Lecture 2 - Principles of Language Ax in Dementia

Ax types of dementia include

screening (e.g. in acute care settings to see why a patient speaks incoherently)

diagnostic

planning for treatment and measuring outcomes

follow-ups/tracking changes

important points to ask about in case history

• name/DOB/age

• vision, hearing

• handedness

• native language/other languages; when learned and where spoken?

• contact person and power of attorney

• history of present illness

• functional independence

• medical history

• social/occupational history

what factors will you look at for ‘history of present illness’ section of case history

• presenting symptoms, time of onset, rate of progression, changes over time (decline typical of dementia; improvements not typical and may be attributed to something else)

• medical/diagnostic procedures completed (dates and results)

• speech and language complaints, SLP intervention in the past

• history of nutrition and swallowing problems

• if possible, get history from at least one additional/reliable source

what factors will you look at for ‘functional independence’ section of case history

basic (e.g. dressing, eating, hygiene) and instrumental (e.g. driving, finances) activities of daily living

what factors will you look at for ‘medical history’ section of case history

• family history of - memory problems, vascular disease, mental health issues, AD or Down’s syndrome

• vascular risk factors - high blood pressure, diabetes, obesity, high cholesterol level

• past illnesses and surgeries (head injuries in particular)

• medications (possible speech/language/cognitive effects)

• alcohol consumption

what factors will you look at for ‘social/occupational history’ section of case history

• use of native/other languages

• how long in Canada (if relevant)

• level of education

• previous occupation(s)

• hobbies and interests (for designing therapy)

• reason for retiring (if retired)

• living arrangements (involve social worker if living alone)

• family members involved in care

• support systems in place

what will you assess when looking at verbal pragmatic skills

• variety of speech acts (e.g. asking questions, commenting, responding with just yes/no)

• topics (e.g. introduction, maintenance)

• turn taking

• lexical selection (non-specific language use, substitution of sounds)

what will you assess when looking at non-verbal pragmatic skills

• physical proximity

• kinesics (e.g. body language, eye contact) — limited eye contact/blinking characteristics of PD and progressive supranuclear palsy

what will you assess when looking at spontaneous speech

assessed throughout the interview and on various tasks

• fluency

• word/sound substitutions (phonemic or semantic paraphasias)

• motor speech problems (e.g. dysarthria and of what type)

• types of errors

• syntax

• cohesion

“forgetting parts may sound cool”

what test batteries can be used to assess spontaneous speech?

Boston Naming Test (BNT), Western Aphasia Battery (WAB), Boston Diagnostic Aphasia Examination (BDAE), etc.

what will you assess when looking at verbal expression

• picture description

• narrative

• oral repetition of words/nonwords/sentences - can tell us about appearance of AOS

• picture naming - most with language disorder have trouble with this

• responsive naming

• automatic speech

“PRO NAP” - always talking about how a nap is a good idea

what’s the difference between confrontation naming and responsive naming

confrontation: naming test, presenting a picture and asking ‘what is this?’

responsive: asking a question (e.g. where do you buy medicine?) - this is sometimes easier

what are some standardized assessments for functional communication?

• ASHA - functional assessment of communication skills for adults (FACS)

• SIB - severe impairment battery

• FLCI - functional linguistic communication inventory

what will you assess when looking at auditory comprehension

• comprehension of conversational speech

• auditory word recognition

• sentences of varying length and/or grammatical complexity

• yes/no questions

• paragraph length material

“CASPY”

what is an important distinction to make when assessing auditory comprehension

whether the patient has trouble with auditory comprehension or whether they have a hearing loss

what will you assess when looking at reading and reading comprehension

• premorbid reading skills/habits

• mechanics of reading (ease and speed of decoding)

• single words (regular, irregular, non-words) - may help identify dyslexia types

• sentences (various morphosyntactic structures and levels of complexity)

• oral reading of paragraph-length material (e.g. grandfather passage, rainbow passage)

• reading comprehension (time, accuracy, comprehension)

differences between surface, phonological and deep dyslexia

surface - difficulty recognizing whole irregular words that do not have one-to-one correspondence

phonological - difficulty with unfamiliar words or nonwords; real words usually read correctly

deep - can read regular/irregular words, cannot read nonwords and makes semantic errors/substitutions (e.g. reads the word “cat” aloud as “dog”)

what will you assess when looking at written expression

• premorbid writing skills/habits

• mechanics/functional writing

• copying words/sentences

• writing to dictation (regullar, irregular and nonwords)

• written picture description

• free narrative

differences between surface, phonological and deep dysgraphia

surface - spells regular and irregular words phonetically, how they hear it; not with the correct spelling

phonological - can spell familiar regular/irregular words; struggle with nonwords or unfamiliar words

deep - semantic errors (e.g. for ‘photograph’, they may write ‘camera’)

what will you assess when looking at cognitive screening

• orientation

• insight

• attention and concentration

• memory (autobiographical, remote, recent)

• learning (encoding, storing/retrieval of verbal info - e.g. story retell)

• visual-perceptual skills

• judgement

• abstract thinking

• can ask the patient to draw a clock - good insights into cognitive function

“o i am learning very joyfully actually”

what will you assess when looking at lexical semantic knowledge (verbal)

• word-picture matching

• receptive vocab (PPVT good for this)

• lexical decision (deciding whether string of words are real words or nonwords)

• synonym judgement

• semantic associations

• word definition

what is the prevalence of semantic impairment among individuals with AD

up to 30% of people with mild-moderate AD

what will you assess when looking at nonverbal semantic knowledge

• cactus and camel test (which of the 4 pictures is associated with the target item?)

• colour-selection test (select the correctly coloured item for each pair)

• object matching test (find the correct recipient for the shown first item) - e.g. potato masher associated with..

• categorization task (various instructions as needed) - e.g. show me the vehicles that fly in the air, have wheels, etc.

the basic components of an SLP dementia assessment include…

• interview (including collateral input)

• language testing

• cognitive screening/functional ability

what is the main purpose of interviews in Ax

to gather info about general status, behaviour, personality and establish context for potential intervention

what is the main purpose of language testing in Ax

to identify strengths/weaknesses/impairments

what is the main purpose of cognitive screening/functional ability

to evaluate potential for therapy/learning