SLP 568 - Quiz 2

brain tumors

- occupying masses that displace neural structures

- may not cause neuronal damage for long periods of time

brain tumors are classified by the...

microscopic structure of their tissues and unique characteristics at molecular level

neurons

receive and transmit electrical signals by sending information throughout the nervous sytem

glial cells

- surround, insulate, and supply nutrients/oxygen to neurons

- outnumber neurons

types of glial cells

astrocytes, oligodendrocytes, microglia, ependymanl cells

glioma

neuroepithelial mass caused by uncontrolled and abnormal proliferation of glial cells in the brain

gliomas may not affect neuron functionality for...

a long time after onset

gliomas may vary from...

nonmalignant (grade I) to highly aggressive (grade IV)

low-grade gliomas represent approximately _____ of all gliomas

15%

glioblastomas account for about _____ of all gliomas

half

glioblastomas (GBM)

malignant (grade IV) tumors

neuroplasticity

ability of the brain to constantly reorganize itself in the short-term and long-term

neuroplasticity takes place during...

learning and repairing after injury

postlesional plasticity after...

injury of peripheral or central nervous system

slow growing brain tumors trigger...

reorganization of language cortical areas, allowing patients to be free of overt symptoms over long periods of time

how does the reorganization of language cortical areas work?

- intrinsic reorganization within injured areas

- recruitment of perilesional structures

- recruitment of other regions involved in the language network

- recruitment of the contralateral hemisphere

strokes are more common than _____ in the US

brain tumors

language disorders are more common in ______ than in stroke patients

primary brain tumors

anomic aphasia is the most common subtype due to...

brain tumor occurrence (before surgical treatment)

iatrogenic speech/language disorders caused by surgical treatment are usually...

mild and transient

_____ is the most common early symptom of brain tumors

language impairment

_____ of patients with exhibit aphasia symptoms before the tumor is diagnosed and _____ after tumor resection in L hemisphere

1/3, 1/3

most common speech/language errors associated with tumors

- semantic and phonological paraphasias

- anomia, circumlocutions

- low MLU, syntactic errors

_____ of patients will develop some form of cognitive disorder at some point during primary brain tumor disease

90%

severity of cognitive impairment is associated with...

characteristics of tumor (location, size, histopathology) and patient (age, physical condition)

cognitive deficits in brain tumor patients

- attention, WM, inhibition

- social cognition

- initiative, abstraction, flexibility

- decision making

awake craniotomies

- resecting "according to functional boundaries of the tumor"

- brain mapping to preserve QOL (language, motor, sensory areas of brain)

direct electrical stimulation (DES)

- electrical current administered directly to brain surface

- creates a functional map

awake crani: pre-op sLP consult

1 week prior to surgery

awake crani: pre-op goal

- communication baseline

- counseling

- ret reference point for post-op outcomes

- guide intra-op paradigms

awake crani: pre-op testing

- oral mech, DDKs

- WAB-R, BNT

awake crani: pre-op counseling

- potential post-op language deficits

- post-op intervention

- course of recovery

- patient's priorities

awake crani: pre-op mapping paradigms

- visual object naming, verbal naming, auditory descriptive naming, reading descriptive naming

- math calculation, non word repetition, Stroop tasks

- 20-60 targets

- goal of 90% accuracy

awake crani: intra-op starts when...

- optimal positioning

- extubated, awakened, and alert

- baseline of mapping paradigms are reestablished

awake crani: intra-op testing

verbal and visual tasks during stimulation by the surgeon and language monitoring by the SLP

a cortical area is considered eloquent if...

a motor response or twitch is generated and/or if language errors are made consistently on at least 2 separate trials

awake crani: during time of resection

- SLP continuously monitors language function

- intermittent repetition of mapping tasks

awake crani: post-op

12-48 hours after surgery, in acute care setting

awake crani: post-op testing

- automatic speech tasks, immediate environment object naming, y/n questions, simple repetition tasks

