Linda S. Carozza, Ph.D. -- carozzal@stjohns.edu
St. John’s University
Staten Island Campus
300 Howard Ave.
Staten Island, NY 10301
Fredericka Bell-Berti, Ph.D. -- bellf@stjohns.edu
St. John’s University
Queens Campus
8000 Utopia Parkway
Queens, NY 11439
Popular version of paper 3aSCb33
Presented Wednesday morning, November 2, 2011
162nd ASA Meeting, San Diego, Calif.
Dementia is a common but not well-understood disorder that affects a large number of older individuals. It is on the increase especially due to the medical advances that extend life and the increasing number of “baby boomers” in the national demographic. The common notion is that dementia, or “senility” as it was called in the past, is an unavoidable consequence of aging. However, the medical fact is that not all aged individuals exhibit dementia. Rather, normal aging may be accompanied by slight changes in function due to a normal process of “cognitive slowing,” however normal healthy elderly people do not necessarily exhibit significant language and memory problems that detract from independence and relative quality of life.
However, when dementia strikes, there are many changes in behavior, cognition, and functionality that serve to eventually render the person dependent on family or perhaps institutionalized care. Dementia is a condition in which cognitive capacity declines, although the cause of the deterioration may not be clear. In some cases, elderly individuals may exhibit temporary or reversible changes in behavior due to isolation, polypharmacology (taking many prescribed and over the counter medications), depression, malnutrition, head injury, and falls, among other conditions. In other cases, there are underlying medical or neurological diseases that accompany dementia. These may include Parkinson’s disease, Huntington’s disease, alcohol-related dementia, HIV dementia and many other causative long standing conditions. The most common cause of dementia, however, remains Alzheimer’s disease.
Alois Alzheimer identified changes in the brains of his patients in the early 1900s.There were changes in the structure of the brains and in the ability of brain areas to communicate (the function of the brain regions) that were both effected in his patients. These tell-tale signs are still seen in the current day when patients’ brains are examined after death at autopsy. Genetic differences that relate to protein metabolism in the neurotransmitter systems of the brain are the most likely culprits. However, different theories exist and most likely there are several paths to full blown dementia with primary and secondary causations.
Science is hard at work to try to identify these patients as early as possible, searching for early bio-markers for this relentless disease that renders patients entirely mute and physically and cognitively incapacitated at the final disease stages. Since there is an intimate involvement among loss of speech, language, and feeding functions in these patients, it is natural that speech scientists have keen interest in the identification of when motor speech declines in these patients. The current pilot investigation involves the consecutive examination of a single case of an elderly Alzheimer’s patient in the mild-to-moderate stage of Alzheimer’s Dementia.
The patient lives in the community and attends an adult day care program to provide stimulation and support. He was verbal and interactive but had clear cognitive changes and was unable to be left alone, requiring 24-hour supervision with family or aides. The subject was able to perform the task of repeating sentences designed to provide information about specific aspects of the timing of speech, including phrasing and pausing, in normal speech that are accomplished automatically, without conscious effort or awareness. This subject was seen at significant intervals to compare performance. The initial recordings indicated differences in speech had already taken place when compared with data on the speech of healthy elderly persons. The second assessment revealed further decline and unexpected changes that are seen in other types of neurological disease although he was still intelligible, eating independently, and had no swallowing dysfunction. Therefore, the potential exists that undetected micro-differences in motor speech coordination are present and are detectable with acoustic analysis of speech, though they are not detected by listeners. If these changes in speech are seen in larger studies, they may represent a key to identifying an underlying subtle neurological decline and a window into an early speech marker of dementia.