Adults 1 - Final🧍

ITS TIME

Goals of Dementia Assessment

Establish baseline, determine cueing techniques, set goals, evaluate level of independence and safety issues

GDS scale stands for….

Global Deterioration Scale

GDS Stages 1-3

Stages 1-3 are pre-dementia stages where the patient shows low to no cognitive decline

GDS Stages 4-7

Stages 4-7 are dementia stages where the patient shows moderate to severe cognitive decline

Direct Approaches to Treat Dementia

1. Reminiscence Therapy

2. Reality Orientation Therapy

3. Spaced Retrieval Therapy

Indirect Approaches to Treat Dementia

1. Supported Conversation Therapy

2. Simulated Presence Therapy

Reminiscence Therapy

Direct Approach to Treat Dementia. focuses on accessing long term memories. Try to strengthen patient’s ability to retain long term memories for as long as possible through sensory stimulation (ex: looking at pictures, listening to old music)

Reality Orientation Therapy

Direct Approach to Treat Dementia. debated whether effective or not. Increase the patients understanding of their surroundings (time and place) Remind them “Your daughter isn’t ten, she is 40.”

Spaced Retrieval Therapy

Direct Approach to Treat Dementia. Focuses on recall of information, matching names to faces.

Supported Conversation Therapy

Indirect Approach to Treat Dementia. Training the caregivers/family members of someone with dementia (with feedback from the SLP if needed). Best for patients with very involved families.

Simulated Presence Therapy

Indirect Approach to Treat Dementia. Play video/audio of loved ones in the background while completing ADLs, soothes and comforts the patient. Only should be used in people with moderate to severe dementia.

What does the left hemisphere specialize in?

step-by-step processing, timing-based tasks, logical thinking. Dominant for language (in most people)

What does the right hemisphere specialize in?

Holistic (Gestalt) processing. visual/spatial skills, context/meaning, emotional cues, face/place recognition, creativity/intuition

Cognition Umbrella includes…

main mental processes involved in Cognition:

1. Language

2. Memory

3. Attention

4. Executive functions

5. Visuospatial processing

6. Pragmatics

Common causes of RHD

Strokes, TBI, brain tumor, surgical removal of brain tissue, infection, neurodegenerative diseases (only need to name two)

What communication skills are typically impaired in RHD?

Discourse, pragmatics, and prosody

What cognitive (non-linguistic) functions are typically impaired in RHD?

Attention, working memory, problem-solving

Stroke recovery phases (need to know all 4)

Hyperacute phase: up to 12 hours

Acute phase: up to 2 weeks

Subacute phase: up to 6 months.

Chronic phase: everything after 6 months post-stroke

Left Visual Field Cut (Homonymous Hemianopia)

Happens after damage to the optic tract, removes patient’s ability to see the left visual field. Does NOT co-occur w/ attention problems.

Homonymous hemianopia = half the visual field is lost

Left Hemispatial Neglect (also called left neglect)

Failure to attend to the left side of the body. Can see the left side of body but will refuse to attend to it. Usually co-occurs with attention problems.

What damage produces the most severe neglect?

Right parietal lobe damage. Most commonly associated with MCA lesions.

Egocentric vs. Allocentric Neglect

Egocentric: patient ignores the left side of their own visual world

Allocentric: patient ignores the left side of each individual object

A patient with egocentric neglect and a patient with allocentric neglect are asked to copy a scene showing a house on the left side of the page with flowers on the right. How would their drawings differ?

Egocentric neglect: they ignore the left side of the page, so the house (left side) is missing while the right-side flowers are included.

Allocentric neglect: they draw both house and flowers in the correct locations, but omit the left side of each object (ex: left side of the house and left portions of the flowers are missing).

Anosognosia

Patient is not aware of their own deficits. Frequently occurs together with neglect.

Prosopagnosia

"Face blindness." Caused by damage to the right ventral posterior temporal lobe, specifically the fusiform face area. Patient can't recognize familiar faces but usually can identify someone once they hear them speak

Retrograde vs. Anterograde amnesia

Retrograde: loss of memory of events BEFORE the injury/illness. Anterograde: loss of memory of events AFTER the injury/illness.

Confabulation

When a patient answers incorrectly, but firmly believes they are correct. Has no awareness they are wrong. (ex: Asking a patient, “how did you arrive to your session today?” and they reply “by boat”, even though your clinic is nowhere near water).

