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Speech and Language Therapy Y1 > BIOMED 9 > Flashcards

BIOMED 9 Flashcards

Acquired communication disorders (108 cards)

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1
Q

What are the 3 ways in which dementia may be classified?

A

Type of disease process
Primary site of cell damage
Prognosis

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2
Q

How may dementia be classified by type of disease process?

A

Degeneration
Vascular
Infection
Trauma
Toxins

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3
Q

How may dementia be classified by primary site of cell damage?

A

Cortical
Subcortical

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4
Q

How may dementia be classified by prognosis?

A

Progressive (majority)
Static / non-progressive

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5
Q

What are the 6 different types of degeneration dementias?

A

Alzheimer’s Disease
Frontotemporal Dementia
Lewy Body Dementia
Huntington’s Disease
Corticobasal Degeneration
Multiple Sclerosis

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6
Q

What are the 2 different types of vascular dementias?

A

Vascular dementia (multi-infarct dementia)
Trauma- punch drunk syndrome

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7
Q

What are the 4 major points of diagnostic criteria for dementia?

A

Significant cognitive decline from previously higher level of functioning
Cognitive deficits interfere with independence in everyday activities
Cognitive deficits do not occur exclusively in context of a delirium
Cognitive deficits are not better explained by another mental disorder

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8
Q

What are 2 non-modifying factors as a risk for dementia?

A

Age is the biggest
Also genetics for a subset of people

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9
Q

What are 2 social modifiable risk factors for dementia?

A

Less education
Low social contact

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10
Q

What are 6 health modifiable risk factors for dementia?

A

Hypertension
Hearing impairment
TBI
Depression
Diabetes
Obesity

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11
Q

What are 3 personal modifiable risk factors for dementia?

A

Smoking
Physical inactivity
Excessive alcohol consumption

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12
Q

What is an environmental modifiable risk factor for dementia?

A

Air pollution

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13
Q

What are the symptoms in Alzheimer’s disease caused by?

A

Neurons in the brain becoming damaged and dying

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14
Q

Which parts of the brain are initially most affected by Alzheimer’s disease?

A

Hippocampus + amygdala

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15
Q

What are the 2 main biological changes that occur in DAT?

A

Amyloid beta plaques develop outside neurons
Tau neurofibrillary tangles develop within neurons

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16
Q

What is the theory of the biological changes that occur in DAT?

A

Amyloid Cascade Hypothesis: amyloid plaques occur first and set off chain reaction

but: may be much more complicated with many
factors contributing to the disease process

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17
Q

What is amyloid beta (Aβ)?

A

Naturally occurring peptide fragment cleaved from a larger protein (amyloid precursor protein, APP)

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18
Q

What is amyloid beta (Aβ) in healthy brains?

A

Cleared/broken down efficiently
Associated with normal cognition + health of hippocampus

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19
Q

Why do amyloid beta plaques develop?

A

Peptide fragment is cut, but incorrect enzyme so doesn’t break down properly

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20
Q

Where are tau proteins typically found?

A

Axons, but also occur in dendrites, nucleus, plasma membrane, synapses

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21
Q

What do functional tau proteins do?

A

Provide support + maintain stability of microtubules

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22
Q

What happens to the tau proteins in DAT?

A

Fold in protein, and they break away + accumulate causing tangles to develop

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23
Q

What are the 4 steps in the amyloid cascade hypothesis?

A
  1. Amyloid beta accumulation
  2. Tau pathology
  3. Neuroinflammation + impaired blood flow
  4. Synaptic dysfunction + neurodegeneration
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24
Q

What happens in the amyloid beta accumulation stage?

