Mild Cognitive Impairment
what is the definition of mild cognitive impairment?
greater than age expected cognitive decline but not significant enough to result in marked loss of functional independence
give an example of how memory could be impaired?
ask the same questions, misplace personal belongings, forget events, get lost on a familiar route
vascular dementia characteristics
language pattern depends on lesion location
-expressive impairments more notable than receptive, phonemic more frequent than semantic errors, dyarhtric speech, difficulties with complex syntax
pragmatic skills to look for verbal and non verbal
verbal->variety of speech acts, topics, turn taking, lexical selection is it appropriate do they have trouble finding words
non verbal->physical proximity, kinesics
errorless learning what is it and what are its benefits
learn new info or forgotten info, name face associations, biographical info, can employ memory aids like calendars,
amnestic single domain
memory most affected/only problem
give an example of how executive function could be impaired?
errors in reasoning and judgment
poor understanding of safety risks, cannot manage finances, poor decision making, inability to plan complex activities
characteristics of creutzfeldt jacob disease/viral dementia
changes in all brain regions, speech dysarthria and apraxia, language aphasia, rapid progression, mutism late stages, death 12-14 months
reading and reading comp what to assess
premorbid reading skills/habits, ease and speed of decoding, single word, sentences various structures, oral reading of paragraph length material, reading comprehension (time, accuracy, comprehension)
reality orientation what is it and what are its benefits
orient patient to reality, improve memory and cognition, reorient to environment,
non amnestic single domain
no memory problem
single domain impairment ie just a language problem
give an example of how visuospatial function is impaired?
cannot recognize faces or common objects, cannot operate simple implements or orient clothing to the body
Alzheimers Dementia characteristics and effect on brain
gradual progression, impairment in at least 2 cognitive domains, language impairments (naming challenges, paraphasias impaired comp., reading writing challenge), atrophy, cortical cell loss, amyloid plaques, neurofibrillary tangles, 6-12 years, prosody preserved
verbal expression what to assess
spontaneous speech-> fluency, word/sound substitutions, motor speech problems, types of errors, syntax, cohesion
picture description, oral repetition, naming confrontation, responsive naming, automatic speech
oral motor exam and functional communication
Spaced Retrieval what is it and what are some benefits
repetition to facilitate learning and retention, if they fail to remember the answer is given to them and they must repeat it, relies on non declarative memory systems, actively engaged by generating response after each retrieval attempt, repeated opportunities to recall makes it accessible, engages implicit or unconscious memory processes, can be incorporated into daily routine, clinician has some control, response can be verbal or nonverbal
amnestic multiple domain
memory is impaired but also other impairments ie language, executive function
give an example of how language is impaired in dementia ?
difficulty retrieving words, hesitations, spelling and writing errors
lewy body dementia characteristics
fluctuating cognition, recurrent visual hallucinations, fainting, sleep disorder, extrapyramidal signs (slowness, trembling, stiffness, loss of facial movements), language similar to AD and dysarthria
what to assess written expression
premorbid writing skills/habits, mechanics/functional writing, copying words/sentences, writing to dictation, written picture description, free narrative
memory books/wallets what are they and what are the benefits
provide recognition cues through visually accessible info to facilitate communication, good for those in mild middle and late stages, language deficits, intelligibility deficits, topic initiation and maintenance, increases positive verbal behaviour and social behaviour, provides thematic structure and increases number of ideas produced, enriches conversation, portable, easily modifiable
non amnestic multiple domain
memory not a problem but do have problems in other things ie language, executive function
give an example of how personality changes in dementia?
withdrawn, overly social, inappropriate, loss of social graces
dementia Parkinsons type characteristics
lack of initiation, difficulty problem solving, impaired memory, poor visuo spatial processing, poor math skills, reduced speed of processing, no aphasia, poor word list generation, hypokinetic dysarthria, depression may further impair
auditory comprehension what to assess
comprehension of conversational speech, auditory word recognition, yes no questions, sentences of varying length/complexity, paragraph length material
reminiscence therapy what is it and what are the benefits
conducted 1 on 1 with trained therapists, patients share memories evoked through stimulating prompts like an object or song, pleasure, socialization, can encourage them to value their lives, improved level of cognition and level of daily life