Impaired Cognition Flashcards
(86 cards)
1
Q
Why do patients benefit from consultation with speech pathology?
A
The diseases & conditions (etiologies) that can cause cognitive communication disorders encompasses the entire spectrum of etiologies in medicine
communication etiologies = medicine etiologies
2
Q
How is etiology different from pathophysiology?
A
Etiology
- cause, set of causes, or manner of causation of a disease or condition
- disease/injury
Pathophysiology
- describes the functional changes associated with or resulting from disease or injury
- what you’d expect to see considering disease/injury (etiology)
Both are important in understanding course, prognosis, and treatment of disease or injury
3
Q
The Etiology of a disease is…
A
the cause, set of causes or manner of causation of a disease or condition
4
Q
Pathophysiology of a disease is…
A
the functional changes associated with or resulting from disease or injury
–> what you’d exprect to see considering disease/injury
5
Q
_________________ & ________________ are important in understanding the course, prognosis, and treatment of disease or injury
A
Etiology & Pathophysiology
6
Q
Name Etiologic Categories
A
DINT 2I TV (Din’t 2 eye TV) Think too much TV = illness
- Degenerative - neurons decline
- Inflammatory -responses to bacteria
- Neoplastic - causes cancer
- Toxic Metabolic - deficiencies/toxicity ( too much junk food is toxic–> deficiencies)
2 I (eyes)
- Iatrogenic - needed surgery now im damaged
- Idiopathic - who knows why?
TV
- Trauma - lots of gunshots, falls, and sports on TV
- Vascular - stroke/neurologic deficits
7
Q
What type of disease etiology causes decline in neuronal function?
A
Degenerative Diseases
(i.e. Alzheimers)
8
Q
What etiology is caused by responses to bacteria, immunologic reactions, viruses?
A
Inflammatory Diseases
e.g. Covid-19, meningitis
9
Q
Which etiology is caused by vitamin deficiencies, complications of kidney and liver disease, hypoxia, hyponatremia, drug toxicity?
A
Toxic- metabolic diseases
10
Q
What etiology does cancer fall under?
A
Neoplastic diseases
11
Q
What etiology is most common cause of neurologic deficits?
A
Vascular diseases
e.g. cerebrovascular disease (stroke)
12
Q
Potential precipitating events (e.g. MVA, fall, gunshot wounds, blast injury, and sports-related injuries all are ________
A
Trauma
13
Q
Disease caused by medical examinations or treatment are considered _____ in etiology
A
Iatrogenic
e.g. nerve damage from surgery
14
Q
Diseases of unknown causes are called ______________ in etiology
A
Idiopathic
15
Q
How are diseases/conditions categorized?
A
CAR-D-D *think cardi-b
- C-onditions of Immunocompromise (please me song)
- A-cute onset diseases that remain stable or improve (started from the bottom now we here)
- R-elapsing remitting diseases (general downward trend) - (Be Careful)
- D-iseases that worsen - (i Like it)
- D-iseases that are episodic -(WAP)
16
Q
- Stroke
- TBI
- Abscesses
- Encephalitis
are _______ diseases that are ______ or ______
A
acute onset diseases
stable
improve
17
Q
what are acute onset diseases?
A
Diseases that remain stable or improve:
Stroke
TBI
Abscesses
Enchephalitis
18
Q
What causes CVAs/Strokes?
A
lack of blood flow to any area of the brain (including brainstem)
19
Q
a lack of blood flow to any area of the brain and brainstem would cause…
A
Cerebrovascular accident (CVA, aka stroke)
20
Q
What deficits most often result due to the loss of blood flow in the left MCA from stroke?
A
cognitive-linguistic defecits
21
Q
What happens as a result of blockage in brain from stroke?
A
- blockage prevents nearby brain tissure from getting nutrients
- Brain tissue is deprived of oxygen & nutrients, it begins to die
22
Q
3rd leading cause of death & leading cause of disability
A
Strokes
700,000 strokes annually
23
Q
Types of stroke are
A
Hemorrhagic
Ischemic
24
Q
Hemorrhagic stroke caused by..
