Flashcards: PRAXIS Adult Treatment 2

the ability to select stimuli in a given environment

ability to make purposeful, specific responses to individual stimuli

■ E.g., reading a book, when someone says your name and you look at them ○ Sustained = concentrating on one task for an extended period of time (keyword = TIME)

■ E.g., being in class for a long period of time, taking a 2 hour test 

ignore distractions (external and internal) 

■ External e.g., parties, ignoring a dog barking while you’re in an online class ■ Internal e.g., daydreaming, being hungry, pain/sickness 

responding to multiple tasks at the same time  

■ E.g., walking and listening to music

shifting focus of attention & altering it between tasks. 

■ E.g., composing music

encoding, organizing, storing information in order to retrieve

orientation & knowledge of recent activities

ability to hold and manipulate information in mind

■ Explicit (AKA declarative) = information consciously declared to have been  learned or experienced 

■ Implicit (AKA nondeclarative) = information whose learning is reflected only by  changes in future behavior or as a result of the prior experience w/o conscious  

higher-level cognitive skills you use to control and coordinate your  other cognitive abilities & behaviors 

○ Initiation and drive 

○ Response inhibition  

○ Task persistence  

○ Organization 

○ Generative thinking  

○ Awareness (self-monitoring) 

Contralateral neglect, hemispatial neglect, visuospatial neglect, spatial neglect, or hemineglect.

Unilateral neglect is a specific attentional disorder in which the brain fails to process stimuli that appear on the side contralateral to a cerebral lesion.

Visual, somatosensory, kinesthetic, and auditory modalities.

Unilateral visuospatial neglect.

Observations (e.g., shaving only one side of the face) and traditional tests like line bisection, single letter cancellation, clock drawing, the test of visual neglect, and the Behavioral Inattention Test.

1) Improve the patient's attention to the neglected space, and 2) address proprioceptive and kinesthetic deficits.

Compensatory treatment involves making environmental changes to help the patient manage their neglect.

Reading aloud, writing, naming, auditory comprehension, speech

internal details

mathematical symbolization

verbal memory

prosody, emotional content, humor, figurative language

external details

visuospatial, organization of digits

non-verbal memory, recognition of facial expression

Right Hemisphere Disorder (RHD) is an acquired brain injury, often resulting from stroke or traumatic brain injury, that leads to impairments in language and cognitive domains, impacting communication.

RHD can affect attention, memory, and executive functions alongside language impairments.

Common symptoms include impaired attention, impulsive behavior, pragmatic communication impairments, and visual neglect.

Anosognosia is a symptom of RHD characterized by reduced awareness of deficits.

Visual neglect is when aspects of visual stimuli are ignored due to RHD.

Prosopagnosia refers to facial recognition deficits, making it difficult for individuals with RHD to remember and distinguish faces, especially in terms of age and gender.

Communication challenges include difficulty understanding and recognizing nonverbal expressions of emotions, impaired communicative effectiveness, and struggles with comprehending abstract or implied meanings, such as humor and sarcasm.

Prosodic deficits in RHD involve difficulty understanding others' speech and a lack of prosodic variation, resulting in issues like monotone speech and reduced speech rate.

form of memory loss

difficulty learning or remembering events after onset →  ■ Person has trouble “laying down new memories” 

difficulty recalling events prior to onset ←  

■ Can’t remember things before incident 

period of confusion – no new learning

Mild Cognitive Impairment (MCI) is an intermediate stage of cognitive impairment that may serve as a transitional phase between normal cognitive changes of aging and dementia.

Symptoms of MCI include impairments in memory, language, thinking, and/or judgment. While memory changes are more pronounced compared to normal aging, the ability to independently complete activities of daily living (ADLs) remains relatively intact.

Assessment of MCI involves the use of screeners such as the Mini Mental State Exam (MMSE), Saint Louis University Mental Status (SLUMS), Montreal Cognitive Assessment (MoCA), and others like the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Short Blessed Test.

Treatment for MCI is an active area of research. Rehabilitative approaches, including cognitive behavioral therapy, and the management of neuroprotective factors (e.g., addressing vascular risks) are being explored.

