Transcript Dementia and Primary Progressive Aphasia (PPA)

Dementia and Primary
Progressive Aphasia (PPA)
Differential Diagnosis
Therapy approaches
The Roles of Speech Language
Pathologists
Impulsive
Forgetful
What we think about DEMENTIA
Childish
Garbled speech
Defining Dementia
Dementia- a group of symptoms related to
memory, and overall cognitive impairment.
Most types of dementia continue to worsen
and are irreversible.
• Alzheimer’s Disease- the most common type of
dementia. Affects up to 80% of those
diagnosed with dementia
• PPA- a form of dementia that involves a
decline in language functions.
SIGNS/SYMPTOMS OF DEMENTIA
• Confusion
• Getting lost in familiar places
• Problems with personal affairs (housekeeping, finances,
grooming)
• Personality changes
• Depression
• Difficulty following simple directions
• Significant memory loss
• Decreasing communication skills
• Dysphagia
• Increased muscle tightness/ rigidity.
• * Progressive loss begins many years before it is diagnosed.
How is Dementia diagnosed?
• A complete medical workup to r/o other
causes of cognitive impairment such as
drug interaction or multi-infarct dementia (
from several small CVA’s)
• Diagnosis team may include physician,
neuropsychologist, SLP, OT, social worker,
and family/friends/caregivers
• Testing to evaluate cognitive functioning
Medical history that can lead to dementia
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Huntington’s disease
Multiple Sclerosis-auto immune demyelinating
Infections such as HIV/Aids, Lyme disease
Parkinson’s disease (30-40%) . (new research –
stim. Astrocytes in hippocampus ento rhinal area
improved memory)
• Pick’s disease-Tau protein damage
• Progressive supranuclear palsy
PPA Diagnosis
•
How is PPA diagnosed?
•
History: assess functionality by interviewing caregivers
and family members regarding orientation, memory,
executive function
•
Medical history and results of other testing : neurological ,
psychological
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1. Functional communication assessment ( an interview)
2. Cognitive Linguistic Quick Test
3. Aphasia testing
4. Oral / swallowing fx
• Signs and symptoms
Focal vs Diffuse
• Vary, depending upon the portion of the brain affected.
• Some people with frontotemporal dementia undergo
dramatic changes in their personality and become
• 1.socially inappropriate,
• 2.impulsive or emotionally blunted,
• **while others lose the ability to use and understand
language.
Medications may be prescribed, all have side effects
• To control behaviors :
• Antipsychotics
(haloperidol,risperidone,olanzapine)
• Mood stabilizers
(fluoxetine,imipramine,citalopram)
• Stimulants (methylphenidate
• To slow rate of symptoms:
• Aricept, Exelon, Razadyne,Namenda
Speech Evaluation +
Speech and Language Evaluation:
• Since a decline in language abilities is the primary symptom of
PPA
What
works?
What doesn't
Talk to family
• A Speech-Language Pathologist evaluates different aspects of
language in detail and can make recommendations for
strategies to improve communication.
• Family members should be included in the treatment sessions
to educate them about how to facilitate communication and
use functional strategies.
Speech Evaluation Cont.
The disorder has an impact on :
relationships,
the ability to continue working,
the ability to perform many routine duties, and
the ability to communicate even the simplest of needs.
Although there are many resources available for individuals with memory loss,
there are relatively fewer appropriate resources for individuals with PPA, their
relatives and friends.
Evaluation with a social worker who is familiar with PPA can address these
issues and provide suggestions for dealing with day-to-day frustrations and
problems.
We may need to make recommendations for social worker to help them
Brain Scan. MRI studies
• Normal brain
PPA Brain
Treatment – Compensatory-Adaptive
• Treatment of Communication Impairments
• To improve the ability to communicate
AAC? Notebook, post
it's, enlarged calendar
• the type of language problems experienced by patients with PPA
may vary, the focus of treatment for improving communication ability
will also vary.
Find the strongest Lang modalities
• At present, there is no cure for the degenerative diseases that
cause PPA. Medical treatments are generally in the realm of
managing behavioral symptoms such as depression, anxiety, or
agitation, which may occur later in the course of the illness.
Clinicians are responsible for facilitating
cognitive-communicative function
• Direct Interventions- spaced retrieval tasks,
graphic and written cues in memory books.
• Indirect Intervention- environmental modifications
• Caregiver Training- repeat key information, give
choices rather than open ended questions, keep
information/questions short and simple, use written
cues for activities (ie: getting dressed, preparing
simple meal), encourage attendance at support
groups, seek adult day cares for respite to prevent
burn out.
Caregivers at home and in the SNFs
* Only 7% of the day in conversation
1.Only to do with ADL
2.Isolating =
3.Less need to communicate
4.Diminishing skills>reduced Stim>
What to do as an SLP?
Educate the people around the client
Follow up on interactions
Speech Therapy
Approaches
• There are 2 basic approaches to treatment for PPA and the dementias
that must always include training the caregivers
• 1.Direct Treatment: focus treatment directly on ways to improve the
functional memory, language, pragmatic skills that are impaired
• 2.Compensatory &. adaptive
*It is recommended that both treatment approaches be used with
PPA patients. Beginning in early stages of the disease, treatment
should be provided to enhance verbal language skills. For example,
treatments focused on word-retrieval skills may be helpful.
Treatment focused on the use of augmentative/alternative
communication strategies also should be provided, even in the early
stages of PPA. These are strategies that either enhance verbal
communication or replace it.
What are some examples?
Direct intervention :
Calendars
Dry erase boards
Labels in the living space
Visual memory activities
Auditory memory activities
Vocabulary and sequences associated with pragmatic skills
and ADL
Set up strategies for the future
Small notebook with
pictures and words
Apps for communication
Find out the best
modality and use it to
assist
•Pictures
•Gesturing
•Tags around the
house
•Consistent routines
Family or caregiver involvement
The patient (and family members) be trained in augmentative/alternative
communication and functional strategies
such as:
• Use of a communication notebook/ smart pad
• Use of gestures
• Use of drawing
•Share. In simple terms results :
•Speech eval
•How client uses AAC or other fx adaptive materials
However, follow-up treatment with a Speech-Language Pathologist is
important in order to further develop the strategy and provide practice in
using it.
Practicing daily routines needs to be emphasized
Areas of cognition to assess and stimulate
1.Orientation - days ,seasons, direction,
2.Attention- focus, ,memory, distractions, redirectability
3.Sequences- ADL, recreation
4.Categories - by function, place etc
5.Ability to use strategies,communication books or
smart pads
For nonprogressive cognitive loss
due to other neurological impairments
?
Assess functional language and cognition
Follow similar procedure as for PPA
Stimulate cognitive function along all
parameters in the areas of cognition
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