Transcript Keeping the Lines of Communication Open

Keeping the Lines of Communication
Open:
A Look at Speech, Language, and Alzheimer’s Disease
Lacie Deeds
Marshall University
CD 315
What is Alzheimer’s Disease?
• Alzheimer’s Disease is a progressive neurological
disorder with a slow onset that causes large
numbers of nerve cells within the brain to die
(Daly, 1999).
• Alzheimer’s disease is the most prevalent form of
dementia.
What is Dementia?
Dementia is a syndrome
characterized by loss of
cognitive functioning
sufficient enough to
interfere with
performing normal
daily activities (Daly,
1999).
To have dementia, the
patient must have
deficits in at least 3 of
these 5 areas:
1. Language
2. Memory
3. Visuospatial skills
4. Personality
5. Cognition
(Glickstein & Neustadt,
1993)
The Alzheimer’s Brain
• The atrophy of cells
within the cerebrum
causes the brain to
shrink (Ferrand &
Bloom, 1997).
• The picture at the right,
provided by the
Alzheimer’s Association
(2006), depicts an
advanced Alzheimer’s
brain in comparison to
a healthy brain.
Image by Jannis Productions and retrieved from
http://www.alz.org/brain/09.asp
The Alzheimer’s Brain
Several anatomical changes occur within the brain:
– Gryi (or the ridges) thin, sulci (or the grooves) widen, and
the cortex shrinks, damaging areas involved in thinking,
remembering, and planning (Alzheimer’s Association, 2006).
– The hippocampus, which is the area of the brain responsible
for the formation of new memories, is also severely affected
by the shriveling of cells.
– Ventricles (fluid filled spaces) grow larger.
The Alzheimer’s Brain
Image retrieved from the American Health Assistance Foundation (2006) at
http://www.ahaf.org/alzdis/about/BrainAlzheimer.htm
The Alzheimer’s Brain
Changes in the brain occur
progressively over time.
The illustration at the left
shows deterioration of the
brain throughout the
course of the disease. As
the areas for speech and
language deteriorate, so do
speech and language skills.
Image retrieved from the American Health Assistance
Foundation (2006) at
http://www.ahaf.org/alzdis/about/Brain_Neurons_AD_
Normal.htm
Who is affected?
Approximately 10% of persons over the age of 65
are affected by Alzheimer’s Disease (Daly, 1999).
While Alzheimer’s is more prevalent in the
elderly, it can affect the middle-aged (40+) and
on rare occasions, even the young (25+)
(Glickstein & Neustadt, 1993).
What is the life expectancy?
Alzheimer’s patients have the outward
appearance of wellness, but cognitive decline
makes the average life expectancy 8-10 years
after diagnosis, but it can be anywhere from 320 years (Daly, 1999).
Even if the individual with Alzheimer’s disease
has no other serious illness, the loss of brain
function itself will eventually cause death.
How is Alzheimer’s classified?
• The Global Deterioration Scale is a seven-point rating
scale that assesses cognitive and functional capabilities
of Alzheimer’s patients from normal aging to severe
dementia (Ferrand & Bloom, 1997).
Images by Jannis Productions and retrieved from the Alzheimer’s Association (2006) at
http://www.alz.org/brain/08.asp
Stages 1 and 2:
Within the Limits of Normal Aging
Stage 1: No Cognitive Decline
Stage 2: Very Mild Cognitive Decline
• Some memory lapses, usually forget familiar words and names or
the location of glasses, keys, etc.
• Problems are not obvious to family members, friends, and
medical professionals.
Stages 3 and 4:
Early-stage Alzheimer’s
Stage 3: Mild Cognitive Decline
• Earliest clear-cut deficits, though still may go undiagnosed.
• Word and name finding problems become obvious to family
members and friends
• Performance issues in social and/or work situations
• Mild to moderate anxiety
Stage 4: Moderate Cognitive Decline
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•
Clear-cut deficits upon clinical interview
Decreased knowledge of recent events
Trouble remembering personal history
Decreased ability to travel to familiar locations
Inability to complete complex mental tasks
Individual may become subdued and withdrawn, especially in
social situations
• Denial (Reisberg, Ferris, Leon, & Crook, 1982)
Stages 5 and 6:
Mid-stage Alzheimer’s
Stage 5: Moderately-Severe Cognitive Decline
• Patient can no longer live alone
• Unable to recall important aspects of current lives, such as
telephone number, address, names of grandchildren, etc.
• Frequent disorientation to time and place
• May need help choosing proper clothing
Stage 6: Severe Cognitive Decline
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Most awareness of recent experiences is lost
Often forget name of spouse or caregiver
Disruptions in sleep/waking cycles
Tend to wander off and become lost
Significant behavioral and personality changes like delusions and
hallucinations
Stage 7:
Late-stage Alzheimer’s
Stage 7: Very Severe Cognitive Decline
• Frequently, all verbal abilities appear to be lost. There is usually
only grunting but occasionally, but a few words or phrases may
be uttered.
