Quiz 3 Flashcards
(115 cards)
1
Q
Dementia is characterized by acquired, persistent impairment of multiple cognitive domains that significantly alters _______, social interaction, occupational function, and the ability to perform ______ activities of daily living.
A
communication; instrumental
2
Q
What is the preclinical condition that may suggest a person is at risk for developing dementia?
A
Mild cognitive impairment (MCI)
3
Q
Mild cognitive impairment is a ______ stage or condition of intermediate symptoms b/w the cognitive changes associated with healthy aging and the salient cognitive impairments seen in Alzheimer’s disease or other dementias.
A
transition
4
Q
What are the two types of mild cognitive impairment?
A
Amnestic MCI
Non-amnestic MCI
5
Q
What type of MCI affects memory only?
A
amnestic
6
Q
Other cognitive functions are initially affected (e.g., language or executive function) is what type of MCI?
A
non-amnestic
7
Q
What is the diagnostic criteria for MCI?
A
- Self-report of memory problems
- measurable memory impairment on standardized test
- No impairments in reasoning, general thinking skills, or ability to perform activities of daily living.
8
Q
List the 4 types of dementia.
A
Alzheimer’s Disease
Vascular Dementia
Dementia with Lewy Bodies
Frontotemporal Dementia
9
Q
Episodic memory deficits
Working memory deficits
Attention and executive function impairments
language and communication impairments
Are all the earliest symptoms of what type of dementia?
A
Alzheimer’s disease (AD)
10
Q
List some modifiable risk factors of AD
A
diet, exercise, controlled cardiovascular risk
11
Q
List some NON-modifiable risk factors of AD
A
older age, positive family history, carrier status for the e4 allele of APOE gene
12
Q
What language and communication aspects are affected earliest in AD?
A
lexical retrieval
discourse
13
Q
What abilities are spared in early dementia?
A
Orientation to self and to other persons Semantic memory Ability to produce fluent sentences Engage in conversation Frequently follow 2-step to 3-step commands
14
Q
These are all abilities in what stage of AD?
ability to follow 1-2 step commands
can sustain attention for some time
can make relevant on topic statements or comments about tangible stimuli during conversation
A
middle-stage
15
Q
What abilities are present in later-stage AD?
A
attend to pleasant stimuli (e.g., music, sensory stimulation) for brief periods of time
16
Q
Vascular dementia is most commonly caused by ischemic or hemorrhagic cerebrovascular disease, ________ disease, or _______ disturbances that damage brain areas vital for cognitive function
A
cardiovascular; circulatory
17
Q
What are risk factors associated with vascular dementia?
A
hypertension hypercholesterolemia (high cholesterol) Type II diabetes mellitus prior history of stroke smoking
18
Q
Vascular is the _____ most common cause of dementia. (first, second, third)
A
second
19
Q
Which type of dementia is related to Parkinson’s Disease? (most commonly diagnosed after age 65)
A
Dementia with Lewy Bodies (DLB)
20
Q
What are Lewy Bodies?
A
abnormal clumps of alpha-synuclein protein
21
Q
When motor deficits precede cognitive impairment, it may be _________?
A
Parkinson’s disease
22
Q
When cognitive impairment precedes motor deficits, it may be _________?
A
Dementia with Lewy Bodies
23
Q
The following symptoms are associated to which type of dementia? hallucinations visuospatial impairment sleep disturbance fluctuating attention and vigilance gain imbalances reduced speech rate and fluency executive function impairments
A
Dementia with Lewy Bodies
24
Q
Frontotemporal Dementia accounts for 10% of dementia cases, most are diagnosed ______ the age of 65.
A
before
25
What is a nonspecific term that describes a disease or disorder of the brain?
Encephalopathy
26
What alters the brains functions and / or structure of the left and right hemispheres?
Encephalopathy
27
A higher percentage of geriatrics have what?
Encephalopathy
28
Approximately what percent of those with encephalopathy are in surgical ICU’s?
20-30%
29
What are presenting features of encephalopathy? Mark all that apply.
