Adult Language Disorders Midterm Key Components 5

Key Components

Module 5

Typical Aging

·       Ways to define aging

o   Chronological age

§  how long a person has lived since birth

o   Biological age

§  functioning of someone’s bodily organs over time

o   Cognitive age

§  how someone’s cognitive abilities change over time

o   Psychological age

§  how someone’s personality changes over time

o   Social age

§  aging according to someone’s social roles & environmental change

·       Models of aging (x3, list and describe)

o   Biopsychosocial models of aging

§  complex interactions among biological, psychological, and sociological factors that influence how people age

o   The life-span model of postformal cognitive development

§  7 stages & helps clinicians consider changes in communication abilities and needs with age due to changes in body structure and function and well as evolving life priorities

o   Motivational theory of life-span development

§  Focuses on adults’ highly individualized abilities to choose, adapt to, and pursue life changes and opportunities

·       List and describe typical age-related changes in the brain

o   Neuron shrinkage and reduced dendritic branching

o   Leads to decreased brain volume

o   Atrophy primarily in the frontal lobes and hippocampus

o   Reduction in neurotransmitters (e.g., acetylcholine and dopamine)

o   Decreased white matter, especially on the frontal lobes

o   Reduced cerebral blood flow

o   Accumulation of amyloid beta or amyloid plaques without accompanying neurofibrillary tangles (associated with Alzheimer's disease)

·       List and describe typical age-related changes in language

o   Memory

§  Episodic memory, working memory

o   Word finding 

§  More “tip-of-the-tongue” experiences

§  Slower response times

§  Less accuracy

§  Reduced verbal fluency

o   Syntactic processing

§  Comprehension

§  Production

o   Reading and writing

§  More likely to be due to such sensory and motor deficits than to linguistic factors per se

o   Discourse

§  Three factors

·       Emotional regulation

·       Personal discourse goals

·       The nature of specific discourse tasks

o   Discourse coherence

o   Pragmatics

§  Aging itself doesn’t have much influence on pragmatic abilities (at least in any real significant ways)

·       List and describe theories of age-related

o   Resource capacity theories

§  Cognitive and linguistic deficits to a reduction in overall cognitive capacity, not the ability to accomplish individual simple tasks

·       Working memory

·       Context processing deficiency

·       Signal degradation

·       Transmission deficit

o   Speed of processing theories

§  Based on the notion that our cognitive processing at all levels slows as we age (the general slowing hypothesis

o   Inhibition theories

§  Based on the rationale that older people have greater challenges than younger people with inhibiting irrelevant information and focusing attention to a particular task in the face of multiple competing stimuli or task requirements

·       Prevention strategies for maintaining skills/preventing age-related loss

o   Maintenance of overall physical, mental, and emotional health throughout the lifespan

·       Describe ‘elderspeak’ and why to avoid

o   The adaptation of language to a person because of their age

o   Conveys stereotypes of older people as childish, incompetent, cognitively impaired, and dependent

o   Should avoid it because no stereotype is a good stereotype

·       How does agism show up in clinical care/how to prevent

o   stereotypes in the media often perpetuate negative & inaccurate stereotypes about the elderly

o   Advocate

§  Suggesting alternate wording in written medical reports

§  Use appropriate word-choice with colleagues and community

§  Provide professional services to counter agism

§  Engage in political activity to change legislature

Dementia

·       Define dementia- key components of definition

o   a group of brain disorders that cause a decline in cognitive abilities (memory, thinking, reasoning, and judgment) severe enough to interfere with daily life and activities. Characterized by acquired, persistent, and impairment

·       Domains impacted by dementia

o   Memory

o   Executive Function

o   Attention

o   Language

o   Visuospatial Function

o   Instrumental activities of daily living

·       Role of SLP in working with dementia

o   SLPs play a key role in the screening, assessment, diagnosis, treatment, and research of dementia-based communication disorders.

·       Describe MCI & criteria for diagnosing it

o   preclinical condition that may suggest a person is at risk for developing dementia

o   Criteria

§  Self-reported memory problems (with input from a family member or caregiver)

§  Measurable memory impairment on a standardized test, (scores outside the range expected for age- and education-matched healthy older adults)

§  No impairments in reasoning, general thinking skills, or ability to perform ADLs

·       2 types of neuroog disoders- list and describe

o   Amnestic MCI

§  Initial concern pertains to memory functioning

§  Can be single-domain or multiple-domain

o   Non-amnestic MCI

§  Initial concern does not pertain to memory functioning

§  Can be single-domain or multiple-domain

·       In general, list and describe the 5 types of dementia (as detailed below)

§   

·       List signs of mTBI at at time of injury

o   (a) loss of consciousness, altered mental status, amnesia, or confusion (can be seen as soon as injury happens or within a couple hours of injury

o   (b) loss of consciousness (LOC) (within 30 minutes of injury)

o   (c) Has a score of 13 to 15 on the Glasgow Coma Scale

§  a neurological assessment tool used to evaluate a person's level of consciousness after a brain injury. It assesses three key areas: eye opening, verbal response, and motor

o   (d) has posttraumatic amnesia (PTA) (within 24 hours of injury)

·       Define recovery from mTBI

o   Returning to baseline levels of performance during daily activities

·       Describe recovery trajectory timelines

o   Adults seen in the ER with concussion tend to recover in about 2 weeks

o   Adults seen in the ER but continue to have persistent symptoms can be in recovery anywhere from 2 weeks to 6 months.