A

Aβ fragments begin to clump together, forming toxic oligomers + amyloid plaques

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25
What happens in the tau pathology stage?
Presence of Aβ plaques disrupts normal function of tau, so it abnormally folds and creates tangles inside neurons
26
What happens in the neuroinflammation + impaired blood flow stage?
Plaques + tangles contribute to chronic inflammation in brain + interferes with blood flow, causing further damage + disruption
27
What happens in the synaptic function + neurodegeneration tage?
Eventually synapse blocked, communication between neurons disrupted Death of neurons = cognitive decline + dementia
28
What are 5 ways DAT impacts communication?
Word finding difficulties Topic maintenance Comprehension difficulties Episodic memory difficulties Frustration + withdrawal
29
How many people have a Parkinson's disease (PD) diagnosis in the UK? How is this changing?
153,000 172,000 by 2030 (due to population growth + aging)
30
How many people are diagnosed with PD every hour/year?
2 /hour 18,000 /year
31
What are 4 risk factors to developing Parkinson's disease?
Age: average age of onset is 60, risk increases with age Genetics: close relative with PD increases risk, though most have no family history Gender: males more likely Environmental: exposure to certain toxins + chemicals
32
What is Parkinson's disease?
Progressive neurodegenerative disorder characterised by... - loss of dopaminergic neurons in substantia nigra - development of Lewy Bodies + Lewy Neurites, composed of alpha-synuclein protein predominantly
33
What do drug treatments for PD focus on?
Neurotransmitter dopamine
34
What is the substantia nigra?
Midbrain dopaminergic nucleus: critical role modulating motor movement + reward functions as part of basal ganglia circuitry?
35
What are the 2 parts of the substantia nigra?
Pars compacta (SNc) Pars reticulata (SNr)
36
What is the role of the pars compacta (SNc)?
Smaller region containing dopamine-producing neurons
37
What is the role of the pars reticulata (SNr)?
Larger region helping regulate movements by inhibiting unwanted movements
38
What are the symptoms of Parkinson's disease regarding movement?
Dyskinesia Bradykinesia Muscle rigidity Postural instability + impaired balance
39
What is dyskinesia?
Involuntary abnormal movements, seen as a tremor/shaking
40
What is bradykinesisa?
Slowed movements... - slow initiations of movement - reduced speed - decreased dexterity - facial masking - freezing
41
What is muscle rigidity?
Limited flexibility + ROM - stooped posture - difficulty turning when walking
42
What is the effect of Parkinson's disease on speech?
Hypokinetic dysarthria - slow rate of speech (bradylalia), sometimes festination (sped up but reduced ROM) - monotone speech - reduced stress + loudness - imprecise articulation - difficulty initiating speech - reduced breath support - reduced facial expressions
43
What are some other symptoms of PD?
Cognitive changes (Lewy body dementia / Parkinson's dementia) Constipation Sleep problems Depression Anosmia (loss of sense of smell) (Visual) hallucinations
44
What is the incidence and lifetime risk of motor neurone disease worldwide?
2 / 100,000 incidence 1 / 300 lifetime risk
45
What is the male to female ratio of motor neurone disease?
1.6 : 1
46
Which age is someone more likely to have motor neurone disease?
>50 years
47
What is the mean duration of motor neurone disease?
2.5 years
48
How many people in the UK have diagnosed motor neurone disease?
5000
49
What is motor neurone disease (MND)?
Group of diseases that affect nerve cells in brain + spinal cord that control muscle movement Over time, nerve cells waste away & die
50
Which cranial nerves important for speech and swallowing can be impacted by MND?
V – trigeminal VII – facial IX – glossopharyngeal X – vagus XI – accessory XII – hypoglossal
50
Which subsystems of speech can be impacted by MND?
Respiration Phonation Resonance Prosody Articulation
51
What are the 5 different types of MND?
Amyotrophic lateral sclerosis (ALS): 90% of cases Primary lateral sclerosis (PLS) Progressive bulbar palsy (PBP) Progressive muscular atrophy (PMA) Spinal muscular atrophy (SMA)
52
What neurons does amyotrophic lateral sclerosis affect?
Upper + lower motor neurons
53
What neurons does primary lateral sclerosis affect?
Only upper motor neurons
54
What neurons does progressive bulbar palsy affect?
Lower motor neurons in brainstem (control muscles involved in swallowing + speaking)
55
What neurons does progressive muscular atrophy affect?
Only lower motor neurons in limbs
56
What neurons does spinal muscular atrophy affect?
Lower motor neurons in spinal cord - genetic - typically starts in infancy / childhood
57
Where are upper motor neurons and lower motor neurons from?
UMN = central NS LMN = peripheral NS
58
What are the 2 types of paralysis involved in MND?
Flaccid Spastic
59
What is flaccid paralysis?
Lower Motor Neuron damage No impulses going into the muscle Hypotonia (low tone), floppy muscles, muscle atrophy
60
What is spastic paralysis?
Upper Motor Neuron damage LMN continue to receive sensory input via spinal cord (contracts whole time, continuous impulse) Hypertonia (high tone), stiff muscles
61
What are the 3 main symptoms of MND?
Muscle weakness and wasting (common areas affected: hands, arms, legs, shoulders, trunk muscles) Motor speech difficulties Eating, drinking, swallowing difficulties
61
What are other symptoms of MND?
Muscle cramps and twitches (muscle fasciculations / involuntary twitches, can be early sign) Stiffness and rigidity Balance problems and falls (weakness in leg muscles) Respiratory problems (weakness in the muscles that control breathing) Fatigue Cognitive changes (less common) Apraxia
62
What are the motor speech difficulties in amyotrophic lateral sclerosis?
