cmd460 quiz 6
role of SLP
-Assess communication strengths and weaknesses → help family and health care colleagues -Provide training and counseling to family and health care workers in terms of effective communication strategies -Person-centered approaches that bring out the strengths of people with dementia are not only the most humane but also the most effective -By strategically addressing the domains of well-being (identity, connectedness, security, autonomy, meaning, growth, and joy)
clinical diagnostic process for alzheimers
-1. Ruling out stroke, FTLD, other neurodegenerative disease. -2. Documenting cognitive changes over time. -3. informal or formal testing. Use of imaging techniques are helpful.
mild cognitive impairment (MCI)
-A condition of cognitive decline that is not consistent with normal aging -Characterized by problems with memory, language, thinking or judgment but they aren't severe enough to significantly interfere with daily life and usual activities.
dementia
-A syndrome resulting from acquired brain disease. -progressive decline in memory and other cognitive domains that, when severe enough, interferes with daily living and independent functioning.
Risk Factors (Nonmodifiable): Age
-About one third of people over age 85 have the disease -The risk of acquiring dementia is higher if an individual has a first-order relative with the disease
incidence and prevalence in US
-Approximately 5.7 million people are living with dementia (AA, 2018). AD accounts for 60-70% of these cases. -Projected to be 13.8 million by 2050
Facets of Dementia that Might Affect the Work of an SLP
-Decline and expected decline -Communication ability and opportunities in Daily Life -Communication accommodations -Caregiver burden -Safety and independence -Continuing care decision
signs and symptoms: perceptual problems
-Difficulty completing previously familiar activities or navigating in familiar environments -Inability to find objects in direct view
how and benefits of SRT
-yields positive results when learning new information -Make sure to select the right target for training with a meaningful context to remember it for
signs and symptoms: executive function problem
-Disinhibition -Impaired judgment, reasoning and problem-solving (e.g., making decisions without regard to safety) -Lack of mental flexibility -Verbal and task perseveration
Barriers to Accessing Treatment
-General treatment approach should promote life participation of people with various forms of dementia. -Beliefs that people with incurable memory loss will not retain enough content from direct speech and language intervention
risk factors (modifiable): Middle life (45-65 years)
-Hypertension -Obesity -Hearing loss
hearing loss: cascade hypothesis
-If you have poor hearing, you get a lot less sensory stimulation to the brain -Social isolation and depression
hearing loss
-Individuals > 60 years, ⅓ of the risk for dementia was associated with hearing loss -Individuals with baseline hearing loss were found to have greater rates of cognitive decline over time than those with normal hearing
Montessori Approaches to Dementia Management
-Intended to enhance activation of intact intellectual and communicative activities and improved compensatory strategies through the use of: --Emphasis on intact abilities --Multimodal stimulation --Environmental accommodations (cognitive, motoric, perceptual, etc.) --Ecologically valid and personally relevant, concrete stimuli --Supported and contextualized cueing --Positive feedback and opportunities for success --Repetition --Minimal reliance on episodic and working memory
Montessori Approach Benefits
-It complements intervention goals of improved independence, self-esteem, positive affect, and participation in meaningful social roles and activities -M-based activities to facilitate socialization and enhance communication in people with dementia have been tested in LT care contexts, adult daycare centers, intergenerational program, individual and group settings
alzheimers disease (AD)
-Leading cause of dementia, comprising about 50-80% of the dementia population -progressive diffuse brain atrophy and accumulation of amyloid plaques and neurofibrillary tangles. These changes tend to begin in the medial/anterior temporal lobe → the hippocampi → to the neocortex and limbic systems. -The onset is gradual with short-term and working memory deficits apparent in the early stage. Long-term memory is relatively preserved in the early and mid stages.
what are the modifiable risk factors associated with dementia?
-Less education (none or primary school only) -Hypertension -Obesity -Hearing loss -Smoking -Depression -Physical inactivity -Social isolation -Diabetes
how to use a memory book
-Looking at and reading one page at a time, stopping to converse about a relevant context -Looking at the picture and using open-ended prompts "Tell me about..." -As a distraction when sad or engaging in undesirable behavior -** Developing memory books and wallets can be a component of direct treatment or part of a functional maintenance program.
assessment tools
-Mini-Mental State Examination-2nd Edition (MMSE-2; Folstein et al., 2010) -Montreal Cognitive Assessment (MoCA; Nasreddine, 2003)
why use Memory books/wallets
-People with dementia tend to have better long-term memory abilities than their short- term or working memory abilities → images and words help to stimulate retrieval of memories → enhanced communicative interaction and social engagement -Increased duration of engagement in conversation -Produce more and more on-topic utterances -Produces utterances of greater length and complexity -Improve naming and accuracy of naming of people and object depicted and labeled
Environmental Changes in M-based LT Care
-Posting bulletin boards near the dining room with name badges for each resident -Colorful, homelike interior spaces -Clear signage, e.g. arrows and text to indicate different places -Clear instructions/requests to cue people to engage in activities -Personalized information on each resident's door -Large-print, high-contrast name tags displaying residents' first names
SLP assessment
-Screen for hearing loss, visual impairment, and depression before conducting the SLP assessment -Assessment protocol is based on the stage of illness and the individual's communication needs and wishes.
