comdis_530_cognitive_linguistic_disorders

8/7/2019 ComDis_530_Cognitive_Linguistic_disorders

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Cognitive + Linguistic Disorders

and other

Communication Disorders

by:Mary V. Andrianopoulos, Ph.D.


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Summary of Motor Speech

Disorders

Problems w motor programming andplanning:

Apraxia of Speech

Problems with motor execution

Dysarthrias

(categories of dysarthrias pending location of

lesion + associated symptoms)


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Apraxia of Speech Motor programming, planning problem of

voluntary speech acts

Dominant hemisphere for language

Apraxia of speech

Not due to weakness or paralysis

Left triangularis + opercularis area usuinvolved

Frontal lobe


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Other types of apraxias

Inability to carry out voluntary motor actsfor certain tasks in the absence of weakness,

paralysis, or sensory loss

Dressing

Construction

Ideomotor Ideational

Limb


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Summary of Dysarthrias

Supratentorial Problems or Dysarthrias Spastic: Bilateral UMN

Unilateral UMN: unil UMN contralateral

Hypokinetic BG

Hyperkinetic BG

Rhythmic vs. arythmic involuntary movements Fast vs. slow movements

Mixed Dysarthria multifocal


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Summary of Dysarthrias Infratentorial Problems

Ataxic: Cerebellar

Flaccid: FCP-LMN (ipsilateral symptoms)

Cranial Nerve specific

Cr. V motor Jaw (sensory mouth)

Cr. VII motor face (sensory tongue + face)

Cr. IX motor pharynx, (Senosry gag + pharynx) Cr. X motor VFs, larynx (sensory VFs + larynx)

Cr. XI motor shoulders (sensory)

Cr. XII motor tongue


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Aphasias

Acquired language impairment Categorized by location of lesion

Types of errors: Fluent vs. non-fluent

Grammatic vs. agrammatic

Problems with expression vs. comprehension


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Differential Diagnosis of the Aphasias

Multimodality deficit in communicationaffecting language-based functions:

Listening

Speaking

Writing

Reading

Impairment of language > other mental or

intellectual functions


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Other aphasic symptoms

Anomia: word finding difficulties Circumlocutions

Paraphasias; word/sound substitutions

Stereotypical utterances

Decreased auditory comprehension

Agrammatic (non-fluent types) Reduction in working memory load

Problems with discourse


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Classification of Aphasia: Non-Fluent

Brocas: agrammatic

(pars triangularis ~L-Frontal)

Transcortical motor: (~L-subcortical/frontal)

Brocas like with preserved repetition Global: (~L-perisylvian area)

poor comprehension with minimal expression


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Classification of Aphasia: Fluent

Wernickes: poor comprehension (~L-superior temporal)

neologisms (jargon) semantic + phonemic paraphasias

Transcortical sensory: (~L-frontal + parietal)

Wernickes-like with preserved repetition

Conduction: (~L-supramarginal gyrus)

Impaired repetition

Anomic: word-finding deficit (~L-angular gyrus)

Transcortical Mixed: Global-like, good repetition

(~L-Frontal + parietal)


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The Agnosias

Impairment to recognize a stimulus Visual agnosia:

sees object, but cant recognize it

Auditory agnosia:

hears sound, but cant recognize it

Tactile agnosia (astereoagnosia), feels, but cant recognize by touch


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Agnosias:usually due to bilateral cortical lesions

Disorders of recognition involving a sensorymodality (with no loss of sensory function).

Prosopagnosia: cant recognize people

Anosoagnosia: cant recognize ones own illness

etc.


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Other neurological cognitive-linguistic

based problems

alexia: reading problems agraphia: writing problems

Alexia with agraphia: L-inferior parietal lobe

Alexia without agraphia:

L-medial occipital + medial temporal lobes

Splenium of corpus callosum


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Right Hemisphere Dysfunctionconstellation of symptoms

Peri-linguistic problems

Verbosity of Speech, tangential responses

Poor comprehension of idioms, sarcasm, double-meanings,

and relevant vs. non-relevant details

Aprosodia: expressive + receptive

Anosoagnosia

Auditory Agnosia, music agnosia

Prosopoagnosia

Visuo-Spatial Disorientation, poor recall non-verbal

material

Left neglect (not L-homonymous hemianopsia) Dressing apraxia


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Left neglect sample


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Dementia

Generalized cognitive decline due to

generalized or diffuse disease processes

Can co-exist with other cognitive-linguistic

and para-linguistic impairments.

Unremitting deterioration of the following: Memory

Perception

Language

Executive functions

Personality


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Forms of Dementia Progressive:

Parkinsons Disease (PD): subcortical, SN Alzheimers Disease (AD):

Hippocampus + bilateral parietal + temporal

Lewy Body Disease: frontal + temporal, BG

Frontotemporal Dementia (FTD): Temporal > Frontal

Huntingtons Disease: subcortical, BG

Non-Progressive:

Vascular Disease: multiple infarcts

Herpes simplex viral encephalitis: bi-temporal


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Dementia: cognitive + memory problems

Cognitive Symptoms:

Depends on location, etiology, progression

Memory Problems: i.e., Alzheimers Disease: persistent + episodic

Anterograde + retrograde decline

Yet, procedural relative strength

i.e., Parkinsons Disease: procedural memory declines

Final stages for many dementias:

Little meaningful output, often mute

Communication breakdown social isolation +

depression


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Impairment of Executive Functions:

Dysexecutive Syndrome Impairment in one or more of the following:

Goal-directed behavior Inability to initiate or stop action

Anticipate outcomes

Adaptation to changing environments

Form concepts + think abstractly

Executive functions are high level: Influence other basics: attention, memory,

motor skills


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Executive Functions of Speech + Language

and associated breakdowns

Inhibition:

ability to suppress a habitual response

Intentionality:

creation + maintenance of goal directed behavior +

insight of concept

Executive memory:

recalling events in correct order Positive + negative affect:

behaviors related to emotion and personality

(Alderman et al., 1998)


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Breakdown in Inhibition

Suppressing problems

Impulsivity

No concern for others feelings

No concern for social rules Disinhibition

Impaired abstract reasoning

Restlessness


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Breakdowns in Intentionality:

Planning problems

Poor decision making Lack of insight

Distractability Dissociation of knowing + doing


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Breakdowns in Memory

Problems with formal conversation Temporal sequencing problems

Perseveration problems


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Breakdowns in Positive + Negative Affect

Variable motivation Aggression

Euphoria

Shallow affect

Apathy


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Examples of Disorders affecting

Executive Functions (Elliot, 2003)

Alzheimers Disease

AIDs-dementia complex Subcortical vascular disease

Psychiatric + antisocial disorders

Depression, schizophrenia

TBI

Korsakoff Syndrome

Obsessive-Compulsive Disorders

Tourettes Syndrome

Attention Deficit/Hyperactivity Disorders Autism

comdis_530_cognitive_linguistic_disorders

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