Primary Progressive Dementia

positive impacts of aging

• lifelong storage of semantic, procedural and episodic memories

• brain experience specialization in areas of cognitive and linguistic strength

aging cognition

• processing speed may slow

• working memory ay decline in complex tasks

• more effortful recall of episodic memory

• semantic memory largely preserved or expanded

elderspeak

speaking to an elder as if they were a child

• talk louder, slower and more motherly

• is demeaning and can have negative influence on communication with patient

mild cognitive impairment (MCI)

condition of cognitive decline that is not consistent with normal aging (typically does not include aphasia)

• impairment in at least one domain (memory, attention, language, executive functioning)

• associated with neurodegenerative changes, not injury

• often progresses into dementia but not always 

• 3 subtypes 

  • amnesic

  • single domain

  • multiple domain

MCI: amnesic

most likely associated with conversion to Alzheimer’s disease 

• episodic memory impairment 

MCI: single domain

prominent deficits in a non-memory domain such as

• executive function

• language

• visuospatial ability

only one domain impaired

MCI: multiple domain

involvement of multiple cognitive domains and may occur with or without memory impairments 

dementia 

major neurocognitive disorder (MND)

• aquireed and persistent impairment of multiple cognitive domains of sufficient severity to limit competence

• domains include

  • memory

  • language

  • attention

  • executive function

  • visuospatial abilities

DSM criteria for MND

1. significant decline in multiple domains 

2. impairment in daily activities and independence 

3. decline is not due to delirium 

reversible symptoms

symptoms may be reversible if causes by issues like:

• untreated depression

• normal pressure hydrocephalus

• vitamin or nutritional deficiency

• some medications

• thyroid disease

• metabolic cause

assessments for dementia

• cognitive screeners

• informal cognitive screening tasks

• caregiver report measures

• formal assessment

dementia types

• alzheimer’s disease (AD)

• vascular dementia (VaD)

• dementia with lewy bodies (DLB)

• frontotemporal degeneration (FTD)

alzheimer’s criteria

• an insidious onset (months to years)

• clear history of worsening cognition

• amnestic or non-amnestic cognitive deficits

alzheimer’s

• severe memory loss, loss of control and mobility, aggressive or delusional behavior

• most common type of dementia

• progressive diffuse brain atrophy and neuritic plaque

• start in medial and anterior temporal lobes

VaD criteria 

• decline in two ore more domains of cognitive functions 

• imaging evidence of cerebrovascular disease 

• temporal relationship between occurrence of vascular event and onset of cognitive deficits 

• no history of gradually progressive cognitive deficits 

VaD

• onset can be from vascular event

• caused by problems of blood supply to the brain

• progression of cogntive-communication symptoms either sudden spurts or slow and continuous

• often have slow gait, poor balance, more frequent falls

DLB

presence of lewy bodies that balloon, clump of neuronal protein that build up in the cerebral cortex

• sleep disturbances, hallucinations, fluctuating attention, reduced speech rate and fluency

• symptoms occur in the absence of significant memory impairment

parkinson’s 

DLB and parkinson’s biologically related, showing presence of lewy bodies 

• combo of cognitive impairments and extrapyramidal signs 

• dementia occurs only in some people with parkinson’s 

FTD

umbrella term for neurodegenerative conditions caused by atrophy of the anterior frontal and temporal lobes  

• onset 45-60 years old

• isolated speech and language impairments earliest symptoms 

  • primary progressive aphasia used when speech and language deficits present for 2 years

• 3 types

  • behavioral

  • language

  • motor

dementia intervention 

• train compensatory strategies 

• direct treatment 

• incorporate loved ones

• focus on social interaction 

primary progressive aphasia

type of aphasia and considered form of dementia

• first symptoms are linguistic in nature

• onset is progressive with rapid progression

• 3 types

  • semantic (sv-PPA)

  • nonfluent (nfv- PPA)

  • logopenic (v-PPA)

assessments for PPA

• SLPs do not diagnose on our own

• not a single tests, but can use subtest from other tests

• capture features on lexical retrieval, syntax and repetition 

subtest

• boston diagnostic aphasia exam (BDAE)

• western aphasia battery (WAB)

• hopkins action naming assessment

sv-PPA

• bilateral anterior temporal lobe atrophy

• prominent anomia (stems from loss of semantic knowledge)

• verbal output includes intact syntax

• frequent pauses, empty speech, numerous semantic paraphasias

• word knowledge fades, understanding language becomes more difficult

sv-PPA intervention 

people in all stages can learn new words, capitalize on 

• spared recognition memory 

• episodic memory 

• consistent rehearsal

• using personally relevant stimuli 

nfv-PPA

trouble repeating, difficulty with grammar

• may have motor speech disorder

• difficulty producing longer an more complex sentences

• atrophy of left inferior frontal

• “broca like aphasia”

• nonfluent agrammatic

nfv-PPA interventions

• using low and high tech AAC

• script training

• communication notebooks

lv-PPA

• degeneration of frontal lobes

• reduced output, reduced rate of speech with frequent pauses, grammatically simple but correct sentences

• impaired auditory comprehension and word finding difficulty  

• impaired repetition, reading and spelling

lv-PPA intervention

• phonological cuing repetition exercises

• high and low tech aac

• client-directed assessment and interventions

PPA intervention

• maintaining language (SFA, script training, etc.)

• training communication partners

• considerations for proactive AAC

documentation 

avoid documenting dementia inless high degree of certainty 

• inaccurate diagnosis may lead to unnecessary grief and stress

• social stigma 

• may impact eligibility for coverage