Topographic Disorientation

spatial disorientation common in RHD: can’t follow maps or familiar routes.

5 Levels of Attention

Focused attention: A student hears a single knock at the door and turns to look at it, ignoring everything else in the room.

Sustained attention: A student reads an essay in full without losing track of what they are doing.

Selective attention: A student studies in a noisy café and is able to ignore everything except their notes.

Alternating attention: A student switches between solving math problems and checking their work against an answer key.

Divided attention: A student listens to a lecture while simultaneously taking notes in real time.

3 core executive control skills

• Information Updating in Working Memory

• Mental Set Shifting/Switching

• Inhibition

Emotional Aprosodia

Difficulty recognizing or reproducing the emotional tone of speech. Cannot do prosody. (common in RHD)

Apragmatism

Impaired ability to use pragmatics appropriately

SLP Evaluation Timeline

1) Case History

2) Family Interview and Patient Interview

3) Informal Eval and/or Formal Eval

4) Report, Follow-Ups

Four goals/questions of RHD evaluation

• What is the extent of the problem?

• At what level do cognitive-communication behaviors break down?

• What improves cognitive-communication behaviors?

• What is the underlying mechanism of the deficits?

Informal evaluations start….

the moment you walk in the room

When should you use a screening tool instead of a full battery?

When you have limited case history, or have time restrictions.

MMSE and MoCA

Both are brief cognitive screeners:

MMSE tests orientation, registration, attention/calculation, recall, and language.

MoCA tests visuospatial/executive skills, naming, memory, attention, language, abstraction, delayed recall, and orientation.

(only need to name one or two things for each)

On the MoCA, a score of 26 or higher indicates….

someone is within normal cognitive limits. Lower than 36 indicates mild cognitive impairment.

What is the CLQT and what does it cover?

Cognitive-Linguistic Quick Test. A comprehensive cognitive battery. Covers multiple cognitive-linguistic domains. The CLQT+ adds a "Semantic Comprehension" subtest for patients with aphasia.

What tests are designed specifically for RHD?

MIRBI-2 and RICE-3, include subtests specifically targeting pragmatics and prosody

BIT test

Behavioural Inattention Test, Designed for quick neglect assessment.

Line bisection and star cancellation (neglect)

Line bisection: patient things the midpoint of a line far to the right of center.

Star cancellation: patient marks only the small stars on the right side of the page, missing all those on the left.

Visual Scanning Training (VST)

behavioral treatment for left neglect, trained to consciously attend to the left side of space through tasks like copying or picture description. only kind of works

When do you address anosognosia vs. not yet?

YES: if a patient acknowledges something seems "off." Use functional activities that visibly demonstrate deficits, to encourage them to realize defecits exist

NOT YET: patients with severe cognitive deficits and zero awareness of their defecits.

Attention Process Training (APT)

Step-by-step training program with increasing difficulty, using visual and auditory tasks, plus self-rating and thinking about one’s own performance. used for RHD

what do the Flanker and Stroop tests target?

Flanker: Patient is shown an image of several arrows pointing in one direction, while a few point the other way. To notice the wrong arrows requires suppressing distractors

Stroop: Word “RED” written in blue ink, patient must say color of ink. Repress urge to read the word.

Both test inhibition

FAVRES test

Uses real-life tasks like planning events, scheduling etc to test executive functions and verbal reasoning

Metacognition

awareness and understanding of your own thought processes. Treatment trains patients to identify obstacles and select a strategy, then evaluate their own performance

Deficits in _____ ___ _____ are thought to contribute to pragmatic impairments in RHD.

theory of Mind

Prosody treatment, motoric-imitative vs. cognitive-linguistic approach

Motoric-imitative: hierarchical treatment of sentences expressing different emotions, patient listens and imitates.

Example:
Clinician (sad tone): “I am so sad today.”
Patient repeats with matching sad intonation: “I am so sad today.”

Cognitive-linguistic: uses emotional labels and various aspects of emotions to build understanding of how emotions are expressed. Compensatory strategy: patient states their emotional state explicitly before speaking (e.g., "I am angry about this situation…").

Example:

The clinician shows a picture of a frustrated face and says, “This is anger. When people are angry, their voice may be louder and sharper.” The patient identifies the emotion and describes the vocal changes using the cue (e.g., “Angry voice = loud, fast, tense”).