• Require help with feeding and toileting (Alzheimer’s
Association, 2006)
• Cannot walk without assistance or sit up without support
• Abnormal reflexes
• Rigid muscles
• Impaired swallowing (Reisberg, Ferris, Leon, & Crook, 1982)
Communication and Alzheimer’s
As a person progresses through
the stages of Alzheimer’s
Disease, the ability to
communicate (including
speech and language)
deteriorates.
Image retrieved from Historical Documents at
http://www.historicaldocuments.com/RonaldReaganSpeeches.htm
Communication and Alzheimer’s
Changes in communication abilities are unique and
specific to each person. Individuals with Alzheimer’s
may exhibit:
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•
•
•
•
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•
•
Circumlocutions (word finding difficulties)
Repetitions
Verbal perseverations (repetition of a particular word or phrase)
Deficits in pragmatic skills like turn-taking and topic
maintenance (Bourgeois, 1991)
Diminished vocabulary and reading comprehension
Faulty linguistic reasoning (Bourgeois, 1991)
Simplification of syntax (sentence structure) (Glickstein &
Neustadt, 1993)
Irrelevant speech
Communication and Alzheimer’s
In the early stages of Alzheimer’s, communication
difficulties are primarily related to short term
memory loss, a reduced attention span and
ability to concentrate, and a lack in the ability to
take in information (Touzinksy, 1998).
These individuals are typically aware of their
problems but often refuse to acknowledge their
impairments and try to cover up their difficulties.
Denial begins to manifest itself.
Communication and Alzheimer’s
Individuals in the middle stages of Alzheimer’s
disease have more visible communication
difficulties. They will engage in repetitive
questioning and may also produce statements that
make little or no sense.
These patients suffer from more severe word finding
problems and declined verbal communication.
For these reasons, they may have difficulty
maintaining a conversation and will often retreat
in social situations (Touzinksy, 1998).
Communication and Alzheimer’s
In the later stages of Alzheimer’s, verbal
communication may be almost completely
nonexistent. Individuals in these stages have
little comprehension skills left and frequently
babble. Verbal expression may be limited to a
few words or phrases (Touzinsky, 1998).
Individuals in late-stage Alzheimer’s often only
retain residual knowledge of the past, a time
when life made sense (Touzinky, 1998).
What can you (the caregiver) do to
help communication?
• Enroll your loved one in speech therapy
• Be patient and supportive
• Show your interest by maintaining eye contact
• Give the person time to speak without interruption
• Don’t criticize or correct
• Encourage the use of nonverbal communication like
gestures
• Limit distractions
• Avoid arguments (Alzheimer’s Association, 2006)
Why speech therapy?
A speech language
pathologist (SLP)
can provide the
individual with
Alzheimer’s with
techniques to help
maintain
communication at
their current level
for as long as
possible.
An SLP can also
teach
communication
strategies that will
be useful as the
disease progresses
and more
communication
abilities are lost.
Why speech therapy?
Because the caregiver and
close family members are
the individual’s primary
communication
partners, the SLP will
hold counseling sessions
where you can voice your
concerns and also teach
useful strategies for
maintaining
communication at
home.
Image copyright of Mike Moreland (1993).
Retrieved from
http://www.faqs.org/health/Healthy-LivingV2/Health-Care-Careers.html
Why speech therapy?
Speech therapy for individuals with
Alzheimer’s disease is important because it
helps to improve communication which
will improve the individuals’ overall quality
of life.
That is the most important goal.
References
Alzheimer’s Assocation. (2006). Communication: Best ways to interact with the person with
dementia. Retrieved October 19, 2006, from
http://www.alz.org/Resources/factsheets/Communications10_5.pdf
Alzheimer’s Association. (2006). Stages of Alzheimer’s disease. Retrieved October 19,
2006, from http://www.alz.org/Resources/FactSheets/FSstages.pdf
Alzheimer’s Association. (2006). What is Alzheimer’s disease? Retrieved November 5,
2006, from http://www.alz.org/AboutAD/WhatIsAD.asp
Bourgeois, M.S. (1991). Communication treatment for adults with dementia. Journal
of Speech and Hearing Research, 34(4), 831-844. Retrieved October 16, 2006, from
the MEDLINE database.
Daly, M.P. (1999). Diagnosis and management of Alzheimer Disease. The Journal of the
American Board of Family Practice, 12(5), 375-385. Retrieved November 1, 2006,
from the MEDLINE database.
References
Ferrand, C.T., & Bloom, R.L. (1997). Introduction to organic and neurogenic
disorders of communication. Needham Heights, MA: Allyn & Bacon.
Glickstein, J.K., & Neustadt, G.K. (1993). Speech-language interventions in
Alzheimer's disease: A functional communication approach. Clinics in
Communication Disorders, 3(1), 15-30. Retrieved September 29, 2006, from the
MEDLINE database.
Reisberg, B., Ferris, S.H., Leon, J.J., & Crook, T. (1982). The global deterioration scale
for assessment of primary degenerative dementia. American Journal of Psychiatry,
139, 1136-1139.
Touzinsky, L. (1998). Validation therapy: Restoring communication between persons
with Alzheimer’s disease and their families. American Journal of Alzheimer’s Disease,
13(2), 196-201. Retrieved November 1, 2006, from the PsychINFO database.