signs and symptoms: learning and memory
-Short-term/working memory deficits — rapid forgetting of information recently seen or heard -Difficulty acquiring and remembering new information (e.g., appointments or events, new routines) without specific supports or strategies -Difficulty recalling names of family and friends -Episodic memory deficits, including difficulty remembering autobiographical events, situations, and experiences
risk factors (modifiable): later life (>65 years)
-Smoking -Depression -Physical inactivity -Social isolation -Diabetes
why have cases been falling between 2012-2020?
-This trend may be due to higher education levels, better access to health care, and improvements in cardiovascular treatments. -fell by 24%
huntington's disease
-a condition that stops parts of the brain working properly over time. -genetic -It gets gradually worse over time and is usually fatal after a period of up to 20 years.
Spaced Retrieval Training (SRT)
-a method of learning and retaining information by recalling the information over increasingly longer period of time -It purportedly targets implicit (unconscious, involuntary) memory, considered to be relatively robust in people with memory disorders (TBI, dementia)
incidence and prevalence worldwide
-an estimated 50 million people are living with dementia (WHO, 2017) -Projected to reach 152 million by 2050
Memory books
-are often in the form of three-ring binders containing photographs and printed words -Photo albums, scrapbooks, recording photo albums, and tablets could be also used (especially if the user can initiate using a device).
What are the two hypotheses associated with hearing loss and dementia?
-common cause -cascade
What are the three reasons that differential diagnosis is difficult (complicated) for individuals with early onset dementia?
-dementia that occurs before the age of 65. -symptoms may be more variable in younger patients than in the elderly, due to different etiologies, lack of awareness about the condition, and misdiagnosis.
signs and symptoms: eating and swallowing difficulties
-forgetting to eat -forgetting to swallow
memory book benefits
-strategies that evoke reminiscence and telling of life stories are far more effective than are those that rely on recent declarative and semantic memory. -Positive and meaningful conversations may also lead to further meaningful positive interactions later
SRT: randomized-interval/adjusted approach
-the time between trials is adjusted according to the individual's performance -Said to enhance long-term retention
SRT:A fixed-interval/uniform approach
-the time between trials remains constant -Said to transfer information into long-term storage
Frontotemporal Dementia
Caused by atrophy of the anterior frontal and temporal lobes; there are behavioral variant and language variant (PPA)
signs and symptoms: attention
Difficulty attending and easily distracted; decreased information-processing speed
impact of music on memory
For some people, when we play music which are personally meaningful to then, it can positively influence their memory, emotion, and engagement
hearing loss : common cause hypothesis
Hearing loss and dementia come from degeneration of brain function
risk factors (modifiable): early life (< 18 years)
Less education (none or primary school only)
Primary Progressive Aphasia (PPA)
The progressive loss of linguistic abilities in contrast to relatively intact cognitive abilities (initially)
Risk Factors (Nonmodifiable): heredity
The risk of acquiring dementia is higher if an individual has a first-order relative with the disease
vascular dementia
The second most common; results from a stroke or multiple focal lesions (multi-infarct dementia)
Dementia with Lewy Bodies (DLB)
The third most common; abnormal protein deposits that are also commonly found in people with dementia of Parkinson's disease; many show neuromuscular problems
signs and symptoms: behavioral and psychosocial
anger,, anxiety, loss of initiative, new suspicions, mood fluctuations, wandering
Risk Factors (Nonmodifiable): Apolipoprotein E (ApoE) gene
increases risk for Alzheimer's disease and is also associated with an earlier age of disease onset.
signs and symptoms: language
forgetting what to say, how to say things, doesn't think before speaking
What are the risk factors of Alzheimer's disease?
heredity, prior experience of brain injury or stroke, risk factors for cardiovascular problems (e.g., high blood pressure, high cholesterol)
Parkinson's-Associated dementia
observed only in some of the PD patients (18-80%)
Can family members who need help taking care of their loved ones with Alzheimer's disease call the Alzheimer's Association 24/7 helpline?
yes, the helpline will give you suggestions and listen to your needs
memory wallets
ypically plastic wallet inserts containing emergency contact information, words that are important to remember, scheduling/calendar/appointment information, addresses, names, phone numbers, and associated pictures.