Dementia: Types, Symptoms, and Diagnosis PDF

Dementia Acquired global loss of brain function with a slow onset Caused by a variety of diseases Syndrome/symptom, not an actual disease DSM-5 Definition Memory loss plus deficits in at least one of the following areas Verbal expression or verbal and written receptive language ski...

Dementia Acquired global loss of brain function with a slow onset Caused by a variety of diseases Syndrome/symptom, not an actual disease DSM-5 Definition Memory loss plus deficits in at least one of the following areas Verbal expression or verbal and written receptive language skills Recognition and identification of objects Ability to execute motor activities Abstract thinking, judgment and execution of complex tasks *Not due to delirium (acute disturbed state of mind) or other mental disorder Role of SLP Must assess and treat cognitive communicative deficits that result in dementia Must recognize, diagnose and provide treatment for cognitive, communicative, or swallowing deficits as a result of dementia or dementia produced illness Mild Cognitive Impairment Changes that are significant enough to not be within normal spectrum of changes with age, but not severe enough to affect ADLs Symptoms include Decreased ability in Concentration word finding abilities short term memory following detail-heavy conversations/writings Normal aging Language remains intact Slight decline in word-finding abilities Sustained attention remains mostly intact Slight decline in selective attention skills Divided attention skills intact during simple tasks Divided attention begins to break down in complex tasks Reaction time is slowed Long-term memory and procedural memory remain intact Episodic and short-term memories are reduced Alzheimer’s Disease Cortical dementia that is most common etiology of dementia Progressive and fatal  Onset usually after age 65 More common in women Stages of Alzheimer’s Early Motor function retained Short-term memory loss, word-finding difficulties, comprehension of verbal language deficits, and personality changes Lasts 2 years on average Mid Negative impact on ADLs and reliance on others More severe memory loss, attention deficits, dramatic personality changes, visuospatial and visuoconstructive deficits, and expressive language deficits May experience wanderlust, sundowner syndrome, disorientation, and confusion Lasts from 4 to 10 years Late Loss of motor function May become non ambulatory, bedridden, incontinent, and unresponsive Memory, cognition, and expressive language deficits are profound May cause muteness and dysphagia Frontotemporal Dementia Degeneration of frontal and temporal lobes Includes Pick’s disease Progressive nonfluent aphasia Semantic dementia Primary progressive aphasia Language deficits are the initial symptoms seen and continue as the primary deficit throughout the course of the disease Once diagnosed (typically BEFORE the age of 65), life expectancy is 7-10 years Eventually will see changes in motor function, episodic memory, behavior, and personality Three PPA Variants Pick’s Disease Dementia resulting from progressive degeneration of frontal and temporal lobes Characterized by personality changes, antisocial and inappropriate behavior, and memory loss in absence of language deficits Differentiated from Alzheimer’s disease early by Notable behavioral, emotional, and personality changes that occur as a result of frontal lobe degeneration Early behavioral, emotional, and personality changes in the absence of significant language deficits are also used to differentiate Huntington’s Disease Subcortical dementia Progressive terminal illness characterized by distinctive involuntary erratic body movements May cause changes in personality, cognition, language, and emotion Neuropathology includes production of mutant Huntingtin protein that creates degeneration Vascular Dementia Mixed dementia caused by small ischemic strokes within the cortex, subcortex, or both Characterized by multiple cognitive deficits Memory loss, aphasia, apraxia of speech, difficulties with executive functioning that occur more suddenly Hyperactive reflexes and weakness are present Lewy Body Disease Results in neuropathological changes in the brain due to presence of Lewy bodies in cell body of neurons Subcategorized into Parkinson’s disease and dementia with Lewy bodies Parkinson’s Disease Characterized by motor abnormalities such as rigidity, tremor, slowness of volitional movement, and cognitive deficits Motor abnormalities at rest, bradykinesia, mask-like facial expressions, difficulty initiating movements for speech, festinantions, paresthesia, micrographia, akinetic movement Assessment of Dementia Detailed case history, review of medical chart, and interview with family and patient Rating scales often used: Mini-Mental State Examination Alzheimer’s Disease Assessment Scale Global Deterioration Scale Dependence Scale Geriatric Depression Scale Comprehensive tests  Arizona Battery for Communication Disorders of Dementia Therapy for Dementia Should improve quality of life and ensure individual is operating at the highest level possible despite deficits Strengthen abilities that can improve Provide stimuli that evoke positive emotion and memories Reminiscence therapy Semi-cued conversation about past events, experiences, and activities to increase orientation and recall of pleasant long-term and episodic memory Cognitive Stimulation Mild-Moderate dementia Improved cognitive skills and quality of life Benefit to memory and thinking skills Involves memory intervention, deductive reasoning/problem-solving, word finding activities/word games, puzzles, etc. Reality Orientation Therapy Engaging individual with present/current surroundings Orientation information associated with immediate environment Validation Therapy Validate what the individual is feeling or saying – even if it is inaccurate Implying there is logic behind all behaviors can help reduce stress and increases positive thoughts/attitude Montessori-based Interventions Structured, hands-on activities Helps individuals with dementia maintain necessary skills to be as independent as possible Ability focused/strength-based Montessori-based Speech Therapy Sorting tasks Create templates Cognitive stimulation using manipulates/functional activities External Memory Aids Providing both graphic and written cues with factual information Calendar Memo boards Memory books/pictures Memory Training- Spaced Retrieval Evidence-based memory technique that uses procedural memory to help individuals recall information over progressively longer intervals of time Caregiver Training/Counseling FOCUSED Caregiver Training Teaching staff effective communication strategies Teaching staff how to communicate with nonverbal patients Involving families Computer-Assisted Cognitive Interventions (CACIs) Successful with mild to moderate cognitive impairments Improves social health and participation Benefits retention of information Helps with retention of trained skills CACI Examples Computer Based Programs ◦ Lumosity ◦ MindSparkle ◦ BrainHQ ◦ Braingle Environmental Modifications Lighting Color of walls (no wallpaper) Cozy/Homelike (this will vary) Dining Room Temperature Courtyard Noise Hallways Reminiscence Therapy Shown to improve mood and behavior, better cognition, reduces stress, higher confidence, reduced depression, higher self-worth, better connection with loved ones  Encourages the discussion of memories that have been stored away and helps stimulate those memories Prevention- Modifiable Risks Reduce/control diabetes Manage/prevent/control high cholesterol Minimize Hypertension Stop smoking Prevent head injury Physical activity Minimize alcohol intake Reduce obesity Prevent/treat depression increase social contact Prevent/address hearing loss Address vision loss What is the role of an SLP in the diagnosis of dementia? Identify early signs of cognitive decline Evaluate cognition and cognitive abilities Brief Cognitive status exam (BCSE) Helps evaluate global cognitive functioning Quick cognitive functioning screener Standardized Mini-Mental State Examination (SMMSE) Tests cognitive impairment Gives individual 10 seconds to answer and move on if they don't Person has to demonstrate cognitive skills Family Confusion Assessment Method (FAM-CAM) Used to identify changes such as thinking, concentration, alertness etc. Can be used to test for dementia Measurement of everyday cognition (ECog) Measurement of everyday functioning/cognition Related to memory, language, visuospatial functions Short portable mental status questionnaire (SPMSQ) For more severe cases Everyday memory survey (EMS) Tests memory function in everyday situations