keeping the lines of communication open: a look at speech, language, and alzheimers disease lacie...

25
Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimer’s Disease Lacie Deeds Marshall University CD 315

Upload: cameron-skinner

Post on 26-Mar-2015

213 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

Keeping the Lines of Communication Open:

A Look at Speech, Language, and Alzheimer’s Disease

Lacie Deeds

Marshall University

CD 315

Page 2: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers 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.

Page 3: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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. Language2. Memory3. Visuospatial skills4. Personality5. Cognition(Glickstein &

Neustadt, 1993)

Page 4: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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

Page 5: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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.

Page 6: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

The Alzheimer’s Brain

Image retrieved from the American Health Assistance Foundation (2006) at http://www.ahaf.org/alzdis/about/BrainAlzheimer.htm

Page 7: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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

Page 8: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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).

Page 9: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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 3-20 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.

Page 10: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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

Page 11: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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.

Page 12: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

Stages 3 and 4:Early-stage Alzheimer’sStage 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 anxietyStage 4: Moderate Cognitive Decline• 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)

Page 13: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

Stages 5 and 6:Mid-stage Alzheimer’sStage 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• 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

Page 14: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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)

Page 15: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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

Page 16: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

Communication and Alzheimer’s

Changes in communication abilities are unique and specific to each person. Individuals with Alzheimer’s may exhibit:

• 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

Page 17: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

Communication and Alzheimer’sIn 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.

Page 18: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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).

Page 19: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

Communication and Alzheimer’sIn 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).

Page 20: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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)

Page 21: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

Why speech therapy?

An SLP can also teach communication strategies that will be useful as the disease progresses and more communication abilities are lost.

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.

Page 22: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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-Living-V2/Health-Care-Careers.html

Page 23: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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.

Page 24: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

ReferencesAlzheimer’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.

Page 25: Keeping the Lines of Communication Open: A Look at Speech, Language, and Alzheimers Disease Lacie Deeds Marshall University CD 315

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.