Generally mixed (spastic + flaccid) dysarthria subtypes
63
What are the motor speech difficulties in progressive bulbar palsy?
Generally flaccid dysarthria
64
What are the motor speech difficulties in primary lateral sclerosis?
Only spastic dysarthria
65
What are the motor speech difficulties in progressive muscular atrophy?
Only flaccid dysarthria
66
What are the motor speech difficulties in spinal muscular atrophy?
Only flaccid dysarthria
67
What dementia may some with motor neuron disease have?
Frontotemporal → behavioural issues
68
What is a stroke according to NICE?
Clinical syndrome of presumed vascular origin characterises by rapidly developing signs of focal / global disturbance of cerebral functions Lasts longer than 24 hours / leads to death
69
What is another name for a stroke?
Cerebrovascular accident (CVA)
70
What are the 2 types of strokes?
Ischaemic (85%) - artery supplying blood to brain is blocked by blood clot Haemorrhagic (15%) - blood vessel ruptures in brain, causing bleeding in brain
71
What is ischaemia?
Interruption of blood flow in a vessel Loss of O2 + glucose to specific area of cells + tissues
72
What is the area of ischaemia called?
Infarct
73
What are the 4 subtypes of ischaemic stroke?
Large vessel disease Small vessel disease Embolic Cryptogenic
74
What is a large vessel disease stroke?
Large arteries blocked due to plaque and thrombus (clot) that forms in blood vessel
75
What is a small vessel disease stroke?
Arterioles blocked due to hypertension / ageing / genetics
76
What is an embolic stroke?
Due to clot (embolus) travelling to brain Common after heart disease / heart surgery
77
What is a cryptogenic stroke?
Rare, cause not determined
78
What are Transient ischaemic attacks (TIAs)?
Resolve quickly, clot dissolves within seconds Stroke symptoms occur but usually last <24h
79
What are the 2 types of haemorrhagic strokes?
Intracerebral haemorrhage (ICH) Subarachnoid haemorrhage
80
What is an intracerebral haemorrhage?
Bleeding into brain tissue (brain parenchyma)
81
What is a subarachnoid haemorrhage?
Bleeding into space under arachnoid mater
82
What is the effect of an ischaemic stroke on neurons?
Neurons starved of oxygen (+ glucose) Infarct size varies depending on which blood vessel blocked
83
What is the effect of a haemorrhagic stroke on neurons?
Neurons disrupted by direct contact with leaked blood Extracellular ion balance (NaK pump) disturbed, becomes dehydrated as blood is a dif composition to extracellular fluid
84
What is the most common and severe type of stroke according to the Oxford classification?
Total anterior circulation infarct (TACI) - MCA artery (90% of time) - affects frontal + parietal + temporal lobe
85
What are the features of a total anterior circulation infarct (TACI)?
Contralateral motor/sensory deficit New higher cortical dysfunction Visual defect
86
What are 3 other stroke subtypes according to the Oxford classification?
Partial anterior circulation infarct (PACI) Posterior circulation infarct (POCI) Lacunar circulation infarcts (LACI)
87
What are the features of partial anterior circulation infarct?
Smaller branch of ACA so only 1/2 of TACI signs
88
What are the features of posterior circulation infarct?
Involves PCA, ataxia + visual loss
89
What are the features of lacunar circulation infarcts?
Mostly affect brainstem, pure motor/sensory (no cortical signs)
90
What is traumatic brain injury (TBI)?
Injury to brain function / indication of brain pathology caused by an external force
91
How is TBI severity measured?
Glasgow coma scale
92
What are the 2 subtypes of TBI?
Focal Diffuse
93
How are diffuse TBIs caused?
Force / event affecting all/most of brain Diffuse axonal injury = shearing of brain's axon as it shifts and rotates inside the skull during rapid acceleration/deceleration
94
How are focal TBIs caused?
External force at a local site Penetrating (bullet, shrapnel) or non-penetrating, causing contusion (fall, blunt force injury, traffic accident)
95
What is the primary injury stage of TBI?
Immediate tissue damage due to direct impact of injury eg: axonal shearing, haemorrhage, penetration of skull
96
What is the secondary injury stage of TBI?
Hypoxia (minutes post injury) Brain bruising, swelling, bleeding, blood clots → raised intracranial pressure (over 24h)
97
What are the 3 haemorrhages in TBI?
Epidural haemorrhage Subdural haemorrhage Intracerebral haemorrhage
98
What is an epidural haemorrhage in TBI?
Directly under skull bone - Blunt trauma to head, typically temporal region - Penetrating, often with skull fracture leading to bleeding
99
What is a subdural haemorrhage in TBI?
Blood enters subdural space due to damage to blodo vessels near dura - Usually blunt force injury but also penetrating
100
What is an intracerebral haemorrhage in TBI?
Bleeding from brain tissue deeper in brain - Blunt force, penetrating, or shearing
101
What is intracranial pressure (ICP)?
Pressure in the cranial vault (usually <20mm Hg)
102
How does haemorrhagic bleeding affect intracranial pressure?
Rise in ICP Compression of medulla in foramen magnum Damage to vital medulla centres (cardiovascular + respiratory)
103
What is aphasia?
Impairment of comprehension / formulation of language caused by damage to cortical centre for language
104
Where is does the lesion for conduction aphasia occur?
White matter connecting the temporal + parietal + frontal lobe Includes arcuate fasciculus - inability to repeat phrases
105
What is dysarthria?
Weakness / paralysis / incoordination of the speech musculature due to damage in motor pathways from stroke or TBI
106
What is apraxia of speech?
Motor planning / programming disorder, muscles aren't weak but brain struggles to plan movement, often due to LH strokes or focal injuries

Speech and Language Therapy Y1 (14 decks)

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