Dementia

Describe the diagnostic criteria for vascular dementia.

(1) Multiple cognitive deficits must be present, including memory impairment and one or more of the following: aphasia, apraxia, agnosia, disturbance in executive function. (2) Cognitive deficits must cause impairment in the ability to execute social and/or occupational skills. (3) Neurologic signs of stroke such as hyperactive reflexes and weakness must be present as well as documented evidence of infarctions on laboratory tests such as brain imaging. (4) Lastly, it is required that these deficits do not occur only during episodes of delirium.

List deficits associated with Pick's disease

Affects the areas of cognition, language, and behavior difficulties. A dementia that results from progressive degeneration of the frontal and temporal lobes. Presents with early behavioral abnormalities, changes in personality, antisocial and often inappropriate behavior, as well as memory loss. Lack of social inhibition and saying things inappropriate to social situations. Poor judgments and general apathy to their disease and behaviors.

Describe rating scales commonly administered to those with dementia

Alzheimer's Diseases Assessment Scale (ADAS) is a scale designed to evaluate the cognitive and noncognitive manifestations of Alzheimer's disease Global Deterioration Scale (GDS) is used to rate level of dementia with a seven-stage scale and to track deterioration over time Dependence Scale is designed to assess the level of dependence of the individual with dementia. It is used generally to assess the need for institutionalization Geriatric Depression Scale (GDS) is used to assess the presence of depression in older adults. The presence of dementia can confound the results so the possibility and presence of dementia needs to be assessed separately so the SLP can differentiate whether the results are from dementia or depression

Describe the difference and neuropathology of cortical vs. subcortical dementia

Cortical dementia is typically associated with the brain's gray matter or cerebral cortex. When these outer layers are affected there are problems with memory, language, abstraction, creativity, judgment, emotion and attention. Common disease include Alzheimer's, frontotemporal dementia, Binswanger's disease and Creutzfeldt-Jakob disease. Subcortical dementia affects the structures below the cortex and are more associated with the brain's white matter. This is characterized by slow mental processing, forgetfulness, impaired cognition, apathy and depression. Common diseases include: Huntington's disease, Parkinson's disease and AIDS dementia complex.

How does the neuropathology associated with lacunar state differ from the neuropathology associated with cortical multi-infarct dementia?

Cortical multi-infarct dementia is the result of small recurrent ischemic strokes to the cortex. When multi-infarct dementia occurs in the subcortex, it is known as lacunar state or lacunar syndrome. Lacunar state is the result of multiple subcortical thrombotic ischemic strokes occurring in small and deep blood vessels that supply blood flow to the brain stem, basal ganglia, and other subcortical structures.

How do delirium and mild cognitive impairment differ?

Delirium is a sudden disturbance in consciousness or a change in cognitive ability that fluctuates through the course of a day with an onset that is a result of a general medical condition. Mild cognitive impairment is negative changes in cognitive abilities that are not within the spectrum of changes associated with normal aging but not severe enough to significantly affect the daily lives of individuals. These individuals experience decreased ability to concentrate, decreased word finding ability, decreased short-term memory, and difficulty following detail-heavy conversations or writings.

How is dementia clinically different from delirium?

Delirium is an acute confusional state. A diagnosis of delirium is typically based on clinical observation of behaviors and cognition, because no diagnostic tests are available. Differentiating characteristics are as follows: Acute onset (hours/days) and a fluctuating course (dementia has a slow, generally undistinguished onset) Inattention or distraction (dementia does not include inattention as a hallmark feature) Disorganized thinking or an altered level of consciousness (which may include hallucinations or delusions)

What is dementia?

Dementia is an acquired global loss of brain function with a slow insidious onset caused by a variety of diseases. A popular definition is as follows, a condition of memory loss plus deficits in at least one other of the following areas: verbal expression or auditory and written receptive language skills, recognition and identification of objects, ability to execute motor activities, abstract thinking, judgment, and execution of complex tasks.

How are direct and indirect therapy strategies different?

Direct therapies include working 1-on-1 with the patient using strategies such as: reminiscence therapy, errorless learning therapy, spaced retrieval therapy, memory prosthesis, and the montessori approach. Indirect therapies include making changes around the patient, instead of TO the patient. Indirect therapies can include life history videos made by the family and making various environmental changes around the patient.

