SPAA 418 Notes 2
SPAA 418 Notes 2 SPAA 418
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This 6 page Class Notes was uploaded by Molly O'Keefe on Thursday October 13, 2016. The Class Notes belongs to SPAA 418 at Ball State University taught by McGrath in Fall 2016. Since its upload, it has received 3 views. For similar materials see in Speech Language Pathology at Ball State University.
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Date Created: 10/13/16
SPAA 418 Exam two Dementia o Also called generalized intellectual impairment o Dementia is an umbrella term for acquired disorders, characterized by progressive deterioration in several cognitive domains o Across the board there is a reduction of Mental faculties, personality changes, emotional lability, dull bland behavior, memory loss o Neurocognitive Disorder New term for dementia according to DSM-5 Most practitioners and organizations still use dementia Alzheimer’s Association Still a group of symptoms that will accompany other diseases or diagnoses o Diagnostic and Statistical Manual of Mental Disorder-4 In order to be classified as dementia Memory must be impaired and At least one of the following must also be impaired: Abstract thinking Judgment Higher cortical functions Personality DSM-5 same as major versus minor neurocognitive disorder-early detection o Dementia effects on language Restricted vocabulary Limited to small talk and steteotypic phrases Perseveration Word finding difficulty Naming problems o Dementia effects on cognition Memory loss (recent or remote memory loss) Time and place disorientation Most people are A + O x 3 o A = Alert o O = Oriented o x3 = Self (you know who you are), Time (what time and day and month it is), Place (where you’re at) o They usually lose time first and then place then self Intellectual decline Faulty judgement Personality may be bland and dull Emotional lability Great deficits in the right hemisphere functioning Spatial orientation and direction Facial recall Patterns Difficulty grasping global concepts o Neurological changes in dementia Some clients have more than one neurological change occurring This would increase the progression of dementia 2 Types of neurological changes Tangles: Dendrites and axons become twisted, tangles and contorted o Alzheimer’s, Parkinson’s Plaques: Minute areas of tissue decline o Found in cortex and subcortical areas o Synapses are reduced o Alzheimer’s, Down’s syndrome, aging Degeneration: Small fluid-filled cavities appear within nerve cells o Common in subcortical regions Atrophy: Brain begins to shrink- loss of tissue o Very common in AIDS related dementia o Etiologies of dementia (Diseases that lead to/cause dementia) Alzheimer’s (1906 by Alois Alzheimer) Typically causes ventricles to enlarge and regions of the brain to lose tissue, form tangles of the dendrites, reduce neurotransmitters or atrophy of the basal ganglia Clinical Presentation: Slow, insidious onset and proceeds steadily until death. Duration of disease varies- death typically occurs approx. 10 years after diagnosis. No known cure Heterogeneous disease (looks different in everyone). Medication can reduce the deficits temporarily (especially memory loss) Risk factors: age, heredity, genetics, head injury Aphasia Video 3 Bob: was aware he said something that didn’t make any sense when it happened, he couldn’t do anything, wasn’t seeing well, he was in the ICU for 5 days, he couldn’t say his daughters name, he thought he was going to go right back to who he used to be, he would cry when he couldn’t get it, it would get better by each week, he would yell and get mad, he couldn’t read the New York times like he did every day, he has gotten better at talking but he is trying hard to answer questions people have or respond to them, he would be great for 2 days then for 3 straight days he could do anything and he’d be frustrated and angry, Chris: had a car accident 18 years ago, 1/6 brain is damage, had a stroke the day after the accident, he couldn’t talk at all, speech is still choppy, Kate: deer came through the windshield, car hit a stump and turned around, deer in the car, several hemorrhages in the brain, she was in a coma for 2 months, did lots of surgeries, had amnesia, she would call her daughter mommy, she was starting to be 6 months, a year, etc old when she was coming out of the coma, she said she knew nothing, she couldn’t say flashcards, couldn’t say anything in the beginning, still works with her writing, “ya know” a lot, when she sits with a psychologist she would talk and talk and talk, Jane: started to get a headache and it got worse and worse, she fell asleep in the car, she heard all of her family crying, she woke up and had been crying, did not know where she was, she was in the hospital, said it hurt and she was mad, she could not speak, she was scared to go home, she cried and said she didn’t want to go home, believes her kids and husband are still hurting from the stroke, her kids are more than 20 years old and they still cry about it, her husband cries when he talks about it, the family is part of the person that has the stroke, she had to learn to walk and speak and now she can, she is so happy, she says she is happier now after the stroke, she has learned a lot of new things 4 3 major stages of dementia: Multiple methods of discussing the stages, some have 13 different stages o Stage 1: Early or mild stage Client sense a decline Reluctant to be tests, trying to hide the problem Disoriented to time Memory for recent events begins to fail Rely on over-learned situations and stereotypic utterance Topic jump Slightly reduced vocabulary Word finding difficulties Minor loss of a desire to communicate This stage resembles behaviors that you & I might exhibit when we are tired or have a fever but we would only have one or two of these problems. Very minor deficits, but the client is exhibiting multiple deficits o Stage 2: Middle or Moderate Stage More noticeable memory loss Disorientation to time and place Increase in perseveration (repeating) of motor & speech behaviors Non-meaningful speech, empty talk Does not correct errors Significant decrease in variety of vocabulary Semantic naming errors, call a pan a “pot” Verbal paraphasia Diminished eye contact Egocentric: everything revolved around them 5 Like to touch objects o Stage 3: Last or advanced stage Disoriented x3 (person, place and time) Fail to recognize family and friends Can’t carry out daily routines Need extensive personal care Go in and out of cognitive awareness Some become non-speaking Lots of jargon Lack of social awareness Final part of this stage- in a vegetative state- tube feed There is no set period of time that each stage will occur, every client is different, progression of etiology, genetics and environment all have an influence on progression o Multi-Infarct Dementia (MID) Multiple small CVAs that occur throughout the brain Appear as millions of pinpoint lesions on CT scans Reduction in active brain tissues, widespread Clinical Presentation: Occurs more abruptly than Alzheimer’s Patient may complain of confusion, gait disturbances, apraxia, transient aphasia episodes, and incontinence No cure of MID except prevention of underlying causes (i.e. hypertension) Depression 6
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