A
ruptured blood vessel that causes bleeding in the brain
25
2 subtypes of hemorrhagic stroke
* intracerebral (within the brain) hemorrhage
* subarachnoid ( within arachnoid space) hemorrhage
26
Name two types of weakened blood vessels that cause hemorrhagic stroke
* Cerebral aneurysm: ballooning, weakened artery
* Arteriovenous malformation (AVMs): tangle of blood vessels; congenital but can become a problem
27
A ballooning, weakend artery is \_\_\_\_
cerebral aneurysm
28
A tangle of blood vessels that are congenital and can become a problem are ---
Arteriovenous Malformations (AVMs)
29
Cerebral aneurysms & Arteriovenous malformations (AVMs) usually cause
hemorraghic stroke
30
What type of stroke accounts for nearly 90% of all strokes?
Ischemic (clots)
31
2 subtypes of Ischemic clots are
* Thrombotic - forms in artery within brain & blocks blood flow
* Embolic- clot forms & travels in bloodstream then lodges & blocks blood flow
32
\_\_\_\_\_ _____ form in arteries within the brain and blocks blood flow causing an ______ stroke
Thrombotic clots; Ischemic
33
\_\_\_\_\_ _____ form and travel in blood stream, lodging & blocking blood flow causing ______ stroke
Embolic clot; Ischemic
34
\_\_\_\_\_\_\_ is the brain's way of reorganizing neural connections to compensate for injury and disease
Neuroplasticity
35
Symptoms of stroke
First few days following stroke is the critical period. Recognize signs:
* F-ace drooping
* A-rm weakness
* S-peech difficulty
* T-ime to call 911
36
Emphasis after stroke is on
* restoring blood flow in order to save brain tissue (as much as possible)
* determining cause & finding treatments
37
Do the majority of strokes improve?
yes or no
**YES!**
often improvment continues often throughout the patient's lifetime (neuroplasticity)
38
What contributes to improvement after stroke?
Neuroplasticity!
neural connections are reorganized in brain to compensate for injury & disease
39
Why is the location of stroke (site of lesion important to determine after a stroke?
* Site of lesions can give insight to what deficits may occur.
Examples:
* Left MCA blockage = results in ischemia to left posterior, inferior frontal lobe = Broca's aphasia
* Subarachnoid hemorrhage in temporal lobe caused by trauma = headache, visuospatial neglect.
40
Severities of
Traumatic Brain Injury
(TBI)
* Mild - brief loss of consciousness
* Most recover within 3-12 months
* Severe- prolonged loss consciousness (including coma)
* Long-term difficulties
41
Types of
Traumatic Brain Injury
(TBI)
**2 types:**
* *_Closed brain injury_*
* cause by a rapid forward or backward movement and shaking of the brain inside the bony skull = bruising & tearing of brain tissue and blood vessels.
* car accidents, falls, and increasing in sports
* *_Penetrating brain injury_*
* caused when there is a break in the skull
* gun shot wounds
42
Shearing of the brain's nerve fibers (axons) that happens when the brain is injured as it shifts and rotates inside the bony skull
Diffuse axonal injury
43
Diffuse axonal injuries are always evident on CT & MRI scans
True or False
FALSE!
Diffuse axonal injuries are often ***microscopic*** that they may ***not show*** on CT (computed tomography) scans or MRI (magnetic resonance imaging) scans.
44
\_\_\_\_\_\_\_\_\_\_\_ start with a localized area of cerebritis (inflammation of the cerebrum) developing into collection of pus & well vascularized capsule
Abscesses
45
How are abscesses similar to stroke?
the deficits will depend on location of abscess
46
Encephalitis is ...
\_\_\_\_\_\_\_\_ the inflammation of the brain parenchyma or tissue itself
47
Types of Encephalitis
* Viral
* Bacterial
48
Area of brain where encephalitis tends to occur
Temporal lobes
49
Deficits that occur with encephalitis
* Significant dysnomia
* impaired new learning
* impaired memory
50
Conditions of Immunocompromise examples
* Progressive multifocal leukoencephalopathy
* HIV infections/AIDS
* COVID-19
* May also include those on immunosuppressant medications or chemotherapy
51
* Progressive multifocal leukoencephalopathy
* HIV/AIDS
* COVID
* those on immunosuppressent medications
* those undergoing chemotherapy
are all examples of what type of etiology?