How is dementia with Lewy bodies similar to both Parkinson's disease and Alzheimer's disease?

Lewy bodies are abnormal deposits of protein that build up in the brain. When Lewy bodies are in the brain stem, they cause a disruption of dopamine neurotransmitters. Dementia with Lewy bodies is similar to Parkinson's disease because too little dopamine can cause parkinsonism characterized by tremor, bradykinesia, and rigidity. Dementia with Lewy bodies is similar to Alzheimer's disease because they both have abnormalities of neurotransmitters in the brain that cause loss of coherence and memory.

Why might life history videos be useful with individuals with dementia?

Life history videos are custom-made personal videos that are composed by an SLP or the family of the individual with dementia in order to provide an audiovisual presentation (with pictures and music) of relevant personal facts such as relationships and past events to increase orientation and decrease confusion and behavioral disturbances.

How might the Montessori approach be used with an individual with dementia?

Montessori methods are used to increase the ability of those with dementia to participate in their daily routines while improving mood and increasing social skills. The most important aspects of Montessori's principles are summarized below: 1. breaking down complex tasks into individual parts and arranging these tasks hierarchically from simple to difficult and from concrete to abstract. 2. providing extensive cues to guide these individuals and facilitate success 3. providing feedback about the accuracy and appropriateness of performance to minimize frustration and failure 4. utilizing materials that yield cognitive and sensory stimulation

Describe a cognitive test for dementia

One example of a comprehensive and standardized test for dementia is the Arizona Battery for Communication Disorders of Dementia (ABCD). In addition to having unimpaired individuals in the normative sample, individuals with a variety of different dementias at varying levels of severity were also included. The ABCD assesses expressive and receptive language abilities, verbal memory, visuospatial skills, and mental status. Results from ABCD indicate severity level of dementia, possible dementia type, and deficit to be targeted in therapy.

What is polypharmacy and why is the aging population at risk for polypharmacy?

Polypharmacy is described as the side effects from taking many prescription drugs at one time, including unexpected interactions of different perscriptions. Because the elderly are typically on many prescription drugs, they are at rick for polypharmacy. Polypharmacy can cause dementia and other cognitive deficits.

How might reminisce therapy be used with an individual with dementia?

Reminisce therapy involves the discussion of past activities, event, and experiences with another person or group of people, usually with the aid of tangible prompts such as photographs, household, and other familiar items from the past, music and archive sound recordings. Reminisce therapy is on of the most popular psychosocial interventions in dementia care and is highly rated by staff and participants. There is evidence which suggests that it is effective in improving mood in older people without dementia. It's effects on mood, cognition, and well-being in dementia are less well understood. This therapy can be done using props as I had previously mentioned to evoke memories and stimulate mental activity. Therapy can be done individually or in a group and often results in some for of life-story book being created. It has proven to also help older individuals with depression as this is a common co-factor of dementia.

Describe spaced retrieval training

Space retrieval training is a therapy procedure in which SLP present new or previously known information to those with memory deficits and then prompt them to recall that information over increasingly greater intervals of time. Space retrieval training should work in an error less fashion. The SLP should set the difficulty well within the ability level of the patient, cue many repetitions and the patient should rarely make an error. In early Alzheimer's disease, SRT has been used successfully to retrain functional information such as face-name associations with friends and family.

Describe spaced retrieval training

Space retrieval training is the presentation of new or previously known information that must be recalled over increasingly greater intervals of time

What is the progression of Huntington's Disease?

Stage 1, the Early Stage,starts at disease onset and lasts for approximately eight years. During the early stage, the patient already has been diagnosed with Huntington's disease, but is fully functional at home and at work. At this stage, patients typically do not experience impaired motor symptoms, but may experience mild cognitive symptoms and psychiatric changes. Stage 2, the early intermediate stage, can last between three and 13 years from disease onset. In the early intermediate stage, the patient is still functional at work, but at a lower capacity. He or she is mostly able to carry out daily activities despite some difficulties and usually requires only slight assistance with daily functions. Chorea, which is irregular involuntary movement in multiple areas of the body, may develop at this stage. Stage 3, he late intermediate stage, lasts between five and 16 years from disease onset. In this stage, the patient no longer can conduct work or manage household responsibilities.He or she will require substantial help for daily financial affairs, domestic responsibilities, and activities of daily living. The patient's ability to think also may become more impaired. In general, cognitive, psychiatric, and motor features worsen at this stage. Stage 4, the early advanced stage, lasts between nine and 21 years from disease onset. The patient is not independent at this stage, but still can reside in their home with help from either family or professionals, although their needs may be better met at an extended care facility.