A. Acute change in mental state
B. Change in personality, behavior, and in cognitive functioning
C. Altered level of alertness
D. Inattentiveness, Lethargy, and Distractibility
E. All of the above
E. All of the above
30
```
Examples of encephalopathy etiologies include
•Infection (bacterial, viral)
•Dehydration, poor nutrition
•Metabolic deficiency
•Hypoglycemia
•Diabetic ketoacidosis
•Drug intoxication
•Anoxia
•Uremia
•Meningitis
•______ ________
```
Brain Tumors
31
Right Hemisphere Brain Damage:
| Characteristics include both: _____ and ______ deficits
Cognitive; Communication
32
```
Right Hemisphere Brain Damage:
Cognitive deficits- (AEA)
1.
2.
3.
```
Attention
Executive function
Awareness of deficits (anosognosia)
33
```
Right Hemisphere Brain Damage:
Communication deficits- (PCPP)
1.
2.
3.
4.
```
Prosody (aprosodia)
Comprehension
Production
Pragmatics
34
```
Right Hemisphere Brain Damage:
Attention difficulty with- (SAUS)
1.
2.
3.
4.
```
Sustained
Alternating
Unilateral neglect
Selective
35
Right Hemisphere Brain Damage:
| Unilateral neglect is ____ a visual deficit
NOT
36
Right Hemisphere Brain Damage:
| Unilateral neglect can occur following damage to _____ henisphere.
Either
37
Right Hemisphere Brain Damage:
Types of neglect:
1.
2.
Left (due to RHD)
| Right (due to LHD)
38
Right Hemisphere Brain Damage:
Types of neglect-
____ neglect is most common, more severe, and lasts longer. ____ neglect is less common, less severe, and resolves more quickly.
Left
| Right
39
```
Right Hemisphere Brain Damage:
Types of neglect-
Can affect various modalities: (MAT)
1.
2.
3.
```
1. Motor
2. Auditory
3. Tactile
40
Right Hemisphere Brain Damage:
Types of neglect-
______ (UVN) affects one's ability to attend to visual information from the left visual field or left side of an object
Unilateral visuospatial
41
```
Right Hemisphere Brain Damage:
Types of Unilateral Neglect-
1.
2.
3.
```
Viewer centered
Object centered
Combinaiton
42
```
Right Hemisphere Brain Damage:
Region of space-
______ space: one's own body
__-____ space: within reaching distance
____-____ space: beyond arm's reach
```
Personal
Peri-personal
Extra-personal
43
Right Hemisphere Brain Damage:
Neglect & Language-
Can affect _____ & _____.
Reading; writing
44
Right Hemisphere Brain Damage:
| Neglect dyslexia: omit, substitute letters on the ____ side of words/sentences
left
45
Right Hemisphere Brain Damage:
| Neglect dysgraphia: begin ____ in the middle or on the right side of the page.
writing
46
Right Hemisphere Brain Damage:
| Executive Function deficits caused by ___ are well-documented. data specific to RHD vs stroke is ____.
Stroke; limited
47
Right Hemisphere Brain Damage:
Awareness-
_______- reduced awareness of deficits, often a hallmark of RHD.
Anosognosia
48
```
Right Hemisphere Brain Damage:
Patients may be unaware of: (UPCC)
1.
2.
3.
4.
```
```
Unilateral neglect
physical deficits (hemiparesis)
communication deficits
consequences of deficits
```
49
```
Right Hemisphere Brain Damage:
Outcomes of anosognosia:
1. ____ participation
2. Longer _____
3. _____ functional status upon discharge
4. _____ outcomes with employment
5. Greater ____ on caregivers.
```
```
Poorer
Treatment
Poorer
Poorer
Stress
```
50
```
Right Hemisphere Brain Damage:
Prosody-
1. Linguistic: ____ and Grammatical
2. ____: conveys mood or emotion
3. Indexical: idiosyncratic speech _____
```
Pragmatic
Affective
Patterns
51
Right Hemisphere Brain Damage:
Prosody-
_____ reduced use of pitch, duration, loudness, and pause time to convey or interpret meaning
Aprosodia
52
```
Right Hemisphere Brain Damage:
Comprehension-
Types of non-literal language:
1.
2.
3.
```
Metaphors/similes
Idioms
Indirect requests
53
```
Right Hemisphere Brain Damage:
Comprehension-
Types of inferences:
1.
2.
```
Bridging
| Elaborative
54
Right Hemisphere Brain Damage:
| RHD is associated with difficulty interpreting __-___ ____ and _____
non-literal language
| inferencing
55
Right Hemisphere Brain Damage:
Comprehension processes-
1.
