Dementia Flashcards
(53 cards)
1
Q
What is the assessment process for dementia?
A
- no single test
- likely to start with GP/hospital teams
- NHS indicators screen for dementia
- case history
- physical
- blood and urine tests
- assess mental abilities
- onward referral
- in depth cog and neuropsych testing
2
Q
What is the main cog screening ax?
A
- Mini-mental state exam (MMSE)
- quick 15 min ax
- orientation, registration, attention, recall, lang, copy
3
Q
What are the clinical Axs for dementia?
A
- structural exams - shape and form of the brain, showing potential atrophy or ‘shrinkage’ of tissue, and changes in structure (CT, MRI)
- Functional scans (SPECT, PET)
4
Q
Which areas of the brain can be affected by dementia?
A
- abstract thinking and judgement
- spersonality
- social conduct
- praxis
- lang
- visuospatia
- construction skills
- memory
5
Q
What is the role of SLT in dementia?
A
- Ax -speech lang comp, expression, social coms, and cog coms
- intervention - develop strategies to improve comp and understanding
- advocacy and support
6
Q
What is the SLT ax process?
A
- Informal ax
- standardised ax
- consideration of environment and com demands/needs
- social activities
- strengths/deficits profile
- knowledge of condition
7
Q
What is the purpose of ax?
A
- ax profile of all speech and lang skills
- obtain lang sample
- differentiate between primary cog and lang deficits
- identify barriers to coms
- understand personal context
- determine intact skills
- contribute to diagnostic process
- determine new strategies needed as disease progresses
8
Q
What formal SLT Ax may be used?
A
- PALPA
- British Picture Vocabulary Scale
- Graded Naming Test
- CQLT
- PASS
- WAB
- CAT
- BDAE
- BNT
- Token test (multilingua)
9
Q
What informal ax may be used?
A
- obs and convos
10
Q
What might SLT intervention focus on?
A
- impairment based - maintenance of function
- activity and ppt based - what do they do and degree of ability
- wellbeing goals
- functional goals
- strategies and adaptations
- mental capacity ax (MCA)
- work with CPS
explanations - AAC
11
Q
What are the aims of SLT intervention?
A
- preservation of independence
- helping person and carers
- maintaining and developing relationships
12
Q
What are the most common dementias on SLT caseload?
A
- dementia of Alzheimer’s type (DAT)
- frontotemporal dementia (FTD)
- vascular dementia
13
Q
What are the causes of vascular dementia?
A
-Narrowing of small blood vessels deep inside the brain (small vessel disease)
- stroke
- multi-infarcts
14
Q
What are the risk factors for vascualar dementia?
A
- high bp
smoking - high cholesterol
- lack of exercise
- overweight
- diabetes
- excessive alcohol
- arterial fibrilation and heart disease
15
Q
What are the early stages of VD?
A
- slow thought
- difficulty planning
- diff understanding
- diff concentration
- mood/behavioural changes
- diff with memory and lang
16
Q
How might VD present in later stages?
A
- sig slow thought
- disorientation and confusion
- mem loss and diff concentrating
- WFD
- severe personality changes eg aggression
- mobility and balance problems with frequent falls
- depression, mood swings, apathy,
- incontinence
- increasing diff with activities
17
Q
What lang diff might there be in VD?
A
- variable and related to location of damage
- often mild initially
- progression depends on further hypoxic events
- dysarthria can coexist
- ax depends on presentation, deficit, and client/carer needs
- can often start with similar axs to stroke
18
Q
What is the cause of DAT?
A
Degeneration of neurons due to amyloid beta plaques outside cell and tau neurofibrillary tangles within cell resulting in loss of neurotransmitters (particularly acetylcholine)
19
Q
What are the triggers of DAT?
A
Unclear
- genetic
- diet
- lifestyle
- toxins
20
Q
What is the diagnostic criteria for DAT?
A
Essential feature : Multiple cognitive deficits that include memory impairment and at least one of the following:
- aphaisa
- apraxia
- agnosia
- disturbance in EF
Deficits must
- be sufficiently severe to cause impairment in occupational or social functioning
- Represent a decline from a previously higher level of functioning
21
Q
What is the general presentation in DAT?
