community affairs

   • home & avocations

   • personal care

T/F: For the people living with dementia, alzheimers accounts of most of the cases

true

Risk Factors for Dementia

• Increasing age

• family history

• being female

• ApoE4 gene

• Cardiovascular disease

• Vitamin defincies (A,C,E)

• previous head injuries

• lower ed

• lower verbal ability

Warning signs for dementia…

• memory loss

• difficulty performing familar tasks

• lang problems— lang form less common than lang content & use

• disorientation to time & place

• problems w/ abstract thought

• misplacing things in unsual places

• personality changes

• loss of initative

What are the causes of reversible dementia?

• Depression

• drug toxicity

• infection

• normal pressure hydrocephalus

• nutritional deficiences

• cardiopulmonary disorders

• resected brain lesions

What are the causes of irreversible dementia?

• Alzheimer’s

• PD

• Huntington’s disease (HD)

• Multi-infarction dementia

• AIDS

• alcoholic dementia syndromes.

Alzheimer’s Disease (AD)

• Memory impairment (both short-term and long-term)

• Breakdown in higher cortical functions (e.g., abstract thinking, judgment)

• Personality changes

• Progressive decline in cognition, memory, and language

• Excludes other specific causes of dementia through history, physical examination, and lab studies.

T/F: Brain atrophy occurs in Alzheimer’s

• True, as it progresses, it kills brain cells mainly in the hippocamus & cortex, leading to impairments in learning, memory, & thinking

How AD differentiates from aphasia

1. Alzheimer’s Disease (AD):

   • Language deteriorates w/ cognitive & memory skills.

   • Improvement not likely

   • Cognitive reorganization is not possible.

2. Aphasia:

   • Language problems are more severe than overall intellectual and memory abilities.

   • Language deficits typically improve with treatment.

   • Clinicians can use intact cognitive processes to reorganize the language system

Role of SLP in dementia

• To aid in the assessment of the disorder

• To differentiate btw language disorders associated with dementia and other types of language disorders frequently seen in the elderly population

• To determine the level of the language deficits & the progression of the dementia

• To evaluate the patient’s communication needs

• To make any appropriate referrals

FOCUSED strategy:

Use to facilliate com in a person w/ dementia

• Face person, get their attention, call their name, eye contact

• Orient person to topic by repeating key words

• Continue on same topic as long as possible

• U Help patient get unstuck, give them word they can’t recall

• Structure ?’s to person can repeat response, provide choices, y/n ?

• E Keep normal exchange of ideas, say “that’ nice” to keep convo going, do not “test” person

• D Keep sentence short and direct, repeat nouns, use gestures, facial expressios