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).