CD484 -- Dementia Quiz

dementia

an acquired global loss of brain function with slow, gradual onset

Alzheimer’s Disease

what is the leading cause of dementia? it causes 60-80% of cases

memory loss plus one additional deficit in an area that affects ADLs

how does one qualify as a dementia patient?

delirium

sudden disturbance in consciousness or change in cognitive ability that fluctuates throughout the course of the day

other medical conditions

what usually causes delirium?

mild cognitive impairment

more severe changes noted than those associated with normal aging, but not severe enough to affect ADLs

decreased ability to concentrate

decreased word-finding abilities

decreased short-term memory

difficulty following detail-heavy conversations

symptoms of mild cognitive impairment

assess and treat cognitive communicative deficits that are a result of dementia

recognize, diagnose, and provide treatment for cognitive, communicative, or swallowing deficits as a result of dementia or dementia-producing illness

what is an SLP’s role with dementia?

language remains intact

sustained attention remains mostly intact

divided attention skills intact during simple tasks

long-term memory and procedural memory remain intact

what areas do not suffer deficits with normal aging (what remains intact)?

slight decline in word-finding abilities

slight decline in selective attention skills

divided attention begins to decline in complex tasks

reaction time is slowed

episodic and short-term memories are reduced

what are some deficits that ARE present in normal aging?

cortical dementias, subcortical dementias, mixed dementias, other considerations

what are some etiologies of dementia?

alzheimer’s

frontotemporal dementia

pick’s disease

kinds of cortical dementias

huntington’s disease

subcortical dementia example

vascular dementia, lewy body disease, progressive supranuclear palsy

kinds of mixed dementias

parkinson’s disease and dementia with lewy bodies

what are the two kinds of lewy body dementias?

drug-induced and depression

what are some other considerations for dementia etiologies?

Alzheimer’s Disease

most common cause of dementia

cortical

progressive and fatal

after age 65

when is the usual onset for Alzheimer’s?

neurofibrillary tangles

amyloid plaques

granulovacuolar degeneration

general neuronal atrophy - shrinking of cortex and widening of ventricles

what does the neuropathology of alzheimer’s include?

clinical signs, autopsy, or Pittsburgh Compound test

how is alzheimer’s diagnosed?

women, family history, history of depression, previous head trauma, education level

risk factors for alzheimer’s disease

early stage

which stage of alzheimer’s is this:

motor function retained

short-term memory loss, word-finding difficulties, comprehension of verbal language deficits, personality changes

lasts about 2 years on average

mid stage

what stage of alzheimer’s is this":

negative impact on ADLs and increased reliance on caregivers

more severe memory loss, attention deficits, dramatic personality changes, visuospatial/visuoconstructive deficits, expressive language deficits

possible wandering, sundowner syndrome, disorientation, confusion

lasts from 4-10 years

avoid messy environments, make sure items are put away neatly and in an organized manner

how can we help with mid-stage alzheimer’s patients experiencing visuospatial and visuoconstructive deficits?

late stage

what stage of alzheimer’s is this:

loss of motor function

memory, cognition, expressive language deficits are profound

muteness or dysphagia

what can profound memory, cognition, and expressive language deficits in late stage alzheimer’s patients cause?

frontotemporal dementia

dementia caused by degeneration of the frontal and temporal lobes

pick’s disease, primary progressive aphasias, progressive nonfluent aphasia, semantic dementia

what does fontotemporal dementia include?

pick’s disease

dementia resulting from progressive degeneration of frontal and temporal lobes

early personality changes, antisocial/inappropriate behavior, memory loss

what is pick’s disease characterized by?

women 50-70 years old

who is usually affected by Pick’s disease?

notable behavioral, emotional, and personality changes without significant language deficits

what differentiates pick’s disease from alzheimer’s disease early on?

frontal lobe degeneration

why does pick’s disease present with such notable behavioral, emotional, and personality changes?

cognitive decline

what can be noted (besides personality changes) with the progression of pick’s disease?

