dementia ashley frazier m.s. ccc-slp the university of north carolina greensboro
Post on 22-Dec-2015
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Learner Objectives
Define dementia and its hallmark characteristics Describe ways in which dementias are
categorized Identify characteristics of language of dementia Use basic scales and bedside exams commonly
used in dementia care Describe SLP role in treatment of patients with
dementia Contrast compensatory therapy with
rehabilitation
Which most accurately defines and describes dementia?
O Progressive disease associated with old age that is characterized by impairment of speech, language, and swallowing
O Disease with various symptoms associated with Central Nervous System deterioration whose major impairments are in the areas of Cognition, Memory and Communication
O Degenerative disease associated with lesions to the brain which most often results in language, memory, and motor disturbance
O Devastating and heartbreaking
What is dementia?
Mixed bag of signs and symptoms of CNS degeneration, complicated by variability, progressive and persistent deterioration of intellectual function
Memory•Forgetfulness•Profound Impairment
Cognition•Problem Solving/Judgement•Orientation•ADL
Communication•Semantics most affected•More automatic structures spared
Various types of Dementia are often categorized into which of these?
O Cortical/Subcortical Types
O Reversible/Irreversible Types
O Both of these
Cortical vs Subcortical Dementia
Examples of Each
DAThttp://
www.youtube.com/watch?v=7wbYEK7O14E&feature=related
Huntington’shttp://www.youtube.com/watch?v=JzAPh2v-SCQ
What differences do you notice between them?
Alzheimer’s Characteristics
Cortical Dementia Disorientation Communication affected Short term memory impaired Long term memory impaired Impaired judgement and abstraction Personality Changes
CLINICAL STAGING OF DAT: NYU/Silberstein Scale p427-428 in textbook
Stage 1 (No Cognitive Impairment) Normal mental and motor function.
Stage 2 (Very mild decline)
Stage 3 (mild cognitive decline) Early Stage Alzheimer’s can be diagnosed in some but not all individuals with these symptoms
Stage 4 (moderate cognitive decline) Mild or early-stage DAT
Stage 5 (Moderately severe cognitive decline) Moderate or mid-stage DAT
Stage 6 (severe cognitive decline) Mid Stage DAT
Stage 7 (Very severe cognitive decline) Late Stage DAT
“HIV is now becoming one of the leading causes of dementia worldwide…”
Sacktor, N. (2002). The Epidemiology of Human Immunodeficiency Virus-Associated Neurological Disease in the Era of Highly Active Antiretroviral Therapy. Journal of Neurovirology, 8(2), 115-121. doi:10.1080/13550280290101094
“Confusion, forgetfulness, cognitive symptoms”HIVD: Acute vs. Chronic
Early on, dementia was acute and severe Entire course was often matter of weeks
Since mid-90’s, more often chronic cognitive involvement that spans life of disease May last for years
“Mental Disorders can develop into full-blown dementia in just a few days from the appearance of the first symptom, or take as long as two months.” (Lezak, 2004, p275)
HIV-D Characteristics
Subcortical dementia * Psychomotor slowing Memory deficits Impaired executive function Impaired visuospatial function Impaired recall/retrieval
*With cortical features – memory is one of the primary deficits
Cognitive Profile
Executive Function Effect on social skills, communication Work/Activities
Memory Effect on HAART adherence Recall & retrieval impact on function Co-morbidity factors
HIV Dementia Scale
Power, et al. (1995) HIV Dementia Scale: a rapid screening test. J Acquir Immune Defic Syndr Hum Retrovirol. 1995;8(3):273–278
CLINICAL STAGING OF ADC: Memorial Sloan Kettering Scale
Stage 0 (normal) Normal mental and motor function.
Stage 0.5 (equivocal/subclinical) Either minimal or equivocal symptoms of cognitive or motor dysfunction characteristic of ADC, or mild signs (snout response, slowed extremity movements), but without impairment of work or capacity to perform activities of daily living (ADL). Gait and strength are normal.