2.
Construction phase
| Integration phase
56
Right Hemisphere Brain Damage:
| Construction phase of comprehension- ____/construct meaning of ____, ____, ____
```
Activate
words
phrases
sentences
(i.e. words with multiple meaning)
```
57
Right Hemisphere Brain Damage:
Integration phase of comprehension-
____ are integrated into context with less appropriate meanings supressed
Meanings
58
Right Hemisphere Brain Damage:
Production-
____ production: content and organization of verbal output
Discourse
59
```
Right Hemisphere Brain Damage:
Pragmatics in RHD
1. ____ eye-contact
2. Reduced use of _____-laden words
3. _____
4. Content of discourse may not be _____ or may be ____
```
Reduced
Emotionally
Egocentric
appropriate; insensitive
60
Right Hemisphere Brain Damage:
Pragmatics Theory of ____ -
One's ability to _____ that another person has ideas, beliefs, feelings, and emotions that differ from one's own
Mind
| understand
61
```
Assessment off CCD after RHD is complicated because
1.
2.
3.
4.
```
1. few reliable, valid assessment tools
2. not obvious pattern of deficits
3. wide range of norma
4. cultural norms affect pragmatics
62
Assessment of CCD after RHD should include _______ and ________.
observation
| objective measures
63
Many cognition/pragmatic assessments used for CCD-RHD were intended for patients with ________.
TBI
64
A specific attentional disorder in which the brain does not process stimuli that appear in, or originate from the side contralateral to the cerebral lesion is called _____?
unilateral neglect
65
Assessments of unilateral visuospatial neglect need to measure _____-centered and _______-centered neglect as well as ________, __________, and _______ neglect.
```
viewer
object
personal
peri-personal
extrp-personal
```
66
The Awareness Questionnaire (Shere, Hart, & NIck, 2003) as well as the Patient Competency Rating Scale (Borgaro & Prigatano, 2003) can be used to assess _______ related to cognition
anosognosia (spell it carefully!)
67
The most reliable assessment for prosody and affect available is the _______________.
Florida Affect Battery
68
The evidence-based triangle for making decisions about treatment interventions includes:
1.
2.
3.
1. current best evidence
2. clinical expertise
3. client/patient values
69
Treatment for _____ has been studied more than any other deficit in RHD
Neglect
70
There are two general types of treatment for neglect in RHD:
1.
2.
1. top down (use of cognitive strategies)
| 2. bottom up (manipulation of stimuli and attentional systems to increase attention)
71
Combinations of _________ training and ________ training may be most efficacious with RHD attention disorders.
direct; strategy
72
Strong evidence is available for __________which adds visualization of a beam of light to the movement of the head.
lighthouse strategy
73
The strategy of 'visual scanning' is considered a top-down attentional treatment.
True
74
The strategy of 'prism adaptation' is considered a bottom-up attentional treatment.
True
75
_______ training is recommended as a practice standard when treating UN ( Cicerone et al., 2011).
visual scanning
76
Name three ways the stimulus can be manipulated with when treating UN:
1.
2.
3.
1. size of target
2. number of targets
3. presence of distractors
77
The object centered neglect of word reading can be reduced by adding ___________.
meaningless characters to the front of of the word.
78
Treatment for executive function & awareness come from the TBI literature and include:
1.
2.
1. metacognitive strategies
| 2. task specific treatment
79
The two types of treatment for expressive aprosodia include ___________ and ________.
cognitive -linguistic
| motoric-imitative treatment
80
List 3 examples of stimuli of contextually-based treatment of discourse and pragmatics:
1.
2.
3.
```
choose 3:
homophone: word pairs
homophones sentences
ambiguous sentences
common idioms
```
81
If a clinician wants to determine if a treatment for TBI is applicable to patients with RHD, six questions can help: Name 3 ________, ___________, and _____.
Is my client significantly similar the most important way?
Is the nature of the client's cognitive impairment similar to that targeted in the research
Is is feasible it apply the intervention in this setting?
82
Explain the difference between mild cognitive impairment and dementia.
Dementia: a cluster of syndromes characterized by acquired persistent impairment or multiple cognitive domains.
Mild cognitive impairment (MCI): a preclinical condition that may suggest a person is at risk for developing dementia, a transition stage.
83
Name one cause of vascular dementia.
