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Dementia

Dementia. Ashley Frazier M.S. CCC-SLP The University of North Carolina Greensboro. Learner Objectives. Define dementia and its hallmark characteristics Describe ways in which dementias are categorized Identify characteristics of language of dementia

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Dementia

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  1. Dementia Ashley Frazier M.S. CCC-SLP The University of North Carolina Greensboro

  2. 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

  3. 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

  4. What is dementia? Mixed bag of signs and symptoms of CNS degeneration, complicated by variability, progressive and persistent deterioration of intellectual function

  5. Various types of Dementia are often categorized into which of these? OCortical/Subcortical Types O Reversible/Irreversible Types O Both of these

  6. Categorizing Dementia Reversible vs. Irreversible Cortical vs. Subcortical

  7. Cortical vs Subcortical Dementia • Examples of Each DAT http://www.youtube.com/watch?v=7wbYEK7O14E&feature=related Huntington’s http://www.youtube.com/watch?v=JzAPh2v-SCQ What differences do you notice between them?

  8. Which Category? OCortical OSubcortical O Reversible

  9. Alzheimer’s Disease

  10. Alzheimer’s Characteristics • Cortical Dementia • Disorientation • Communication affected • Short term memory impaired • Long term memory impaired • Impaired judgement and abstraction • Personality Changes

  11. Mini Mental State Exam

  12. 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

  13. “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

  14. “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)

  15. 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

  16. Cognitive Profile • Executive Function • Effect on social skills, communication • Work/Activities • Memory • Effect on HAART adherence • Recall & retrieval impact on function • Co-morbidity factors

  17. HIV Dementia Scale Power, et al. (1995) HIV Dementia Scale: a rapid screening test. J Acquir Immune DeficSyndr Hum Retrovirol. 1995;8(3):273–278

  18. 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 social comprehension and output are at a rudimentary level. Nearly or absolutely mute. Paraparetic or paraplegic with double (urinary and bowel) incontinence.

  19. 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

  20. “Clock Drawing” & Visuospatial Tests

  21. Practice: MMSE 3 objects: Apple Table Penny Close Your Eyes

  22. 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 26-27 • Ages 70 to 79: Median MMSE Score 25 • Age over 79: Median MMSE Score 23-25 • High School Education • Ages 18 to 69: Median MMSE Score 28-29 • Ages 70 to 79: Median MMSE Score 27 • Age over 79: Median MMSE Score 25-26 • College Education • Ages 18 to 69: Median MMSE Score 29 • Ages 70 to 79: Median MMSE Score 28 • Age over 79: Median MMSE Score 27

  23. Comfort with MMSE? O Very Comfortable O Sort of Comfortable O Not very comfortable O Can’t figure it out

  24. 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)

  25. 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

  26. 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

  27. 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

  28. 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

  29. 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

  30. 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

  31. Singing For The Brain http://www.youtube.com/watch?v=J4S_FX9bieg&feature=BF&playnext=1&list=QL&index=3

  32. 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. Counseling Education Advocacy http://www.asha.org/docs/html/PS2005-00118.html

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