Retained neuropsychological abilities of individuals with Alzheimer's disease

Occupational Therapy Interventions to Improve Driving Performance in Older People With Mild Cognitive Impairment or Early-Stage Dementia: A Systematic Review

IMPORTANCE

For a person with mild cognitive impairment (MCI) or early-stage dementia, driving is important for independence. However, driving presents safety concerns for both the person and family members. It is important to determine whether occupational therapy interventions can prolong safe driving for this population.

OBJECTIVE

To determine the effectiveness of occupational therapy interventions to improve driving performance in older people with MCI or early-stage dementia.

DATA SOURCES

We conducted a search of MEDLINE, PsycINFO, CINAHL, and gray literature using Google Scholar. Study Selection and Data Collection: Studies were included if they evaluated interventions that (1) aimed to improve the driving performance of older people (M age ≥60 yr) with MCI or early-stage dementia and (2) could be designed or delivered by an occupational therapy practitioner who specializes in driving. Citations were reviewed independently by two authors, and quality appraisal was conducted using the Cochrane risk-of-bias guidelines.

FINDINGS

One Level I randomized controlled trial (RCT) and 4 Level III quasi-experimental studies were included; these studies had 231 participants in total with reported M ages of 65.6-72.5 yr. One study evaluated a compensatory approach, whereas the others evaluated a remedial approach. The studies used different measures to assess outcomes and reported mixed effects.

CONCLUSIONS AND RELEVANCE

Low strength of evidence suggests that occupational therapy interventions may improve the driving performance of older people with MCI or early-stage dementia. More RCTs are needed that include long-term follow-up measures and address clinically important outcomes. What This Article Adds: In the absence of conclusive evidence from research studies and best practice guidelines, occupational therapy practitioners must rely on their clinical experience and their clients' abilities. Development of evidence and guidelines in this area is critical. It is also important for practitioners to work closely with clients, families, and interdisciplinary team members to carefully monitor fitness to drive.

Partner-Specific Communication Deficits in Individuals With Alzheimer's Disease

Purpose Speakers adjust referential expressions to the listeners' knowledge while communicating, a phenomenon called "audience design." While individuals with Alzheimer's disease (AD) show difficulties in discourse production, it is unclear whether they exhibit preserved partner-specific audience design. The current study examined if individuals with AD demonstrate partner-specific audience design skills. Method Ten adults with mild-to-moderate AD and 12 healthy older adults performed a referential communication task with two experimenters (E1 and E2). At first, E1 and participants completed an image-sorting task, allowing them to establish shared labels. Then, during testing, both experimenters were present in the room, and participants described images to either E1 or E2 (randomly alternating). Analyses focused on the number of words participants used to describe each image and whether they reused shared labels. Results During testing, participants in both groups produced shorter descriptions when describing familiar images versus new images, demonstrating their ability to learn novel knowledge. When they described familiar images, healthy older adults modified their expressions depending on the current partner's knowledge, producing shorter expressions and more established labels for the knowledgeable partner (E1) versus the naïve partner (E2), but individuals with AD were less likely to do so. Conclusions The current study revealed that both individuals with AD and the control participants were able to acquire novel knowledge, but individuals with AD tended not to flexibly adjust expressions depending on the partner's knowledge state. Conversational inefficiency and difficulties observed in AD may, in part, stem from disrupted audience design skills.

Descriptive Analysis: Survey of Direct and Indirect Interventions for Persons With Dementia-Based Communication Disorders

Results of a survey made available to SIG 2 and SIG 15 affiliates via the SIG listservs revealed information on direct and indirect interventions utilized for persons with dementia-based communication disorders. Fifty-eight practicing speech-language pathologists (SLPs) participated and reported using the following direct interventions most frequently: specific verbal instruction, cognitive stimulation, memory wallet, spaced retrieval, and errorless learning. The overwhelming majority of participants utilized caregiver training as the most frequent indirect technique. Barriers and facilitators to providing intervention for persons with dementia-related communication disorders were identified.