Conditions of Immunocompromise
52
Progressive Multifocal Leukoencephalopathy (PML)
* Disease of white matter of the brain
* caused by virus infection that targets myelin making cells (which insulates neurons).
* has been noted to occur in patients with AIDS
* and in those taking natalizumab to treat Multiple sclerosis or rheumatoid arthritis
* has a subacute onset of altered mental status
* and focal symptoms related to location of PML lesions
53
What is the cause of PML (progressive multifocal leukoencephalopathy)?
* A virus infection targets cells that make myelin which insulates nerve cells
* Disease of white matter of the brain
54
What patients has PML been noted to occur in?
* AIDS
* those taking natalizumab for MS or RA
55
Symptoms of PML
* subacute onset of altered mental status
* focal symptoms related to location of PML lesions
56
How does HIV/AIDs affect the body?
* by killing CD4+T cells which weaken the immune system
* allowing opportunistic infections
57
Why are T cells important?
* they are essential to the immune response
* without T cells, body cannot fight infections or kill cancerous cells
58
Cognitive changes caused by HIV virus
* HIV-associated Neurocognitive disorder (HAND)
* group of neurocognitive disorders consisting of:
* HAD - HIV associated dementia, used to be called AIDS dementia complex ; more severe form of HAND
* considered subcortical-type dementia
* impairments in attention, processing speed, executive function & verbal memory.
* MND - mild neurocognitive disorder
* some patients see improvment in cognitive testing with antiretroviral medication
59
COVID-19 cognitive deficits
Potential link between inflammatory status & cognitive functions in COVID-19 patients
* potential cognitive dysfunction
* sustained attention deficit is correlated with inflammatory level
60
Multiple Sclerosis (MS) and Systemic Lupus Erythematous (SLE) are examples of
\_\_\_\_\_\_\_\_\_\_ __________ diseases
relapsing remitting
61
Demyelinating disease consisting of a relapsing & remiting course,
with slowd overall course (if treated)
Multiple Sclerosis (MS)
62
Cognitive impairments resulting from MS
* Memory
* sustained attention
* processing speed
* executive function
\*\*50% of patients have cognitive impairments
63
Autoimmune disease that occurs when your body's immune system attacks your own tissues and organs; affects many different body systems
Systemic Lupus Erythrematosus
| (SLE)
64
• Alzheimer’s Disease (AD)
* Parkinson’s Disease (PD)
* Frontotemporal dementia (FTD)
* Primary Progressive Aphasia (PPA)
* Progressive Supranuclear Palsy (PSP)
* Corticobasal Syndrome (CBS)
* Amyotrophic lateral sclerosis (ALS)
* Multiple System Atrophy (MSA)
* Creutzfeldt-Jakob disease (CJD)
* Brain tumors
are all _________ \_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_
Diseases that Worsen
65
Alzheimer's Disease (AD)
-cause
_Wide belief:_ Plaques (beta amyloid protein deposits) & tangles (tau protein fibers) play a role in blocking communication among nerve cells & disrupting processes that cells need to survive
* scientists do not know exact role that plaques & tangles play in AD.
* Those with AD tend to develop more than normal plaques & tangles in a predictable pattern
* starts to develop in areas more important for memory
* 2/3rds of all dementia is result of AD
66
Alzheimer's Disease (AD)
- hallmarks
- related communication/cognitive impairments
* Hallmark* : slowly progressive memory impairment
* Communication/Cognitive deficits:*
* agnosia (inability to process sensory information; inability to recognize objects, persons, sounds, etc.)