- oral mech, motor speech, DDKs

awake crani: post-op deficits

can be caused by retraction, edema, or resection of eloquent brain tissue, and are usually considered transient and improve quickly

awake crani: post-op cueing

- avoid communicative frustration

- probe responsiveness to cues for areas of potential therapeutic benefit

awake crani: post-op counseling

- language function

- communication strategies

- potential for improvement

- possible need for speech/language tx

cognitive and linguistic rehab goal

enhance successful daily functioning and independence and reduce impairment

types of rehab: direct restorative tx

reinforcing, strengthening, or reestablishing previously learned patterns of behavior (restoration)

types of rehab: functional contextualized tx

establishing new patterns of cognitive activity (neuroplasticity)

types of rehab: compensatory tx

compensating for impaired neurological systems

what to consider with terminal patients

- speech/lang services

- assistive tech

- AAC

computer-based training shows promise for improving...

executive functions

exercise (aerobic, yoga, strength training) is linked to improve...

neural activity and brain-behavior outcomes like attention and inhibition

cognitive decline can still occur within...

normal aging

language in healthy aging

- slight decline in word finding and syntactic complexity

- no change in comprehending everyday discourse

attention in healthy aging

- sustained attention mostly intact

- slight decline in selective attention (esp. in loud environment)

- divided attention intact during simple tasks, but breaks down in complex tasks

reaction time in healthy aging

slowed

memory in healthy aging

- LTM and procedural intact

- reduced STM

mild cognitive impairment

changes that are significant enough to be outside the normal spectrum of changes with age but doesn't affect ADLs

MCI may increase the risk of...

later progressing to dementia

MCI prognosis

- some progress to dementia

- some never get worse

- some eventually get better

what to do for MCI that's likely to worsen

- pt can do things to slow down decline (physical activity, social engagement)

- clinician can prepare/educate pt and family members

MCI arises from...

a lesser degree of the same types of brain changes seen in AD or other dementias

MCI in the brain

- small strokes or reduced blood flow through brain blood vessels

- shrinkage of hippocampus (important for memory)

- enlargement of ventricles due to neuron loss

MCI symptoms

- decreased sustained attention, word finding abilities, STM, episodic/semantic memory

- EF difficulties

- difficulties following detailed convos/writing

- no functional impairment

- no significant occupational/social impairment

3 criteria for diagnosing MCI

1- self report of cognitive decline, with corroboration from family member or caregiver

2- measurable cognitive impairment on standardized testing, outside expected age/education range

3- functional independence and ADLs are unaffected

2 types of MCI

- amnestic

- non-amnestic

amnestic MCI

- memory impaired

- most common

- majority of clients with amnestic MCI progress to AD

non-amnestic MCI: single domain

- attention/EF impaired

- relatively isolated impairment in a single non-memory domain (i.e. EF, visuospatial)

non-amnestic MCI: multiple domains

- slight impairment in multiple non-memory domains

- not enough to constitute dementia

mild neurocognitive disorders

- MCI

- evidence of modest cog decline

- does not interfere with independent completion of ADLs

major neurocognitive disorders or dementia

- significant cog decline

- disrupts independence in ADLs

dementia

- group of symptoms, not a stand alone etiology

- chronic, persistent cog disorder causes by brain injury or disease

- severe enough to interfere with an individuals functioning/daily life

cog domains affected by dementia

- memory, EF, attention

- language

- visuospatial

- instrumental ADLs

progressive types of dementia

- Alzheimer's disease (AD)

- frontotemporal dementia (FTD)

- Lewy Body dementia (LBD)

potentially reversible/stoppable types of dementia

- medication-induced

- metabolic, endocrine, nutritional, systemic

- vascular dementia, hydrocephalus, tumors, hematoma

- depression

Alzheimer's disease (AD)

most common dementia type

neuropathology of AD

- beta-amyloid plaques: dense protein deposits that accumulate outside and around neurons

- neurofibrillary tangles: twisted fibers of tau protein that build up inside neurons