Delirium is a disorder characterized by fluctuating attention, increased distractibility, poor awareness, and persistent confusion, often accompanied by disordered perceptions like hallucinations.

Delirium can be triggered when the combined strain of illnesses, environmental circumstances, or other risk factors disrupts brain function. Examples include medications, lack of sleep, or urinary tract infections (UTIs).

Delirium involves a very rapid change in mental status (hours to days), with persistent inattention and confusion. Dementia, on the other hand, progresses over years and is characterized by more gradual cognitive decline.

Diagnosis of delirium involves a physical and neurological examination, observations, interviews, review of medical history, lab testing, and possibly cognitive assessments like the digit span test.

There is no specific medication for delirium. Instead, healthcare providers address identified causes and contributing factors, such as increasing mobility or adjusting medications, as part of the treatment.

Dementia is a syndrome resulting from acquired brain disease, characterized by a progressive decline in memory and other cognitive domains, which interferes with daily living and independent functioning.

Dementia can impact various cognitive domains, including complex attention, executive function, learning and memory, language, perceptual-motor skills, and social cognition.

Dementia is caused by common neurodegenerative diseases, including Alzheimer's disease, Lewy body disease, vascular pathology, frontotemporal dementia (FTD), Huntington's disease, and Parkinson's disease.

Alzheimer's disease is the leading cause of dementia.

Approximately 5.7 million people are living with dementia in the United States.

The first step in assessing dementia is to gather a comprehensive case history.

Throughout the assessment of dementia, you should consider cognitive-communication abilities, executive control, cognitive and communication demands of daily tasks, compensatory strategies, and the communication support network.

Cognitive-communication assessment involves evaluating communication participation, information processing abilities, executive control, task analysis, compensatory strategies, and the support network.

A clinical swallow assessment may be performed to evaluate swallow function, which is relevant to overall health and well-being.

Audiologic assessment or referral may be important due to the link between hearing loss and dementia.

The Mini-Mental State Exam (MMSE) is used as an overall measure of cognitive impairment.

The Montreal Cognitive Assessment (MoCA) is designed to test for mild cognitive impairment.

The MoCA assesses short-term memory, visuospatial abilities, executive functions, attention, concentration and working memory, language, and orientation to time and place.

The ABCD is a comprehensive assessment and screening tool for dementia in individuals aged 15 and older.

The results from the ABCD are useful for making differential diagnoses, developing treatment goals and patient care plans, monitoring patient change over time, and planning discharge.

The Dementia Rating Scale is designed for individuals aged 56 years to 105 years.

The Dementia Rating Scale is used to measure mental status in adults with cognitive impairment.

The results of the Dementia Rating Scale are used to track changes in cognitive status over time. It offers two forms that allow for a better characterization of declining cognitive status and an improvement in the evaluation of treatment efficacy

The Functional Linguistic Communication Inventory is a standardized test battery used to assess the functional language of patients with moderate to severe dementia.

The Global Deterioration Scale provides caregivers with an overview of the stages of cognitive function for individuals suffering from primary degenerative dementia, such as Alzheimer's disease.

Caregivers can observe an individual's behavioral characteristics and compare them to the GDS to get a rough idea of the individual's stage in the disease process.

The Global Deterioration Scale is broken down into 7 different stages

Stages 1-3 are the pre-dementia stages, while stages 4-7 are the dementia stages. Beginning in stage 5, an individual typically requires assistance to survive.

Each stage of the Global Deterioration Scale is numbered (1-7), given a short title (e.g., Forgetfulness, Early Confusional), and accompanied by a brief listing of the characteristics for that stage.

Alzheimer's Disease is primarily attributed to memory loss.

Alzheimer's Disease is the most common form of dementia.

The primary site of degeneration in Alzheimer's Disease is the cortical region of the brain.

Alzheimer's Disease typically has an insidious onset, often occurring after the age of 65. It has a slow and progressive course with plateaus not being unusual. It can occur in both familial and non-familial forms and may coexist with other conditions like Parkinson's disease.