A
- early presentation often ‘forgetting things’ and some WFDs
- can appear depressed
- disorientation in cog function as disease progresses
22
Q
What is the general lang presentation in DAT?
A
- spoken output lacks content
- WFD
- clear articulation
- good syntax (until late stages)
- fluent speech
- preserved reading aloud
23
Q
What are the features of mild stage DAT?
A
- depression
- anterograde and retrograde amnesia
- WFD
24
Q
What are the potential impact of mild stage DAT features on comms?
A
- Withdrawal from interaction
- Less initiation of communication
- Losing thread of conversation
- Repetition of topics, questions
- Distress over poor memory
- Covering up difficulties or masking
25
What are the features of moderate stage DAT?
- increased WFDs
- reduced content and specificity of output
- comprehension difficulties
- episodic memory and WM impairment
- Impairments in problem solving
- Difficulty shifting set
- Reduced attention span, difficulties dividing and shifting attention
- Overall reduction of insight and awareness of language/communication impairment including of communicative partner
26
What are the potential impacts of the features of moderate stage DAT on coms?
- Verbose output but with reduced content
- Poor reference to conversation partner and cues
- Reduced awareness of errors or attempts at repair
- Losing thread of conversation
- Repetition of topics, questions
- Less relevant responses
- Difficulty understanding and responding to longer or more complex utterances
- Difficulty coping with conversation in groups
27
What are the features of severe stages DAT?
- echolalia
- neologistic speech
- mute
- apathy
- aggression
28
What are the potential impacts of severe stages of DAT on coms?
- Little to no initiation of communication
- Sig withdrawal from interaction
- Distress/aggression at caregiving acts
- Limited awareness of CPs
- Repetitive utterances with no obvious trigger
- Little orientation to time, person, place
- Disinhibition
Often remain responsive to gentle touch, tone of voice
- May calm to music, singing, television
29
What is the prevalence of FTD?
- Second most common dementia in the under 65 age group
- Third most common neurodegenerative dementia across all ages
30
What is the cause of FTD?
- Progressive atrophy of either the frontal or temporal lobes
- As disease progresses all areas are affected
- Unclear cause but build-up of proteins implicated e.g. tau and TDP – 43
31
What are the features of FTD?
- All FTD subtypes are steadily progressive
- Declining function in everyday life
- Accumulation of social, cognitive, and neurological disabilities
- Survival duration highly variable
- Tends to be convergence of syndromes over time
- Wandering, intrusive behaviours, apathy, incontinence, mutism, and dysphagia common toward the end of life
32
What are the variants of FTD
Behavioural variant (bvFTD)
Primary progressive aphasia (PPA) which can be broken into
- Progressive non-fluent aphasia (nfvPPA)
- semantic dementia (svPPA)
- logopenic (lvPPA)
33
What are the challenges of FTD variants?
- diff to diagnose and work with
- SLTs need strong knowledge of different presentations to be confident in practice
34
Why might bvFTD be diff to diagnose?
- shares symptoms with primary psychiatric disorders s(e.g. SZ, OCD, borderline personality disorder, and bipolar)
- Shares symptoms with neurodegenerative diseases (Progressive supranuclear palsy, corticobasal degeneration, and MND)
35
What is the progression of bvFTD?
- Insidious onset and slow progression with early decline of social interpersonal behaviour, regulation of personal behaviour, insight
- Emotional blunting
36
What are the features of bvFTD?
- impulsivity and social disinhibition
- Loss of ability to empathise - can become detached in relationships
- Decline in personal hygiene and grooming
- May become more irritable
- Mental rigidity and inflexibility
- may become overly friendly and trusting
- Obsessive-compulsive behaviours (hoarding is common)
- Eating tastes can change – some develop a strong preference for sweets
- Apathy and inertia
37
Describe PPAs
- Clinically heterogeneous group of dementias
- speech and lang affected first in all 3 sub variants though in distinctly different ways initially
- All 3 variants progress in severity
- Speed of progression varies though all will ultimately require care and support with basic activities
- Presentation can vary between individuals within the same subtype
38
What are the key features of nfvPPA?