Quantitative analysis of formal caregivers' use of communication strategies while assisting individuals with moderate and severe Alzheimer's disease during oral care

This cross-sectional observational study examined formal caregivers' use of task-focused and social communication strategies while assisting individuals with moderate and severe Alzheimer's disease residing in a long-term care facility during a basic activity of daily living: toothbrushing. Thirteen formal caregiver-resident dyads were observed during a total of 78 separate toothbrushing sessions. All caregiver utterances occurring during the task were transcribed and coded for type of communication strategy utilizing a multidimensional observational coding scheme, which was developed a priori. Overall, the majority of residents, irrespective of disease severity, successfully completed toothbrushing with the support of caregiver assistance. Caregivers assisting residents with moderate and severe AD were found to use a variety of communication strategies, with task-focused strategies accounting for the majority of use. For the most part, the communicative strategies employed did not differ across disease severity. However, some differences were identified including the use of one proposition, paraphrased repetition, using the resident's name, and provision of full assistance, with these strategies being used more often when assisting individuals with severe AD. This study adds to the emerging literature supporting the use of specific communication strategies while assisting residents with AD during the completion of daily tasks.

LEARNING OUTCOMES

From reviewing this study, readers will be able to identify a variety of communication strategies, both task-focused and relational, that formal caregivers utilize while assisting residents with moderate and severe Alzheimer's disease (AD) during a basic activity of daily living. Furthermore, the reader will be able to distinguish between communication strategies that are optimal when assisting individuals with moderate AD as compared to assisting individuals with severe AD.

Humour, irony and sarcasm in severe Alzheimer's dementia – a corrective to retrogenesis?

Retrogenesis is claimed to be the process by which degenerating mechanisms in the brain, as found in Alzheimer's disease (AD), reverse the order of acquisition of functions, including language, in normal child development. In FAST (Functional Assessment Staging of Alzheimer's disease) stages of AD are translated into corresponding developmental ages. Humour, irony and sarcasm are communicative strategies linked to meta-linguistic abilities developed late in childhood. If found in the conversation of people with moderately severe AD according to FAST, this could be an indication of problems in the FAST scale and subsequently in the concept of retrogenesis concerning speech and language abilities. Comprehensive, open-ended, naturalistic conversations between three nursing home residents with moderately severe AD according to FAST and their professional care-givers were analysed with concepts developed in linguistics as to the occurrence of humour, irony and sarcasm. Although the data material was limited, the findings indicate an unexpected communicative competence of the three participants. This is a corrective to retrogenesis and a caveat for poor expectations of intelligible conversations with demented people for professionals and the people they advise. Implications for research strategies and for the general knowledge of communicative competence in AD are addressed in the discussion section, and possible ways of elucidating deterioration of speech and language abilities in AD are suggested.

The effects of modified spaced-retrieval training on learning and retention of face-name associations by individuals with dementia

The purpose of this project was to assess the effects of spaced-retrieval training (SRT) on learning of new and previously known associations by individuals with dementia in two treatment conditions: one in which the recall intervals were filled with activities unrelated to the information being learned (unrelated condition) and one in which the intervals were filled with related activities (related condition). Thirty-two individuals with mild to moderate dementia (30 with a diagnosis of Alzheimer's disease; two with vascular dementia) participated in the study. On average, participants learned the associations in fewer than four sessions and retained the information for variable amounts of time, up to 6 weeks. Previously known associations were learned significantly faster than new associations. The modified SRT format, in which the within-session recall intervals were filled with information related to the target association, did not result in faster learning or longer retention of learned associations. Participants learned previously known associations in the standard SRT format (with unrelated information in the recall intervals) significantly faster than new associations taught in the modified SRT condition. Cognitive impairment, as measured by the Mini-Mental State Examination, was significantly correlated with time to learn new associations, but did not explain a large proportion of the variance in new learning. Theoretical and clinical implications are discussed.

Diagnostic utility of sound naming in early Alzheimer's disease

While it is well known that picture naming (PN) is impaired in Alzheimer's disease (AD), sound naming (SN) has not been thoroughly investigated. We postulated that SN might be impaired more severely and earlier than PN, given the early involvement of the temporal cortex by AD-related pathology. SN and PN were assessed in 21 normal participants, 40 patients with mild cognitive impairment (MCI), and 27 patients in early stages of AD. Our results showed that SN accuracy and latency were more sensitive to advancing pathology in AD than PN accuracy and latency. SN was more useful and specific in distinguishing MCI patients from normal participants and therefore in potentially identifying the subset of MCI patients who already have impairment in more than one cognitive domain and may actually have incipient AD. These findings indicate a potential diagnostic utility of SN for early detection of the disease. Furthermore, even though most AD patients demonstrated more or less comparable impairment in both tasks, some were disproportionately impaired on SN and others were differentially impaired on PN. Future studies may be able to show that these discrepant groups correspond to patients with right and left hemisphere predominant AD, respectively.