Communication deficits in Alzheimer's Disease include common aphasia, which can start as either fluent or nonfluent. The semantic system is most affected, followed by syntax and phonology. Language comprehension deficits, difficulty with topic maintenance, echolalia, lack of meaningful speech, and gradual progression to mutism can occur.

Behavioral symptoms of Alzheimer's Disease can include depression, insomnia, incontinence, delusions, agitation, restlessness, hyperactivity, disorientation, delusions of persecution, and loss of initiative.

The primary site of degeneration in Lewy Body dementia is the cortical region of the brain.

Lewy Body dementia is characterized by periods of normal cognition alternating with abnormal cognition. It has a progressive course, often rapid in nature.

Communication symptoms of Lewy Body dementia include a motor speech disorder with hypophonia (reduced volume) and disorganized speech.

Behavioral symptoms of Lewy Body dementia include visual and auditory hallucinations, pronounced fluctuations in alertness and attention, which can lead to periods of delirium (confusion) and daytime drowsiness. Additionally, individuals may experience Parkinsonian motor symptoms such as rigidity and loss of spontaneous movement.

The primary site of degeneration in Vascular-Cortical dementia is the cortical region of the brain.

When multiple lesions or infarcts are present in both gray and white matter, Vascular-Cortical dementia is sometimes referred to as multi-infarct dementia (MID).

Symptoms of Vascular-Cortical dementia may begin suddenly and often progress in a stepwise fashion after each small stroke. Some strokes may not have noticeable clinical signs.

Communication symptoms of Vascular-Cortical dementia include prominent motor speech disorders with slurred speech, word retrieval difficulties, and difficulty following instructions.

Behavioral and cognitive symptoms of Vascular-Cortical dementia include depression, mood changes, confusion, problems with short-term memory, wandering or getting lost in familiar places, and impaired coordination or balance.

The primary site of degeneration in Vascular-Subcortical dementia is the subcortical region of the brain.

Vascular-Subcortical dementia is also known as Binswanger's Disease.

Vascular-Subcortical dementia is usually due to chronic, untreated hypertension.

Communication symptoms of Vascular-Subcortical dementia include difficulty with speech (dysarthria), reduced spontaneous communication, and difficulty with swallowing (dysphagia).

Behavioral and cognitive symptoms of Vascular-Subcortical dementia include progressive loss of memory and other cognitive functions, apathy, irritability, depression, slowness, poor balance, unsteady gait, and urinary incontinence not caused by urological disease.

The primary site of degeneration in Frontotemporal Lobar dementia, including Pick's Disease, is the cortical regions of the frontal and temporal lobes.

Frontotemporal Lobar dementia is attributed to the degeneration of the frontal and temporal lobes, often associated with Pick's Disease.

Frontotemporal Lobar dementia has an insidious onset, often occurring before the age of 65 (young onset), and it generally has a progressive but often slow course.

Communication symptoms of Frontotemporal Lobar dementia include reduced speech output, nonfluent speech, progressive decrease in expressive vocabulary, word-finding problems, reduced spontaneous conversation, and echolalia (meaningless repetition of phrases).

Frontotemporal Lobar dementia is associated with a wide range of behavioral changes, including executive dysfunction (in frontal variant), personality changes, disregard for social conventions, uninhibited behavior, and symptoms like depression, irritability, and mood fluctuations.

The primary site of degeneration in Primary Progressive Aphasia (PPA) is the cortical regions of the frontal and temporal lobes.

PPA is characterized by a gradual loss of language function while memory, visual processing, and personality remain relatively well-preserved until advanced stages. It may be caused by a variety of underlying diseases, potentially including genetic factors.

In the initial stages of PPA, typically around 2 years after onset, language impairment is predominant while cognitive skills, such as memory, remain intact. As the disease progresses, other mental skills, including memory, can become impaired.

Communication symptoms of PPA usually begin with word-finding problems and progress to impaired grammar (syntax) and comprehension (sentence processing and semantics). Symptoms associated with impaired speech production, such as dysarthria and apraxia, can also be present.