Increasing difficulties with grammatical aspects of speech and speech production
39
What is the diagnostic criteria of nfvPPA?
One of the following must be present
- Agrammatism in language production (verbal and written)
- Effortful halting speech productions with inconsistent speech sound errors and distortions (apraxia of speech)
Two of the following must be present
- Impaired comprehension of syntactically complex sentences
- Spared-single word comprehension
- Spared object knowledge
40
What is the general presentation of nfvPPA?
- Progressive breakdown in lang output
- Effortful non-fluent speech
- phonemic or articulatory errors are dominant for some
- For others dominated by expressive agrammatism with telegraphic phrases
- Features commonly coexist as the disease progresses
- Impaired sentence comp for syntactically complex sentences initially
41
What are the features of mild nfvPPA?
- Slow effortful speech production
- Grammatical errors in speech and writing
- Leaving out small grammatical words
- Poorly structured sentences
- Words in the sentence may be incorrect order
- Word omissions
- Reduced fluency
- Reduced intelligibility
- Comp diffs with sentences of increasing length and complexity
- Motor difficulties
- Apraxia of speech
42
What are the later features of nfvPPA?
- Increasing impairments in reading, writing, spelling
- Reduced comp
- Behavioural changes
- Deterioration in EF
- May show motor signs similar to Parkinson’s e.g. tremor, impaired mobility and dexterity
43
What are the key features of svPPA?
- WFD
- semantic paraphasias
- word comp impairment
44
What is the diagnostic criteria for svPPA?
Both of the following must be present
- Impaired object naming
- Impaired single word comp
Three of the following must be present
- Impaired object knowledge (frequency effect)
- Surface dyslexia/dysgraphia
- Spared repetition
- Spared grammaticality and motor aspects of speech
45
What is the cause of svPPA?
- due to atrophy of anterior temporal lobe/s which can vary in the different hemispheres
- temporal lobe is responsible for ability to understand the meaning of the world around us
46
What can impaired temporal lobe function affect?
- Conceptual and lexical knowledge:
- Smells
- Tastes
- Sounds
- Visual stimuli
- Pain
- Gesture
47
What are the mild/moderate features of svPPA?
- WFD
- diff with meaning recall of words
- diff recalling functions of daily objects
- errors in word selection/substitution
- fillers
- frequency effect at first then progresses to higher frequency too
- surface dyslexia and dysgraphia
- Hierarchical deterioration in semantic knowledge – early stages close semantic errors , later stages category errors
- Fluent speech which may be verbose, circumlocutory, vague, lacking content
- Difficulties with comp of spoken lang
48
What are the later features of svPPA?
- reduction in verbal output
- changes in behaviour and personality
- increased obsessions
- impaired facial recognition
- absent/impaired spoken comp
- absent/ impaired object/sound recognition
49
What are the key features of logopenic variant PPA (lvPPA)?
- phonological difficulties
- WFDs and impaired fluency
50
What is the cause of lvPPA?
- thought to involve the cortical areas/connections generating the phonological loop
- more recently identified
- May be linked to both FTD and Alzheimer’s pathologies – presence of amyloid protein
51
What is the diagnostic criteria for lvPPA?
Both of the following must be present
- Impaired single-word retrieval in spontaneous speech and naming
- Impaired repetition of phrases and sentences
Three of the following must be present
- Phonological errors in spontaneous speech or naming
- Spared single-word comprehension
- Spared motor speech
- Absence of frank agrammatism
52
What is the general presentation of lvPPA?
- Marked WFD
- Reduced rate of speech
- Hesitant but grammatically correct speech
- Word-finding pauses
- Impaired phonological WM
demonstrated by a disproportionate difficulty repeating spoken phrases versus single words
- Preservation of receptive
- Many have underlying Alzheimer’s pathology, leading to more widespread cognitive deficits
53
What is the presentation of later stages lvPPA?
- Increasing cog impairments
- Increasing memory diff
- Increased diff using household objects
- Better comp than expression
- May develop apraxia of speech
- Severe dysarthria
- Little initiation of communication
- Apathy towards participating in conversation
