Dementia and Cognitive Communication

Dementia

• Acquired global loss of brain function, slow onset
• Caused by various diseases, not a disease itself
• DSM-5 defines dementia as memory loss and deficits in verbal/written communication, object recognition, motor skills, abstract thought, and complex task execution.
• Not due to delirium or another mental disorder.

Role of SLP in Dementia

• Assess and treat cognitive-communication deficits arising from dementia or related illnesses.
• Diagnose and treat cognitive, communication, and swallowing problems.

Mild Cognitive Impairment (MCI)

• Changes in cognition significant enough to be outside the typical aging range but not severe enough to interfere with daily activities (ADLs).
• Symptoms include decreased concentration, word-finding difficulties, short-term memory problems, and inability to follow detailed conversations.

Normal Aging

• Language remains largely intact, with minor declines in word-finding abilities.
• Attention is mostly stable, with some decline in selective attention and divided attention abilities, especially in complex tasks.
• Long-term and procedural memory are unaffected; episodic and short-term memory may be slightly reduced.

Alzheimer's Disease

• Cortical dementia, the most common type, progressive and fatal.

Frontotemporal Dementia

• Degenerative frontal and temporal lobes.
• Includes Pick's disease, progressive nonfluent aphasia, and semantic dementia.
• Initial symptoms are predominantly language deficits, progressing to include cognitive decline.

Primary Progressive Aphasia (PPA)

• Language deficits are the initial and main symptoms, occurring before broader cognitive decline.
• Typically diagnosed before age 65; life expectancy is 7-10 years.
• Characterised by changes in motor skills, episodic memory, behaviour, and personality.
• PPA has three variants.

Pick's Disease

• Progressive degeneration of frontal and temporal lobes.
• Characterized by personality changes, inappropriate social behavior, and memory problems that do not involve language deficits.

Huntington's Disease

• Subcortical dementia, progressive, and terminal.
• Defined by involuntary, erratic movements (chorea).
• Can cause changes to personality, cognition, language, and emotional well-being.

Vascular Dementia

• Mixed dementia caused by small strokes in the brain, affecting multiple cognitive domains like memory, language, and executive functioning.
• Symptoms include aphasia, apraxia and difficulties with planning.

Lewy Body Disease

• Neuropathological changes due to Lewy bodies in neurons (cell body).
• Subcategorized as Parkinson's disease and dementia with Lewy bodies.
• Parkinson's disease: motor issues (rigidity, tremors, slow movements), cognitive deficits, and in some cases problems with swallowing or speech.

Therapy for Dementia

• Arizona Battery for Communication Disorders of Dementia: to improve quality of life.
• Cognitive Stimulation: Improved cognitive skills and quality of life.
• Reality Orientation Therapy: Engaging individuals with their immediate surroundings and current situations to improve context.
• Validation Therapy: Validate the individual's feelings and experiences, even if the feelings do not make logical sense to an outside observer.
• Reminiscence Therapy: Semi-cued conversations about past events and experiences to increase orientation and recall.
• External memory aids: tools that aid in retaining factual information.

Prevention of Dementia

• Modifiable risk factors including diabetes management, cholesterol control, smoking cessation, physical activity, alcohol moderation, and preventing head injuries.

Assessment of Dementia

• Brief Cognitive Status Exam (BCSE): assess global cognitive functioning.
• Quick Cognitive Functioning Screener.
• Standardized Mini-Mental State Examination (MMSE): evaluates cognitive impairment.
• Family Confusion Assessment Method (FAM-CAM): used to assess everyday cognitive skills.
• Everyday Memory Survey (EMS): evaluates memory function in daily living situations.