·       List variables (x8) that influence mTBI recovery

o   Individuals who experience gender based violence

o   Individuals who experience domestic based violence

o   Individuals who experience intimate partner based violence

o   Individuals who have been precariously housed (homeless)

o   Individuals who have been involved in criminal justice system

o   Refugees/ asylum seekers (especially those seeking safety from country at war)

o   Racial/Ethnic minorities

o   Individuals who have co-occurring emotional or physical trauma

·       List risk factors (x8) for extended recovery from mTBI recovery

·       Categories of mTBI

o  

·       Be prepared to discuss the neurophysiology of concussion as described in the lecture

o   Impairments in cellular communication

§  Early on, disruption of ionic balance of neurons.

·       Potassium rushes out of cells while sodium and calcium rush into the cells.

·       Excess Glutamate is released (excitatory transmitter that causes neurons to fire when released. Important for learning, memory, cognition and sending messages between

§  Shortly after injury, brain is in “hyperactive mode” and that takes up a lot of energy.

·       7-10 day decrease in cerebral blood flow, and hypometabolism

o  
Hypoactivity lasts longer in kids than adults

§  These physiologic changes cause many of the acute symptoms associated with mTBI (like motor changes, and slower processing)

·       Changes in brain/microstructural changes after mTBI

o   In addition to cellular impairments regarding communication, microstructural changes occur.

§  Diffuse axonal injury remains a hallmark of TBI

·       Axons stretched too thin or broken due to linear and rotational forces of the cells

§  Impaired synaptic communications can result in increased dysfunctional frontal lobe, cerebellum & corpus callosum

§  Unmyelinated cells (like the ones kids have) are at greater risk for damage

o   Some research suggests thalamic structure & function may also be affected

§  Thalamus deals with sensory processing as well as having cortical projections tied to functions like language & working memory.

o   Edema can also occur. Neuro-physiologic functioning at cellular level may remain impaired even after behavor ahs returned to normal

·       Describe the role and limitations of imaging in mTBI

o   Computed Tomography (CT) & MRI are used to rule out severe complications

§  Like skull fracture, intracranial hemorrhage, & brain edema

o   mTBI

§  CT & MRI = insensitive to subtle changes in brain (like diffuse axonal injury) and don’t give any relevant info to long term prognosis.

o   Neuroimaging is NOT recommended as part of routine evaluation following mTBI, even in emergency medicine.

§  HOWEVER, it may be recommended to those who present with clinical red flags (see pg 364)

o   Imaging that IS USED for mTBI

§  Diffusion tensor imaging (DTI)

§  Functional MRI (fMRI)

§  Positron emission tomography (PET)

§  Single photon emission computed tomography (SPECT)

§  Electroencephalography (EEG)

·       List and describe the 5 Concussion Phenotypes

o   Cognitive

§  Most common in adults

§  Clients report dysfunctional attention, processing speed, working memory, new learning, and/or executive functioning.

o   Headache/migraine

§  Most common in anyone with mTBI and persists the longest

§  Hypersensitive to light, noise and smells

o   Ocular Motor

§  Common in post mTBI

§  Impairments with eye convergence, tracking and rarer occurrences with fourth cranial nerve palsy & double vision.

o   Vestibular

§  Troubles with dizziness, balance, vertigo, and lightheadedness

o   Anxiety/Mood

§  Emotional, irritable, anxious, nervous, sad, depressed, hypervigilant, and ruminating thoughts.

·       What are other associated changes with concussion (x3)

o   Sleep & Daytime wakefulness

o   Insomnia

o   Need for increased sleep

·       Describe conversational changes in mTBI, including mazing

o   Mazing = linguistic disfluency that involves disruptions in the flow of speech. (AKA linguistic nonfluencies)

o   Changes in comprehension, working memory, social communication, auditory comprehension, working finding & reading skills

·       Discuss speech disorders in mTBI, including stuttering

o   Dysarthria (but only for the more severe cases)

o   Stuttering

§  Can be related to things like preexisting conditions, PTSD, Depression, or anxiety, but it is unlikely to be neurogenic

·       Define CTE

o   Chronic traumatic encephalopathy (CTE) is a progressive degenerative brain disease caused by repeated head injuries, such as concussions and sub concussive hits

·       Describe the symptoms of CTE

o   decreased memory and executive function skills

o   aggression, depression, & erratic behaviors

o   changes in motor function and balance problems

·      
List and describe 4 mechanism of blast injuries

·       List and describe hearing loss considerations in mTBI

o   Occur in up to 60% following blast-related mTBI

§  Which is higher than the cases with non-blast-related mTBI

o   Permanent sensorineural hearing loss is the most prevalent type of auditory impairment

§  35% to 100% incidence rate reported in blast-injured patients

o   ruptured tympanic membrane causing a conductive hearing loss (4% to 79% incidence) is also really common.