A faculty-student research team at Misericordia University had its research paper, “Could Anticoagulants Improve Communication in Dementia? A Case Study,’’ published in the November/December issue Today’s Geriatric Medicine.
Misericordia University faculty members Kathleen Scaler Scott, Ph.D., C.C.C.-S.L.P., associate professor of speech-language pathology; James Siberski, M.S., C.M.C., CRmT, assistant professor and coordinator of the geriatric care management program, and Ruixia Yan, Ph.D., associate professor of speech-language pathology, collaborated with Sarah Tokach, M.S., C.F.-S.L.P., of Conyngham, who graduated from the speech-language pathology program in May 2016.
In the single-subject case study, researchers studied an 86-year-old female resident of a skilled nursing facility who has a diagnosis of vascular dementia. Researchers interviewed family members and reviewed medical records and home movies before administration of blood thinners and afterward.
According to the published study, the subject’s family began noticing cognitive symptoms that suggested the onset of dementia at the age of 79, one year after she began taking medication for high-blood pressure. Symptoms continued to worsen over time.
At the age of 84, the subject was transferred to a skilled nursing facility for long-term care. Months later, a blood clot was discovered in the test subject’s leg and she was diagnosed with atrial fibrillation (A-fib).
Doctors treated her blood clot with blood thinners, lovenox, and then warfarin. The subject remained on warfarin and previous blood pressure medications for five months. After suffering a mini stroke, doctors introduced an additional anticoagulant — plavix – to treat her for blood clots.
The subject’s family began to notice improvements in her communication skills about one week after taking warfarin. Investigators were told about the improvement about one year following the start of blood thinners. Investigators used a method known as conversation analysis to analyze the family videos taken before and after the start of blood thinners. Following blood thinners, the subject’s rate of speech changed from below average to within average range. She was found to be a more active participant in conversation, initiating more dialogue on a wider variety of topics. Gains in communication skills were determined to be maintained for six months after the stabilization of blood thinners.
The Misericordia team’s research is the first to analyze conversations of a patient with dementia following blood thinners. Their findings support previous research that found a link between those with a-fib and dementia symptoms when anticoagulation was not at the appropriate level. The research team hopes to inform physicians to consider ruling out atrial fibrillation as a possible contributing factor to cognitive decline.
The research shows that timely and effective medical management of a-fib holds promise for improving cognitive and communication symptoms of patients diagnosed with dementia. Physicians can improve the quality of life of the patient and family by limiting or reversing cognitive decline and its impact on communications.
“Regardless of whether improvements were the result of one or a combination of anticoagulants, the changes observed suggest important clinical implications for caregivers, speech-language pathologists and other medical professionals when considering the symptoms of an individual with vascular dementia,’’ Misericordia researchers wrote in their report.