What is the speech-language pathologist's role with individuals with dementia?

The SLPs roles are many for the individual with dementia. They include: identifying risk factors, providing prevention information, educating other professionals, third-party payers, and legislators on the needs of persons with dementia and the role of SLPs in diagnosing and managing cognitive communication and swallowing disorders associated with dementia, educating caregivers about possible communication difficulties and providing strategies to facilitate effective communication, making decisions about the management of cognitive-communication deficits associated with dementia, developing treatment plans for maintaining cognitive-communication and functional abilities at the highest level throughout the underlying disease course, and treating the cognitive aspects of communication, including attention, memory, sequencing, problem solving, and executive functioning

Describe errorless learning

The primary basis for errorless learning therapy is that the difficulty level of the therapy task is set well within the ability level of the patient. This is done to minimize the possibility of patient failure. The rationale is to avoid the production of errors by the patient entirely. It is believed that when patients produce errorful responses to therapy stimuli, they are in effect practicing the production of errors, which increases the odds of future failures. Errorless learning therapies for anomia and memory deficits are effective in remediation of those deficits to some degree according to research.

Describe the role of the substantia nigra in relation to Parkinson's Disease.

The substantia nigra is a small, crescent shaped cell mass located in the brainstem. It is responsible for regulating movement and coordination. In individuals with Parkinson's disease, the cells within the brainstem are destroyed, particularly in the area of the substantia nigra. This may result in discoordination of movement, tremor at rest, stiffness, and loss of balance.

Why is assessment important in dementia?

There are many reasons to assess individuals for the cognitive and communication changes associated with dementia. The purpose of assessment usually varies according to the particular situation of the affected individual. The initial purpose of assessment to identify if there is a problem, later the purpose is to identify the specifics; what they are good at, what the deficits are, and the severity of the deficits. It also helps to set goals for the patient and determine the best methods for treating. Also, during the assessment can be a time for counseling the family and caregivers if nessecary.

What are two medications popularly used to reduce symptoms of dementia?

There are two common medications that are now commonly prescribed to individuals with Alzheimer's disease. These medications are donepezil and memantine. They are both used to decrease the symptoms of the disease, focusing on improving cognitive function, and reducing behavioral and psychological symptoms often seen in individuals with Alzheimer's disease. Donepezil has been shown to have greater benefits in the beginning and middle stages of the disease, with memantine showing greater improvement in the middle and later stages.

How does dementia onset differ between Alzheimer's disease and vascular dementia?

Vascular dementia occurs as a result of a stroke. Because of this, it has a very sudden onset following the stroke and cell death secondary to this. Alzheimer's Disease has a slow progression of cell death. Vascular dementia and Alzheimer's can co-occur. In these instances, vascular dementia can worsen/make more noticeable the deficits associated with Alzheimer's.

Why must speech-language pathologists treat both communication and cognitive deficits that are the result of dementia?

When treating an individual with Dementia, it is important to target both communication and cognitive deficits. As speech therapist, we are not only concerned about language, but communication as a whole. Communication and congition can not be separated as neatly as we think, Effective communication arises in no small part from intact cognitive abilities. Problems in communication usually arise when cogntive abilities are disrupted.

Three stages of Alzheimer's

early stage: Short-term memory loss, word finding deficits (anomia), receptive language deficits, personality changes i.e. losing keys, forgetting why you went to the store mid stage: Disorientation, short-term memory loss continues to worsen, attention deficits, more dramatic personality changes that are uncharacteristic of dealing with frustration and anger, visuospatial deficits, visuoconstructive deficits, expressive language deficits, wanderlust, general confusion, bladder incontinence, sleep disturbances, sundowner syndrome (usually refer to someone whose abilities decline or whose behavior worsens toward nightfall) late stage: Lack of motor function, bedridden, incontinence, unresponsiveness, severe to profound memory deficits, severe to profound cognitive deficits, fluent but empty speech, mutism, dysphagia.

Why are environmental manipulations important for individuals with dementia?

to keep them safe