Early detection of Alzheimer's disease: a new working memory paradigm

OBJECTIVES

Early detection of Alzheimer's disease (AD) offers the chance to decelerate the patients' cognitive decline and to prolong a self-determined, independent life. Neuropsychological testing is one key approach to establish an early diagnosis. Whereas more global cognitive abilities can be preserved until further progression of the disease, specific executive abilities such as dual-task or active inhibition processes decline very early. Our recently developed working memory paradigm, the Block Suppression Test (BST), requires an active inhibition of irrelevant stimuli and thus should differentiate between Alzheimer patients and controls in early disease stages more accurately than classical screening instruments.

METHODS

In a pilot study we applied the BST, the MMSE, the clock drawing test, a digit-word transformation task as well as verbal and spatial memory span tasks to a group of 13 patients with Alzheimer's disease and 13 elderly controls and compared the instruments' capability to differentiate between patients and controls.

RESULTS

The BST showed the highest sensitivity among all applied tests with a perfect differentiation of healthy subjects and patients. The patients' backward spans were significantly reduced, in the inhibition condition they showed disproportionally worse performances.

CONCLUSIONS

Our results reveal a specific inhibition deficit in mild AD rather than a global working memory breakdown. The BST thus was superior for early diagnosis. However, these findings must be replicated in a larger sample to prove the BST's applicability for the early diagnostic assessment of AD and other dementias.

Clinical psychoacoustics in Alzheimer's disease central auditory processing disorders and speech deterioration

BACKGROUND: Difficulty in speech understanding in the presence of background noise or competing auditory signals is typically present in central auditory processing disorders. These disorders may be diagnosed in Alzheimer's disease as a result of degeneration in the central auditory system. In addition perception and processing of speech may be affected. MATERIAL AND METHODS: A MEDLINE research was conducted in order to answer the question whether there is a central auditory processing disorder involved in Alzheimer's disease. A second question to be investigated was what, if any is the connection, between central auditory processing disorders and speech deterioration?Articles were retrieved from the Medline to find relevance of Alzheimer's dis ease with central auditory processing disorders, they summed up to 34. Twelve papers were studied that contained testing for CAPD through psychoacoustic investigation. An additional search using the keywords 'speech production' and 'AD' produced a result of 33 articles, of them 14 are thoroughly discussed in this review as they have references concerning CAPD. The rest do not contain any relavent information on the central auditory system. RESULTS: Psychoacoustic tests reveal significantly lower scores in patients with Alzheimer's disease compared with normal subjects. Tests concerning sound localization and perception of tones as well as phoneme discrimination and tonal memory reveal deficits in Alzheimer's disease. Central auditory processing disorders may exist several years before the onset of clinical diagnosis of Alzheimer's disease. Segmental characteristics of speech are normal. Deficits exist concerning the supra-segmental components of speech. CONCLUSIONS: Central auditory processing disorders have been found in many cases when patients with Alzheimer's disease are tested. They may present as an early manifestation of Alzheimer's disease, preceding the disease by a minimum of 5 and a maximum of 10 years. During these years changes in the central auditory system, starting in the temporal lobe, may produce deficits in speech processing and production as hearing and speech are highly connected human functions. Another theory may be that spread of degeneration of the central nervous system has as a consequence, speech deterioration. Further research and central auditory processing disorders testing in the elderly population are needed to validate one theory over the other.

Anesthetic considerations in patients with Alzheimer's disease

Alzheimer's disease is a form of dementia that is estimated to affect approximately 3 to 4 million Americans. Given the substantial number of people affected with this disease, it is likely that anesthesiologists will encounter many patients with Alzheimer's disease. Questions as to potential problems including informed consent, drug interactions, and preoperative progression of the disease may arise. This review describes anesthetic considerations, including pharmacologic and physiologic issues, in this growing population.