huntington’s disease

subcortical dementia

progressive terminal illness characterized by distinctive involuntary erratic body movements

huntington’s disease

involves degeneration of basal ganglia, hippocampus, substantia nigra, and purkinje of pons

stages one and two

stages of huntington’s disease:

motor symptoms of chorea

emotional problems

difficulty concentrating/memory problems

problems with executive functioning

sleeping/swallowing difficulties

stages two, three, and four

stages of huntington’s disease:

chorea and hyperkinesis that interfere with speech production and swallowing

train on AAC devices

what should huntington’s patients do during stages two, three, and four to prepare for future loss of verbal and written expression?

stage five

stages of huntington’s disease:

nonambulatory

rigidity

bradykinesia

incoordination

total dependence

high risk of aspiration

use of AAC systems

vascular dementia

second leading cause of dementia

vascular dementia

mixed dementia caused by small ischemic strokes within the cortex, subcortex, or both

memory loss, aphasia, apraxia, difficulties with executive functioning

cognitive deficits associated with vascular dementia

lewy body disease

dementia that results in neuropathological changes in the brain due to the presence of lewy bodies in cell body of neurons

Parkinson’s disease

dementia in which patients present with motor abnormalities such as rigidity, tremor, slowness of volitional movement, and cognitive deficits

motor abnormalities at rest, bradykinesia, mask-like facial expressions, difficulty initiating movements for speech, festinations, paresthesia, micrographia

characteristics of parkinson’s

micrographia

small, cramped handwriting

festinations

speeding up repetitive movements (such as shuffling feet while walking)

paresthesia

burning feeling in skin/extremities

dementia with lewy bodies

combination of overall decrease of volitional movement and difficulty initiating motor movement alongside cognitive deficits

significant sleep disturbances and hallucinations/delusions

what are some key characteristics of dementia with lewy bodies?

progressive supranuclear palsy

rare neurodegenerative disorder involving degeneration of the frontal lobe, basal ganglia, and cerebellum

men above the age of 60

who is most affected by progressive supranuclear palsy?

ocular motor problems, personality changes, executive functioning, memory, attention, apathy, impulsivity, balance, dysarthria

issues people with PSP may suffer from

3-5 years

what is the life expectancy for someone with PSP

related causes such as asphyxiation or dysphagia

why do most dementia patients end up passing away?

detailed case history, review of medical chart, interview with family and patient

what should be included in an assessment of dementia?

auditory assessment, motor status, cognitive ability, emotional status, education level, occupation, problem solving ability, living arrangement, impact on safety awareness, reason for referral

what should be included in dementia assessment case history?

toileting, communicating pain level, visiting with family

how could communication affect ADLs?

mini-mental state exam, alzheimer’s disease assessment scale, global deterioration scale, dependence scale, geriatric depression scale

dementia rating scales often used:

slow progression or reduce symptoms

what can medicine do for dementia?

improve quality of life and ensure individual is operating at highest level

reduce demands on impaired abilities

increase use of intact cognitive abilities

caregiver training

provide stimuli that evoke positive emotion and memories

therapy for patients with dementia should…

maximize the potential for participation

when trying to ensure an individual is operating at the highest level possible, we are trying to…

they can all be skilled interventions, but with progressive diseases we can’t just see a patient forever for the same intervention

there are more options early on

things to keep in mind when deciding therapy strategies for dementia

assistive technology

dementia therapy strategy that may use AAC or other non-communication related strategies to assist in ADLs

reminiscence therapy

therapy strategy that uses a semi-cued conversation about past events, experiences, and activities to increase orientation and recall pleasant long-term and episodic memory

cognitive simulation therapy

group therapy for mild-moderate dementia that uses themes, mental stimulation, and activities that improve cognitive function

errorless learning

therapy strategy in which patients are provided with information at a difficulty level within the ability of the patient to maximize patient success and minimize patient failure

spaced retrieval training

therapy strategy: presentation of new or previously known information that must be recalled over increasingly greater intervals of time

memory prostheses

therapy strategy: external memory aids such as memory books/wallets, calendars. smart phones, or personal digital assistance to augment memory

Montessori approach

therapy approach: supports interests and needs by structuting the environment in a certain way and encourages them to remain independent as long as possible

simulated presence therapy

therapy strategy that is aimed to reduce anxiety and challenging behaviors by using audio voice recordings of loved ones

cognitive, visual, auditory

cognitive changes that can be made in therapy

life history videos

therapy strategy that uses custom-made videos that provide audiovisual presentation of personal facts and past events to increase orientation and decrease confusion