Stage 1 (mild) Unequivocal evidence (symptoms, signs, neuropsychological test performance) of Functional intellectual or motor impairment characteristic ADC, but able to perform all but the more demanding aspects of work or ADL. Can walk without assistance.
Stage 2 (moderate) Cannot work or maintain the more demanding aspects of daily life, but able to perform basic activities of self-care.Ambulatory, but may require a single prop.
Stage 3 (severe) Major intellectual incapacity (cannot follow news or personal events, cannot sustain complex conversation, considerable slowing of all output) or motor disability (cannot walk unassisted, requiring walker or personal support, usually with slowing and clumsiness of arms as well).
Stage 4 (end stage) Nearly vegetative. Intellectual and socialcomprehension and output are at a rudimentary level. Nearly or absolutely mute. Paraparetic or paraplegic with double (urinary and bowel) incontinence.
Assessment
Full Neuropsych Evaluation likely SLP may be “front line” in early stages Differential dx from similar looking
diseases ABCD (AZ Battery Comm Dementia) Global Deterioration Scale “Bedside Eval” – quick tests
Practice: MMSE Scoring
Normal score: 24 or higher
There are published norms based on age, education, gender. There are norms for native Spanish speakers, and the “very old” population
Example: Eighth Grade Education
Ages 18 to 69: Median MMSE Score 26-27Ages 70 to 79: Median MMSE Score 25Age over 79: Median MMSE Score 23-25
High School EducationAges 18 to 69: Median MMSE Score 28-29Ages 70 to 79: Median MMSE Score 27Age over 79: Median MMSE Score 25-26
College Education
Ages 18 to 69: Median MMSE Score 29Ages 70 to 79: Median MMSE Score 28Age over 79: Median MMSE Score 27
Comfort with MMSE?
O Very Comfortable
O Sort of Comfortable
O Not very comfortable
O Can’t figure it out
Impact of Dementia
"For me, disabled is not being able to keep up, not being able to fully function, and feeling the guilt, and feeling the sadness and the emptiness, the loss. That's disability – just feeling exhausted and worn out"
(study participant, O'Brien, Bayoumi, Strike, Young, & Davis, 2008)
Impact of Dementia
Disruption in self-care abilities Slowed information processing Impaired problem solving Changes in affect Reduced social functioning
Failure to adhere to medication regimen Very difficult for caregivers
Which describes the role of the SLP in the treatment of clients with dementia?
O Build memory skills so that patient can function more effectively at work and home
O Help patient become more focused and clear in conversations with friends and family members to reduce frustration
O Develop compensatory strategies for deteriorating skills to support participation in daily activities and connection to loved ones
Role of SLP
Develop strategies to compensate for cognitive changes
Critical to maintain medical compliance Support for family/caregiver
Increased responsibilities as disease progresses
Society not very supportive Enabling meaningful connection with
patient vital
Role of SLP (ASHA)
Increase reliance on spared systems and decrease dependence on impaired ones
Strengthening of knowledge and processes that have the potential to improve
Design interventions that will evoke a positive emotion in the client
http://www.asha.org/docs/html/TR2005-00157.html
Role of SLP (ASHA)
Must consider the cultural background of their clients
Direct intervention: work directly with individuals who have dementia
Indirect intervention: environmental modifications, development of therapeutic routines and activities, and caregiver training
http://www.asha.org/docs/html/TR2005-00157.html
Role of SLP - Strategies
Restorative Promote recovery and restore function
Compensatory Internal
Enhanced Learning Mnemonics
External Environmental Modifications External Aids
Parsons & Robertson http://www.medscape.com/viewarticle/513278
http://www.youtube.com/watch?v=J4S_FX9bieg&feature=BF&playnext=1&list=QL&index=3
Singing For The Brain
The “Other” Role of SLP
ASHA has a progressive nondiscrimination statement which includes “sexual orientation” as a protected status and strongly urges the membership to develop cultural competence as a matter of ethical service delivery.
CounselingEducationAdvocacy
http://www.asha.org/docs/html/PS2005-00118.html
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