- general neuronal atrophy: shrinking of cortex and widening of ventricles

modifiable risk factors for AD

- heart healthy diet

- social/cognitive engagement

- regular physical activity

- controlling cardiovascular risk

- preventing TBI (modifying home environment)

nonmodifiable risk factors for AD

- older age

- positive family history (esp. in 1st degree relatives)

- carrier status for the e4 allele of APOE gene

preclinical AD

- no symptoms

- possible biological changes in the brain

MCI due to AD

- very mild symptoms

- may or may not interfere with some everyday activities

mild dementia due to AD

symptoms interfere with some everyday activities

moderate dementia due to AD

- symptoms interfere with many everyday activities

- difficult to make meaningful comments

severe dementia due to AD

- symptoms interfere with most everyday activities

- usually nonverbal

earliest of symptoms of AD

- episodic & working memory deficits

- impairments in attention/EF

- lang/comm impairments adversely affecting word retrieval and discourse

AD: mid stage

- negative impact of ADLs and reliance on others

- more severe memory loss and dramatic personality changes, - deficits in attention, visuospatial, expressive lang

- wanderlust, sundowner, disorientation, confusion

AD: late stage

- loss of motor function

- may be non-ambulatory, bedridden, incontinent, unresponsive

- deficits in memory, cog, and expressive lang are profound

- may cause dysphagia, nonverbal

vascular dementia (VaD)

- second most common cause of dementia

- caused by cerebrovascular disease, cardiovascular disease, or circulatory disturbances that damage brain areas vital for memory and cognitive functions

risk factors for VaD

similar to AD

people with vascular dementia may worsen faster than...

those with AD

symptoms of VaD

- confusion and episodic memory impairments

- slowed processing

- wandering or getting lost in familiar places

- rapid, shuffling gait

- loss of bowel/bladder control

- emotional lability

- difficulty following instructions

- problems handling money

a diagnosis of VaD requires

- objective evidence of cardiac and/or other systemic vascular conditions

- evidence of cerebrovascular disease etiologically tied to onset of

dementia symptoms

- focal neurological signs and symptoms (e.g., difficulties in movement, sensation, or speech-language)

- brain imaging evidence for ischemic, hemorrhagic, or white matter

lesions on CT or MRI scans

frontotemporal lobar degeneration (FTD)

heterogenous group of rare neurodegenerative disorders that result in significant impairments of behavior, personality and distinct types of language impairment

hallmark symptoms of FTD

progressive decline in behavior and/or language

FTD is _____ and has a _____

rapdily progressive; strong genetic component

neuropathology of FTD

-progressive, focal atrophy of the frontal and anterior

temporal brain regions

- spongiform changes in the cortex

- abnormal tau protein inclusions

types of FTD

- behavioral variant (bvFTD)

- language variant/primary progressive aphasia (PPA)

- motor variant (mvFTD)

behavioral variant of FTD (bvFTD)

- most common form

- personal changes, apathy

- progressive decline in socially appropriate behavior, judgment, self-control, and empathy

- lack of awareness or concern for effect of behaviors

- cog decline is less dramatic than behavior disturbance

ALS is most commonly associated with...

bvFTD

language variant of FTD / primary progressive aphasia (PPA)

- episodic memory functions remain largely preserved for many years

- most salient symptom is the language impairment, eventually followed by cognitive decline

- pts maintain/intensify involvement in complex hobbies

diagnostic criteria of PAA

- gradual onset of language problems, isolated in initial stages of disease

- impaired ADLs related to language deficit

- no initial prominent visuospatial, episodic memory deficits, or behavioral disturbances in first 2 years

- impairment not explained by stroke, tumor, TBI, or other condition

types of PPA

- semantic variant (svPPA)

- nonfluent/agrammatic variant (nfvPPA)

- logopenic variant (lvPPA)

semantic variant PPA (svPPA)

- loss of semantic knowledge

- picture naming deficit

- single-word comprehension deficit

- comprehension is better in context

- not super aware of errors