CD 422 Final Exam

• dementia is a clinical syndrome of chronic and progressive symptoms that result from acquired brain disease.

  • may be reversible, progressive, or relatively static
  • exclusionary diagnosis
  • SLPs do NOT have the authority to diagnose dementia
• dementia is a symptom, not a singular diagnosis
• reversible dementia: may occur in approximately 10-20% of cases. due to treatable conditions such as nutritional deficiencies, metabolic disorders, endocrine disorders, and toxicity.
• progressive dementia: several forms associated with Parkinson's, Pick's disease, and Huntingdon's disease). dementia due to Alzheimer's is most common.
• rapidly progressive dementia: dementias that take less than a few months up to two years from the initial presentation of symptoms to significant decline
• static dementia: can sometimes be caused by a TBI
• dementia of the alzheimer's type (DAT) is classified as a cortical form of dementia. changes in cognition and communication are evident before decrease in motor skills.
• three major neuropathologies for DAT include:

  • neuronal degeneration
  • neurofibrillary tangles: cells become entangled, can't function because they can't communicate
  • senile (neuritic/amyloid) plaques
• early symptoms of DAT include:

  • lapses in memory (recent events)
  • faulty reasoning
  • poor judgement
  • disorientation
  • alteration of mood (e.g., depression, apathy, irritability, suspiciousness)
  • behavioral changes
• middle stage symptoms of DAT include:

  • mental impairments become more obvious
  • disturbances in language and communication appear
  • patients become more restless and agitated
  • wanders; gets lost
• final stage symptoms of dementia include:

  • profound motor deficits
  • complete incontinence
  • loss of almost all intellectual and cognitive abilities
• aphasia is NOT caused by dementia, but the language deficits can be similar.
• early language deficits of DAT include:

  • anomia
  • subtle comprehension deficits
  • topic maintenance
• late stage language deficits of DAT include:

  • paraphasias
  • hyperfluency
  • incoherent speech
  • impaired reading/writing (they can READ, not COMPREHEND)
  • echolalia/palalia
  • impaired pragmatics
  • mutism
  • logoclonia: when the individual repeats the final syllable of the word
• vascular dementia: second most common form of dementia. all connected to poor health of the vascular system.
• large vessel occlusions (vascular dementia): cause the death of brain tissue involving left anterior arteries, bilateral anterior artery, posterior cerebral arteries, and posterior middle arteries.

  • symptoms depend on frequency of infarcts and areas of damage
  • due to thrombotic or embolic CVAs.
• lacunar state (vascular dementia): special type of neural atrophy associated with a variety of subcortical dementia.

  • due to cerebral infarcts occuring within deep structures of the brain in small-end arterial branches.
  • involves lacunae, small holes/gaps within the brain
• binswanger's disease (vascular dementia): subcortical arteriosclerotic encephalopathy with cortical structures mostly spared.

  • acute CVAs that eventually lead to a slow accumulation of focal neurologic symptoms
• dementia with lewy bodies: third most common form of dementia, onsets between the ages of 50 and 80. RAPID course, more so than DAT.

  • neuropathology: presence of lewy bodies (small spots within damaged nerve cells, typically found in substantia nigra)
  • main characteristics: cognitive deficits, visual and auditory hallucinations, paranoia, rapid eye movements, sleep disturbances, muscle rigidity, slowness of movement
  • distinguishing characteristic: greater impairments in visuospatial skills than memory skills, especially in earlier stages
• parkinson's disease: idiopathic; average age of onset is between 50-60 years, males more so than females.

  • sometimes results in subcortical dementia
  • loss of dopaminergic neurons in the basal ganglia
  • bradykinesia (overall slowness), tremor, rigidity, disturbed gait (festinating gait, shuffling) and posture, swallowing disorders.
• pick's disease: considered part of a group of diseases called frontotemporal dementia (FTD). results from a form of cortical dementia.

  • degeneration of cells in the left and right frontal/temporal lobes with presence of pick bodies and pick cells.
  • typical age of onset is 40-60 yrs
  • characterized by profound personality and behavioral changes
• huntingdon's disease: genetic, neurodegenerative disease. typical age on onset is between 35-40 yrs.

  • reduced inhibitory neurotransmitters in the basal ganglia, such as GABA
  • behavioral changes (e.g., excessive complaining, emotional outbursts), serious psychiatric disturbances, schizophrenic like behaviors, hallucinations, chorea
• progressive supranuclear palsy (PSP): extrapyramidal disorder with neuropathy related to neuronal loss in the basal ganglia and brainstem.

  • similar symptoms to Parkinson's WITHOUT tremors.
  • eye deviations are an early symptom.
• AIDS dementia complex: infectious type of dementia caused by neurotoxins in the brain.

  • changes in subcortical white matter and basal ganglia that process to the cortex.
  • terminates in a subcortical form of dementia and death.
  • disturbed gait, tremor, headache, weakness, facial nerve paralysis
• creutzfeldt-jakob disease: extremely rare; infectious dementia caused by a prion.

  • widespread development of spongeiform state in the brain. rapid, certain fatality.
  • used to be called mad-cow disease.
• cognitive-linguistic processes: the organization of thoughts, feelings, and emotions that generate the intent to communicate; organized and converted to verbal symbols that follow rules of language.
• motor speech planning and processing: selection and sequencing of sensorimotor "programs" that activate the speech muscles at the appropriate coarticulated times, durations, and intensities.
• neuromuscular execution: neuromuscular transmission and subsequent muscle contractions and movements of speech structures.
• motor speech processes consist of motor speech planning and neuromuscular execution
• speech is dependent on the coordinated interactions of five components:

  • respiration
  • phonation
  • resonance
  • articulation
  • prosody
• motor speech disorders fall into two categories: apraxia and dysarthria
• apraxia of speech: impaired capacity to plan or program sensorimotor commands necessary for directing movements that result in phonetically and prosodically normal speech.

  • NO MUSCLE WEAKNESS PRESENT
  • left hemisphere damage almost always present, frequently paired with aphasia, oral apraxia, and right-side hemiplegia
• AOS affects articulation and prosody.
• errors in AOS are variable and unpredictable.

  • groping movements are common
• dysarthria: a group of neurologic speech disorders resulting from abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required from the control of ALL components of speech.

  • ASSOCIATED WITH WEAKNESS, SLOWNESS, OR INCOORDINATION OF SPEECH MUSCLES
  • CNS or PNS damage.
  • due to neuromuscular execution deficits
  • different underlying neuropathologies between types
• flaccid dysarthria: due to damage to lower motor neurons involved in speech.

  • weakness
  • hypernasal speech
  • phonatory insufficiency (stridor, breathiness)
  • imprecise consonants
  • monopitch/monoloudness
• spastic dysarthria: due to bilateral upper motor neuron damage.

  • hyperactive reflexes
  • pathologic reflexes
  • harsh/strained vocal quality
  • slow rate with prolonged phonemes
  • reduced pitch
  • loudness variability
  • paresis/spasticity of other body parts
• ataxic dysarthria: due to cerebellar damage; some overlap with AOS.

  • incoordination
  • slurred speech
  • irregular articulatory breakdowns
  • vowel distortions
  • dysprosody
  • excess loudness variations
  • excess and equal stress
• hypokinetic dysarthria: due to basal ganglia damage; think Parkinson's disease.

  • rigidity
  • tremor
  • bradykinesia
  • fast/articulated speech rate
• hyperkinetic dysarthria: caused by lesions in the basal ganglia; think Huntingdon's disease.

  • involuntary movements
  • harsh/strained vocal quality
  • hypernasality
  • decreased articulation/speech intelligibility