Activities of daily living, judgment, insight, and behavior are relatively spared or minimally affected in individuals with Primary Progressive Aphasia (PPA).

The primary site of degeneration in Parkinson's Disease-related dementia is the subcortical regions.

Parkinson's Disease-related dementia has a sporadic and gradual course. The average age of onset is around 60 years, with a higher risk for those aged 50 years and older, especially in men. The reported incidence of dementia in Parkinson's Disease patients varies across studies.

Communication in Parkinson's Disease-related dementia is characterized by hypokinetic dysarthria, naming problems, impaired discourse comprehension, and micrographia (writing in extremely small letters).

Behavioral symptoms of Parkinson's Disease-related dementia include immobility or slow voluntary movements, diminished facial expression, resting tremors, increased muscle tone, and resistance to movement. Other symptoms include disturbed gait and posture, memory problems, confusion, hallucinations, executive dysfunction, apathy, depression, social withdrawal, and anxiety.

The diagnosis of Parkinson's Disease-related dementia requires the presence of Parkinson's Disease (neurologic/motor) along with deficits in one or more cognitive domains (e.g., attention, executive function, visuospatial processing, verbal free recall). Additionally, one or more behavioral symptoms such as apathy, depression, hallucinations, or excessive daytime sleeping should be present.

The primary site of degeneration in Huntington's Disease is the subcortical regions of the brain.

Huntington's Disease has a gradual onset, and the rate of progression as well as the age of onset can vary from person to person.

Communication in Huntington's Disease is characterized by naming difficulties, use of shorter/simpler utterances, grammatical errors, and difficulty comprehending subtle aspects of discourse. Dysarthria of the hyperkinetic type, including variations in loudness, monopitch, and harsh voice quality, are common. Mutism may occur in the final stages.

Behavioral symptoms of Huntington's Disease include excessive complaining, eccentricity, irritability, emotional outbursts, violence, and extreme confusion in the final stages. Additionally, there are spasmodic involuntary movements of limbs, neck, and head. Impaired memory, attention deficits, and slowness with all intellectual activities are also observed.

The primary site of degeneration in dementia associated with Multiple Sclerosis is the subcortical regions of the brain.

Dementia related to Multiple Sclerosis is characterized as a chronic neurological disease that affects the central nervous system (CNS).

Communication in dementia related to Multiple Sclerosis includes dysarthria, which can lead to unclear articulation, difficulty controlling loudness, and poor pitch control. There are also problems comprehending and using language related to cognitive changes.

Behavioral and physical symptoms of dementia in Multiple Sclerosis include fatigue, vision problems, weakness, gait, balance, and coordination problems, pain, dizziness, and vertigo. Additionally, emotional changes, anxiety, depression, and cognitive dysfunction may be observed.

The goal of cognitive-communication treatment for dementia is to maximize the individual's quality of life and communication success by using approaches that meet their needs and values.

Treatment approaches for dementia include caregiver training, assistive technology, cognitive stimulation therapy, computer-based cognitive interventions, environmental modifications, external memory aids, Montessori for Aging and Dementia, simulated presence therapy (SimPres), spaced retrieval (SR), validation therapy, and eating and swallowing interventions.

Assistive technology for dementia includes items, equipment, or systems used to enhance, maintain, or improve the functional capabilities of individuals with disabilities, including memory aids, navigational tools, and hearing assistive technology systems.

In the early stages of dementia, individuals are likely to use a wider range of devices and systems compared to those in later stages.

Examples of assistive technology for dementia include electronic pill boxes, smart home systems, phone applications as memory aids, navigational tools like GPS, and hearing assistive technology systems such as FM systems, induction loops, and personal amplification devices.

Cognitive Stimulation Therapy (CST) is a group treatment designed for individuals with mild to moderate dementia. It involves theme-based mentally stimulating activities led by a speech therapist to enhance cognitive functions like thinking, concentration, and memory.

Group CST treatment typically consists of 14 or more sessions with themed activities, held twice weekly. Each session follows a specific theme, includes activities catering to group interests, and maintains consistency through warm-up activities, a reality orientation (RO) board, and a theme song.