Ischemic or hemorrhagic cerebrovascular disease
84
How would you distinguish dementia with Lewy bodies from Parkinson's disease?
DLB: cognitive impairment precedes motor deficits;
PD: motor deficits preceded cognitive impairment
85
Which type of dementia has an onset age before 65 years and accounts for 10% of dementia cases?
Frontotemporal Dementia (FTD)
86
Name one evidence-based treatment to be used with patients who have dementia.
Reading roundtable
spaced retrieval
Memory books
87
True or False: Unilateral neglect is a visual deficit.
true
88
True or False: Left neglect is more common than right?
true
89
Unilateral visuospatial neglect (UVN) can be viewer centered or ____________ centered.
Object
90
Define anosognosia
reduced awareness of deficits, hallmark of Right hemisphere damage (RHD)
91
Define aprosodia
a disruption in prosody; reduced use of pitch, duration, loudness and pause time to convey or interpret meaning.
92
Assessment of Right hemisphere damage- Cognitive communication disorder (RHD-CCD) should include ____________ as well as objective measures.
observation
93
Although there is a paucity of treatment efficacy research for disorders associated with RHD, the exception is _______________.
Unilateral visuospatial neglect (UVN)
94
Right hemisphere damage- Cognitive communication disorder (RHD-CCD) can affect both cognition and communication, including: executive function, ______________, prosody, comprehension, production, and ___________.
awareness; pragmatics
95
What are the 3 categories of mTBI?
sports related concussion (SRC), Mixed-mechanism (MM), Military-related concussion
96
You are completing a chart review on your patient who comes with cognitive complaints that have persisted 2 months following a concussion. You review imagining available which includes a CT and MRI. Both indicated normal results. Is the lack of findings on imaging important to the diagnosis?
No
97
How might auditory comprehension impairments in patients with mTBI impact your evaluation or treatment?
an audiologist is needed to assess for central auditory processing disorder (CAPD)
98
True or False: Stuttering in mTBI is likely neurogenic.
False
99
Why would assessment be postponed for 2 weeks to 3 months?
the assessment is specifically for persisting symptoms
100
Give two reasons why you would refer to a neuropsychologist in working with a patient with mTBI.
1. many formal standardized assessments are not sensitive enough to postconcussive impairments and 2.neuropsychologists deal with emotional impairments of mTBI.
101
Regarding the emotional problems caused by mTBI, would it be best for you to treat these yourself or refer? To whom might you refer?
refer; neuropsychologist
102
What are the variants of FTD?
behavioral (bvFTD), language variants (PPA), and motor variants that can occur with or without bvFTD and/or PPA
103
Semantic variant (svPPA), nonfluent or agrammatic variant (nfvPPA) and logopenic variang (lvPPA) fall under which FTD variant?
Language (PPA)
104
Which diseases fall under motor variants?
ALS, CBS, PSP
105
According to ASHA, what role do SLPs have in MCI/dementia?
SLPs play a role in screening, assessment, diagnosis, treatment, and research of dementia-based communication disorders
106
What are some things we have to consider as part of the assessment?
- Thorough review of prior and current medical history (comorbidities, medication)
- Hearing impairment
- Vision impairment
- speech/language/communication
- depression
- global cognitive function
- mobility/balance impairments
107
What type of treatment for dementia is within our scope of practice?
Behavioral
108
T/F: Identifying the presence of cognitive communication disorder resulting from dementia or MCI is a treatment goal for dementia?
False; assessment goal.
109
T/F: Documenting impaired and spared cognitive-communicative abilities is one of the goals for assessment of dementia?
True
110
T/F: Establishing a baseline of cognitive-communicative functioning after the onset of intervention is one of the goals for assessment of dementia?
False; PRIOR.
111
T/F: A goal for dementia assessment includes assessing personal and environmental factors that influence a client or family.
True
112
T/F: We should not provide information and resources about dementia or MCI and counsel family members about expected progression. It should be left up to the doctor.
False
113
T/F: Using dynamic assessment approaches or structured therapy trials does not determine patient candidacy for particular interventions.
False; does
114
T/F: Indirect treatment for dementia includes patients undergoing treatment themselves.
False; direct treatment
115
Training professional and personal caregivers, modifying environment, counseling family members, etc. is what type of dementia treatment?
Indirect
