Brooke Hallowell April 2017 Why are we here? Empowering People with Dementia and Those Who Care About Them: Evidence-Based Strategies to Enhance Meaningful Communication Brooke Hallowell Hallowell, B. (2017). Aphasia and other acquired neurogenic Hallowell, B. (2017). Aphasia and other acquired neurogenic language disorders: A guide for clinical excellence. San Diego, language disorders: A guide for clinical excellence. San Diego, CA: Plural Publishing. ISBN13: 978-1-59756-477-9 CA: Plural Publishing. ISBN13: 978-1-59756-477-9 What is neurodegenerative disease? What are neurodegenerative conditions? • Any neurogenic condition that progressively gets worse over time • A broad category of disorders entailing progressive changes in the brain that result in progressive loss of neurological functioning • Primary neurodegenerative conditions relevant to clinical aphasiology • Neurodegenerative diseases impacting cognitive-linguistic abilities o Mild cognitive impairment (MCI) o Any types of dementia � A condition of cognitive decline that is not consistent with normal aging o Some forms of mild cognitive impairment (MCI) o Dementia � A constellation of symptoms including � Memory impairment � One or more cognitive and/or linguistic impairments o Primary progressive aphasia (PPA) � The progressive loss of linguistic abilities in contrast to relatively intact cognitive abilities Hallowell, B. (2017). Aphasia and other acquired neurogenic Hallowell, B. (2016). Aphasia and other acquired neurogenic language disorders: A guide for clinical excellence. San Diego, language disorders: A guide for clinical excellence. San Diego, CA: Plural Publishing. ISBN13: 978-1-59756-477-9 CA: Plural Publishing. ISBN13: 978-1-59756-477-9 What are common forms of dementia? What is dementia? • The criteria for the diagnosis of dementia Alzheimer's o Memory impairment disease (AD) AIDS o One or more cognitive/linguistic impairments MCI due to dementia AD complex • Most common symptoms Creutzfelt- Vascular o Memory problems Jacob dementia disease o Behavior problems Dementia Dementia • People with dementia develop different Korsakoff's with Lewy Syndrome problems with bodies (DLB) o Attention Parkinson's o Executive functions Huntington's disease disease o Critical thinking Frontotempo dementia ral dementia o Language (FTD) Hallowell, B. (2017). Aphasia and other acquired neurogenic Hallowell, B. (2017). Aphasia and other acquired neurogenic language disorders: A guide for clinical excellence. San Diego, language disorders: A guide for clinical excellence. San Diego, Source : “Alzheimer's disease brain”. by Garrondo, derivative work:, license CC.0. Public Domain [modified]. CA: Plural Publishing. ISBN13: 978-1-59756-477-9 CA: Plural Publishing. ISBN13: 978-1-59756-477-9 1
Brooke Hallowell April 2017 Is there such a thing as “reversible” dementia? What are implications of an incorrect diagnosis of dementia? • The term “reversible” dementia is inaccurate and misleading o By definition, dementia is progressive and gets worse over time • Unnecessary difficult emotional reactions of patients and caregivers • The “progressive” nature of dementia is the key to distinguish it from other non-progressive, dementia-like disorders • Hardships related to untoward stigma on o e.g., Pseudo-dementia (or transient confusional state) a social level • Situations in which dementia-like symptoms may be noted despite the absence of a true dementia • Incorrect prescription of medication and other interventions o Depression o Dietary imbalances • Being deemed ineligible for coverage of o Vitamin deficiencies some crucial rehabilitation-related services o Drug effects o Some third-party payers consider dementia to be a “red flag” diagnosis o Drug interactions Source: “Holzfigur” By Counselling, licensed under CC0 Public Domain. o Post-surgical states Hallowell, B. (2016). Aphasia and other acquired neurogenic Hallowell, B. (2017). Aphasia and other acquired neurogenic language disorders: A guide for clinical excellence. San Diego, language disorders: A guide for clinical excellence. San Diego, CA: Plural Publishing. ISBN13: 978-1-59756-477-9 CA: Plural Publishing. ISBN13: 978-1-59756-477-9 What are some special challenges in identifying What is mild cognitive impairment (MCI)? etiologies of language disorders? • A condition of cognitive decline that is not typical of normal aging • Etiologies Acquired Individual o Neurodegenerative disease vs. Differences Exacerbated o Head injury o Neoplasm o Infectious processes Multiple Concomitant • Age o Metabolic disorders Etiologies Conditions • Socioeconomic status • Cultural/linguistic background • Health status • Memory problems are the most common complaints of people with MCI • Emotional health • Social support Hallowell, B. (2017). Aphasia and other acquired neurogenic Hallowell, B. (2017). Aphasia and other acquired neurogenic language disorders: A guide for clinical excellence. San Diego, language disorders: A guide for clinical excellence. San Diego, CA: Plural Publishing. ISBN13: 978-1-59756-477-9 CA: Plural Publishing. ISBN13: 978-1-59756-477-9 Introduction Cognitive-Linguistic Intervention • Cognitive intervention may lead to changes in the brain: for people with MCI and • Increased brain metabolism • Increased cortical thickness Dementia • Increased density of white matter tracts • Best outcomes achieved when implemented early (when individuals with MCI retain the capability to learn and apply strategies) (Jean et al., 2010; Stoot & Spector, 2011) 2
Brooke Hallowell April 2017 What we do not know What we do know • Are specific interventions best for specific deficits? • Use repetition-based intervention that targets specific cognitive domains • What outcome measures are most valid? • Provide direct training of strategies and functional skills • Delivery: Is individual treatment better than group treatment? • Empower clients with education regarding healthy aging and brain • Dosage: How long should treatment sessions last? How long should habits intervention programs last? • Provide goal-oriented, strategic social opportunities that support • Long-term effects: How long will program effects last? cognitive engagement When developing a Cognitive When developing a Cognitive Intervention Intervention Program… Program… 1. Base your program on a framework that considers the impact of 2. Purpose should be to improve cognitive and social functions cognitive impairment on lives of affected individuals 3. Include outcome measures that assess effects on function, activity Health Condition: MCI Key Element addressed limitation, life participation restrictions and personal and environmental factors Body & Functions Brain damage leading Target-oriented to impairments in repetition-based memory, language, EF intervention Activity Ability to complete Selection and direct specific tasks training of memory strategies Participation Fulfillment of social Provision of goal- roles oriented strategic social engagement Contextual factors Address modifiable Empowerment through risk- and protective education about factors healthy aging Outcome measures Typical Formats • Include a mix of objective and subjective outcome measures Duration: • Objective measures: standardized tests evaluating cognitive domains • 8-24 sessions (plus booster sessions in regular intervals after completion of the training) • Subjective measures: questionnaires of client/ family perception, mood, and • 60-120 minutes participation) • Include pre-and post assessments Components: • Individual and group sessions • Computer-based and paper-and-pencil tasks arranged in a “circuit” 3
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