Research suggests that individuals who participate in CST may experience ongoing improvements or maintenance of cognitive function over an extended period.

Computer-Based Cognitive Interventions involve using computer technology and software programs, such as touchscreen tablets, to enhance cognitive functioning in individuals with dementia. This includes improving processing speed, attention, and working memory.

Environmental Modifications involve changes or adaptations to the living environment to enhance overall functioning and support communication needs of individuals with dementia. These modifications aim to reduce barriers and accommodate impaired body function.

Cognitive aspects are supported through personalized living spaces, labels, signs with text and graphics, sequencing cards, cues for way-finding and orientation, and verbal instructions to aid memory and orientation.

Visual aspects involve reducing glare, improving lighting, organizing furniture and items, and providing clear sightlines. Auditory aspects include minimizing background noise, reducing noise reverberation, and using amplification devices when necessary.

External Memory Aids are tools aimed at assisting individuals with memory problems in their daily activities. They compensate for memory deficits, enhance independence, improve communication, reduce anxiety, and decrease responsive behaviors like repetitive questioning.

These aids contribute to cognitive enhancements in the environment, facilitating memory recall and supporting day-to-day functioning.

Examples include checklists, daily planners, calendars, programmable watches, pill reminders, smartphones, recorded messages (voicemails), memory books, memory wallets, and communication cards.

Montessori for Aging and Dementia is a person-centered approach based on the work of Dr. Maria Montessori. It focuses on the abilities, needs, interests, and strengths of elders with dementia in a supportive environment, empowering them to engage in meaningful activities.

This approach encourages individuals with dementia to engage in meaningful activities throughout their lives and supports them in maintaining independence and caring for themselves and others.

The approach integrates characteristics like freedom, structure and order, reality and nature, beauty and atmosphere, and specialized materials into eldercare settings.

Activities can include caring for oneself independently, engaging in meaningful tasks, and even providing support and care to others within the eldercare community.

Simulated Presence Therapy (SimPres) is an emotion-oriented approach used in dementia care. It involves playing audio voice recordings of the individual's close relatives to reduce anxiety and challenging behaviors.

The goal of Simulated Presence Therapy is to improve well-being by decreasing agitation and withdrawal behaviors in individuals with Alzheimer's disease who have adequate hearing and retained communication skills.

Simulated Presence Therapy involves playing audio recordings of the voices of the individual's close relatives. This approach aims to create a sense of familiarity, comfort, and emotional connection for the person with dementia.

Individuals with Alzheimer's disease who have adequate hearing and retained communication skills are more likely to benefit from Simulated Presence Therapy in terms of improved well-being and reduced challenging behaviors.

Spaced Retrieval (SR) is a technique used for learning and storing information to facilitate easy access. It utilizes classical conditioning and preserved implicit memory, teaching new memory associations through systematic spaced practice.

Spaced Retrieval establishes new memory associations by prompting a previously relevant response through lead questions. It involves systematic practice over increasing intervals of time and employs the principles of errorless learning.

Errorless learning in Spaced Retrieval aims to minimize errors by providing prompts and cues immediately following instruction. This strategy helps prevent mistakes and reinforces accurate recall.

Spaced Retrieval takes advantage of preserved implicit (unconscious or automatic) memory, using classical conditioning principles to create functional memory associations.

Ask a question to elicit the target response.

If correct, choose another target; if incorrect or unknown, provide the correct answer and have them repeat it.

Ask again after 15 seconds; repeat answer and questioning if necessary.

If correct, double the time interval (15s, 30s, 1m, 2m, 4m, 8m, etc.) and ask again.

If incorrect, provide the correct answer immediately and ask at the last correct time interval.

Validation Therapy is an approach that involves accepting and acknowledging the reality, values, and emotions of individuals with dementia. It aims to reduce stress, promote communication, and minimize negative behaviors. Techniques include centering oneself, reminiscing, using extremes, matching emotions, rephrasing, and engaging the senses to effectively communicate with individuals with dementia.