* apraxia
* aphasia
* executive function impairments
67
Parkinson's Disease (PD)
Cause
* caused by loss of dopamine-producing nerve cells in substantia nigra
* dopamine acts as messenger between parts of brain & nervous system
* that help control & coordinate body movements
68
Parkinsonism
umbrella term used to descrive symptoms of tremors, muscle rigidity & slowness of movement
69
Types of Parkinson's Disease (PD)
* Parkinson's disease: idiopathic
* most common
* Vascular
* Drug-Induced
* Other
70
Parkinson's Disease (PD)
Cognitive deficits
* slower cognitive functioning and processing speeds
* attention
* working memory
* executive function deficits
* all most common as opposed to language deficits
71
Frontotemporal Dementia (FTD)
cause
* group of related conditions resulting form progressive degeneration of temporal and frontal lobes of brain
* scientists believe it's caused by large build up of one of three kinds of protein within brain cells
* tau
* TDP-43
* fused-in sarcoma (FUS)
* causing brain atrophy
72
Frontotemporal Dementia (FTD)
symptoms & hallmark
* Presenting symptom - behavioral difficulties
* saying inappropriate things or lack emotion
* Hallmark - Executive dysfunction
73
Types of Frontotemporal Dementia (FTD)
* Behavioral variant frontotemporal dementia (bvFTD)
* Semantic variant primary progressive aphasia (svPPA)
* Non-fluent/aggrammatic variant primary progressive aphasia (nfvPPA)
74
Primary Progressive Aphasia (PPA)
-cause
* cause = atrophy in frontal, temporal or parietal lobes
* primarily on left side of brain
* atrophy may be caused by abnormal proteins
75
Primary Progressive Aphasia (PPA)
types
• Semantic variant primary progressive aphasia (svPPA)
• Non-fluent/agrammatic variant primary progressive
aphasia (nfvPPA)
* lopopenic variant primary progressive aphasia (LvPPA)
* at autopsy, patients with lvPPA are often found to have AD, not FTD
76
Caused by atrophy in frontal, temporal or parietal lobes primarily on left side of brain
may be caused by abnormal proteins
Primary Progressive Aphasia
77
Progressive Supranuclear Palsy (PSP)
cause
deficits
* buildup of tau proteins in brain
* deficits
* impaired balance
* impaired eye movements (inability to look down)
* spastic dysarthria
* dysphagia
* bradykinesia
* rigidity
* frontal behavioral changes
* Executive dysfunction & poor recall
78
Corticobasal Syndrome (CBS)
cause
deficits
* buildup of tau or amyloid proteins causing brain atrophy
* Impairments:
* limb apraxia
* visuospatial impairments
* rigidity
* acalculia
* frontal dysfunctions
* alien limb phenomenon
* language impairments later on
* might develop memory or executive impairments later on
79
Amyotrophic Lateral Sclerosis (ALS)
cause
* most common motor neuron disease in adults
* progressive muscle paresis & paralysis
* 20% of patients also have FTD signs & symptoms
* 50% of patients have mild executive function impairments
* Unknown why motor neurons are dying in the disease
* more clues pointing to inflammation
80
A rare, degenerative neurological disorder affecting your body's involuntary (autonomic) functions
including:
* blood pressure
* breathing
* bladder function
* motor control
Multiple System Atrophy (MSA)
81
Creutzfeldt-Jakob Disease (CJD)
cause
symptoms
deficits
A fast, progressive, invariably fatal neurodegenerative disease
* cause = misshapen prion proteins
* symptoms =
* personality changes
* anxiety
* depression
* deficits =
* memory loss
* executive dysfunction
* blurred vision or blindness
* insomnia
* dysarthria
* dysphagia
* dyskinesias
82
**Brain Tumors**
types
causes
* Types:
* Primary
* Metastasis from other cancer sites
* Glioblastoma accounts for 50-60% of all cases
* life expectance 12-15 months after diagnosis
83
**Brain tumors**
symptoms
deficits
*Symptoms:* depend on type of cancer/location
* Seizures
* headaches
* nausea
* vomiting
* changes to personality
*Deficits*
* memory loss
* changes to personality
* attention
* executive dysfunction
84
Transient Ischemic Attacks (TIAs)
Seizures
are _______ that are \_\_\_\_\_\_\_\_
Diseases that are Episodic
85
Appears exactly like a stroke but resolves within 24 hours
Transient Ischemic Attack
\*If symptoms last longer than 24 hours, considered a stroke
86
**Seizures**
## Footnote
cause
deficits
recovery
* Causes = variety; Epilepsy is a seizure disorder
* Slowly recover following seizure
* postictal period (altered state of consciousness after an epileptic seizure) can be a few hours - 24 hours
* Cognitive communication impairments -
* may occur during or in postictal period, but usually resolve
