Cognition
Cognition: what is it? |
▪ Thought or Consciousness |
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▪ The mental events or processes that allow you to acquire and work with information or knowledge |
Cognition: what “processes”? |
▪ Memory, working (short-term) — temporary storage & long-term — persistent storage l |
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▪ Language (ability to understand & express thoughts) |
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▪ Attention (concentration, allows you to focus on) |
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▪ Executive functions (control of behaviour, problem solving, planning & strategy) |
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▪ Perceptual function (allows you to take in information through senses, then utilise this information to respond & interact with the world) |
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▪ Motor function (voluntary movements: dialing the phone, un/buttoning clothes etc) |
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▪ Social cognition (recognising emotion of others, how you deal with others, imagine what someone else might be thinking or feeling etc) |
Cognitive impairment Terms
Dementia |
Alzheimer's |
Major neuro-cognitive disorder (NCD) |
Alzheimer's is the most common dementia |
Many people use major neurocognitive disorder instead of saying dementia |
Cognitive impairment
− It is NOT normal for age-related
cognitive decline to interfere with
activities of daily living!
- If the cognitive decline does interfere with activities of daily living then it is a cognitive impairment |
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Age-related cognitive decline
Evidence: Seattle Longitudinal Study: |
➢ began in 1956 focusing upon age changes in cognitive abilities |
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➢ on multiple measures – • 80% of participants showed little decline – 60 y.o. • 67% showed little decline – 81 y.o. |
Memory: decreases |
• moderate and not experienced by everyon? |
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• substantial, beginning in early adulthood and affecting everyone? |
Speed: decreases |
• learning, processing, problem-solving |
Major NCD
Diagnosis:
▪ decline in one or more cognitive abilities (based on concerns and confirmed in testing)
▪ significant enough to interfere with activities of daily living
▪ decline is not reversible
▪ Age-related changes
▪ Physiological, age-related changes, when the elderly are trained, there is the ability to improve before the decline. Reversible
▪ If it is a cognitive impairment is not reversible, you can train them but they won't get better. Progressive the client gets worse |
Irreversible NCD
“irreversible”—progressive; no recovery, worsening symptoms
Statistics
▪ 50 million people worldwide
▪ ~70,000 Kiwis living with dementia today (1.4% of the total population)
▪ triple by 2050
Contributing factors: life expectancy |
Irreversible cognitive impairment
Damage to nerve cells in the brain
Area of the brain affected —
Subcortical damage
• Cause: e.g., Parkinson’s (PD)
Cortical damage
• Cause: e.g., Alzheimer’s (AD)
• No point in training because nerves are dying, this isn't happening with the physiological effect of aging as the neurons are just separated and not connecting so with the training they can reconnect again. When nerve cells are dying they cannot reconnect so it is irreversible.
• Depends where the nerve cells are dying so if it's in the subcortical damage then it's dementia due to Parkinson's whereas if it is cortical damage it is Alzheimer's.
• Can have both at the same time |
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Subcortical: Parkinson’s
early stages: |
motor impairments |
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resting tremor |
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immobility/rigidity → slow movement |
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difficulty walking |
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Dysarthria (speech problems) |
progression: |
cognitive issues |
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executive function, memory, processing speed |
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40% cases develop dementia |
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When this issue progresses it has cognitive issues |
Cortical: Alzheimer’s
Stats
➢ the most common type of dementia → 50-80% of all
dementia diagnoses
➢ in 5-15% of all people aged 65+
➢ in 15-50% of all people aged 80+
➢ more common in women than men |
MCI and Stages of AD
Mild cognitive impairment (MCI)
• mild NCD (DSM-5)
• affects especially new memories
• little effect on activities of daily living (ADL) →
independence in everyday activities
• not all MCI becomes AD |
early (mild) AD
• noticeable decline, especially new memories
• affects task performance—increasing difficulty with
ADL
• increasing language difficulty—vagueness
• independent living with support |
middle-stage (moderate) AD
• much support needed
• even easier ADL becomes difficult
• decreasing vocabulary and communicative
participation
• behavioural issues—e.g., aggression, hallucination |
late-stage (severe) AD
• professional support—living outside the home
• issues remembering essential life information
• loss of function— e.g., muteness, motor function |
Diagnosis of AD
• Interviews (person, family)
• Medical imaging (brain scans)
• Medical and cognitive tests |
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Language issues in AD
Sentence comprehension
• multiple verbs in a sentence
• multiple nouns that can perform the action
Grammar
• preference for simple structures in sentence
production
• difficulty with irregular past tense forms
Discourse
• vagueness; less information given
• reliance on simple words, esp. verbs
Language in AD diagnosis
Montreal Cognitive Assessment (MoCA)
• 3 items confrontation naming
• repetition of two complex sentences
• say all the words you can think of beginning
with the letter ___
Mini Mental State Exam (MMSE)
• naming and repetition
• follow spoken and written commands
• write a sentence |
Communicative interventions for early AD
Adaptive
▪ regain control after communicative failure
▪ e.g., encourage, give time to organise thoughts or ask partner to speak slowly
Facilitative
▪ prevent or repair communication breakdown
▪ e.g., description in place of word
Scripting
▪ practicing spoken discourse |
Communicative interventions for mid-to-late AD
Focus on communicative participation
▪ communication vs. isolation
SLP trains the caregiver as a communication partner
▪ monitor, advise, encourage, and modify
Changes to caregiver’s communication habits
▪ short sentences
▪ simple, familiar words
▪ slower speech rate
▪ repetition
▪ signalling of topic changes
Caregiver attitude toward the person with AD
▪ respect
▪ encourage participation |
Communicative interventions for AD: Broad points
Egan et al. (2010) review, Collins & Hunt (2022)
▪ memory aids can help with specific topic maintenance
▪ e.g., memory books, personalized images (e.g., family members, previous occupation)
▪ caregiver training, positive relationships and shared activity can help with increasing utterances or non-verbal
expressions
▪ divided attention has negative effects
Williams, Theys, and McAuliffe
▪ targeting verbs may improve the production of both verbs and nouns |
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