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Cognition and Communication Disorders Cheat Sheet (DRAFT) by

Cognition and Communication Disorders

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Cognition

Cognition: what is it?
▪ Thought or Consci­ousness
 
▪ 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
 
▪ Language (ability to understand & express thoughts)
 
▪ Attention (conce­ntr­ation, allows you to focus on)
 
▪ Executive functions (control of behaviour, problem solving, planning & strategy)
 
▪ Perceptual function (allows you to take in inform­ation through senses, then utilise this inform­ation to respond & interact with the world)
 
▪ Motor function (voluntary movements: dialing the phone, un/but­toning clothes etc)
 
▪ 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
 

Age-re­lated cognitive decline

Evidence: Seattle Longit­udinal Study:
➢ began in 1956 focusing upon age changes in cognitive abilities
 
➢ 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?
 
• 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
 

Subcor­tical: Parkin­son’s

early stages:
motor impair­ments
 
resting tremor
 
immobi­lit­y/r­igidity → slow movement
 
difficulty walking
 
Dysarthria (speech problems)
progre­ssion:
cognitive issues
 
executive function, memory, processing speed
 
40% cases develop dementia
 
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
 

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