484 dementia

what is dementia

acquired global loss of brain function with slow, gradual onset

what is the most common cause of demntia

Alzheimer’s disease, which leads to cognitive decline and memory loss.

symptoms of demntia

defecits in expressive and receptive language

difficulty recognition/identification of objects

inability to execute motor activities

difficulties on abstract thinking, judgement and execution of complex tasks`

what is delerium

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

what causes delerium

medical conditions, can come and go as the condition does

characteristics of mild cognitive impairment

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

can go away

normally progresses to alzheimer’s or dementia

symptoms of MCI

decreased ability to concentrate

decreased word-finding ability

decreased short term memory

difficulty following detail heavy conversation/writings

SLP’s role in dementia

assess and treat cognitive communicative deficits that are results of dementia

recognize, diagnose, and provide treatment for deficits resulting from dementia (communication and swallowing)

education of staff and caregivers

factors of normal aging

language remains intact, a slight decline in word-finding ability

Sustained attention remains mostly intact, decline in selective attention skills

divided attention skills intact during simple tasks, may decline in complex tasks

reaction time is slowed

long term memory and procedural memory remains intact, episodic and short term memories are reduced

types of cortical dementias

Alzheimer’s disease (most common), frontotemporal dementia, Pick’s disease

type of subcortical demntia

Huntington’s disease

types of mixed dementia’s

vascular dementia, lewy body disease (Parkinson’s disease and dementia with Lewy bodies, progressive supra nuclear palsy

Alzheimer’s characteristics

most common cause of dementia

cortical dementia

progresive and fatal. no treatments to slow or stop dementia

Alzheimer’s onset

early onset ages 5-60, in rare cases 30-40

onset usually after age 65

neurofibrillary tangles

abnormal intracellular clumps of proteins.

these proteins are insoluble and cells cant’ properly dispose of them, leading to cellular death

amyloid plaques

abnormal deposits of amylodnada, neurons cannot work properly. leads to cellular death

garnulovascular degenration

fluid sacks that are abnormal and prevents neurons from functioning properly

neuropathy includes prescence of

neurofibrillary tangles, amyloid plaques, granulovascular degeneration, general neuronal atrophy

general neuronal atrophy

shrinkage of cortex and widening of ventricles

How is Alzheimer’s diagnosed? `

clinical signs, autopsy, or Pittsburgh compound test

Risk factors of Alzheimer’s

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

early stage Alzheimers

motor function is retianed

short term memory loss, word-finding difficulty, comprehension of verbal language deficit, personality changes

lasts about 2 years

mid stage Alzheimers

negative impact on ADLs, increased reliance on caregivers

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

wanderlust, sundowner syndrome, disorientation, confusion

lasts 4-10 years

late-stage Alzheimer’s

loss of motor function

profound memory, cognition and expressive language deficits

may cause muteness and dysphagia

pneumonia, anorexia, aspiration risks

frontotemporal dementia

degeneration of frontal and temporal lobes

may include Pick’s disease, primary progressive aphasias (progressive confluent aphasia, semantic dementia)

Pick’s disease

dementia resulting from progressive degeneration of frontal and temporal lobes

less common thatn Alzheimers

progressive terminal illness

Symptoms of Pick’s

personality changes, antisocial and inappropriate behavior, memory loss and absence of language deficits, no social intuition

language deficits in Pick’s

significant and pronounced

assessment is difficult because of language deficits

Pick’s may result from…

abnormal spherical accumulations, aka pick bodies and ballooned neurons

atrophy of frontal and temporal lobes

no amyloid plaques or neurofibrillary tangles

How is Pick’s differentiated from Alzheimer’s

early behavioral, emotional, and personality changes without significant language deficits in Pick’s

Huntington’s disease

type of subcortical dementia

progressve terminal illness

distinctive erratic body movements

fatal

hereditary

What symptoms result from Huntington’s disease

movement disorders, changes in personality, cognition language and emotion

What causes Huntington’s

Degeneration of basal ganglia, hippocampus, substantial nigra, Purkinje cells of pons

Stages 1 and 2 of Huntington’s

Motor symptoms of chorea

emotional problems

difficulty concentrating

memory problems

difficulties with executive functioning

sleeping and swallowing difficuty

slow movement

Stages 2,3,4 of Huntington’s

chorea and hyperkinesis that interfere with speech

training on AAC for future loss of verbal and written expression

relying on caregiver more

What is chorea

involuntary movement

vascular dementia

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

how is vascular dementia characterized

multiple cognitive defecits

memory loss, aphasia, apraxia pf speech, and difficulties with executive functioning occur suddenly

impairments affecting ADL’s

hyperactive reflexes and weakness

acute onset followed by progression of degenration

neuropathy related to infarcts in areas of brain

Lewy body disease

results in neuropathological changes in brian due to presence of ewy bodies in cell body of neurons

Parkinson’s

motor abnormalities= rigidity, tremor, slow volitional movement, cognitive deficits

bradykinseia

mask-like expressions

difficult initiating speech movements

festinations

paresthisia

loss of dopamine-producing cells in substantia nigra as a result of Lewy bodies

what is a festinations

sped up, repetitive movement

what is paresthesia

burning or prickling sensation felt in hands, arms, legs or feet usually

dementia with lewy bodies

Decrease in volitional movement and difficulty initiating motor movement

Cognitive deficits

significant sleep disturbances and hallucinations

caused by deterioration of cortex and subcortex due to lewy bodies

Progressive supra nuclear palsy

rare neurodegenerative disorder

average onset age 60

degeneration of frontal lobe, basal ganglia, and cerebellum

progressive supra nuclear palsy symptoms

ocular motor problems, personalist changes, executive function difficulty, attention deficit, apathy, impulsivity, balance issue, dysarthria

how is dementia assessed

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

goals of therapy for dementia

should imporve quality of life, reduce demands on impaired ability, incerease use of intact cognitive abilities, porvide stimuli that invokes positive emotion and memories, caregiver training

reminiscence therapy

Semi-cued conversation about past events, experiences and activities to increase orientation and recall of pleasent long-term memory

cognitive stimulation therapy

group tx for mild-mod dementia

uses themes, mental stimulation, activities that improve cognitive function

errorless learning

difficulty level of task is set within the ability of the patient to maximizepatient success and minimize patient failure

spaced retreival

presentation of new or previously known information that must be recalled over increasingly greater interest

memory prostheses

external memory aids such as memory books/wallets, calendars, smartphones or personal digital assistance to augment memory

mentossrori approach

supports interests and needs by structuring the environment in a certain way, encourages them to remain independent as long as possible

stimulated presence therapy

aimed to reduce anxiety and challenging behaviors by using audio/voice recordings of loved ones

types of enviromental modifications

cognitive, visual, auditory