Adult Neurogenic Adult Neurogenic Language and Cognitive-Language and Cognitive-Communicative DisordersCommunicative Disorders

Chapter 19Chapter 19

http://www.youtube.com/watch?v=1aplTvEQ6ewhttp://www.youtube.com/watch?v=rUTHNS45Qmc

Case of teenager who had a stroke and has aphasia(“Connect” is an aphasia research and advocacy center in

London)

(Adult) Neurogenic Language (Adult) Neurogenic Language and Cognitive-Communicative and Cognitive-Communicative

DisordersDisorders• AphasiaAphasia

• Right-hemisphere disorder/syndrome (RHD)Right-hemisphere disorder/syndrome (RHD)

• DementiaDementia

• Traumatic brain injury (TBI)Traumatic brain injury (TBI)

ONSET DISTRIBUTION OF BRAIN DAMAGE

APHASIA Typically sudden (unless from tumor)

Focal

RHD Typically sudden (unless from tumor)

Focal

DEMENTIA

Insidious/slow Diffuse

TBI Sudden Typically diffuse, but sometimes accompanied by focal damage

AphasiaAphasia• EtiologyEtiology: Focal damage (not diffuse damage), : Focal damage (not diffuse damage),

usually from stroke, in the cortex and/or subcortex usually from stroke, in the cortex and/or subcortex of the dominant hemisphere, which is usually the of the dominant hemisphere, which is usually the left hemisphere left hemisphere (See figure 11-2 in W&A)(See figure 11-2 in W&A)– Stroke / cerebrovascular accident (CVA)Stroke / cerebrovascular accident (CVA)

•Occlusive stroke: Occlusive stroke:

Thrombosis or embolismThrombosis or embolism

•Hemorrhagic: Hemorrhaged Hemorrhagic: Hemorrhaged

aneurysm, or arteriovenous aneurysm, or arteriovenous

malformation bleedmalformation bleed– Tumor (neoplasm)Tumor (neoplasm)– Focal penetrating Focal penetrating

head injuryhead injury

Aphasia (cont.)Aphasia (cont.)• DefinitionDefinition: Change in ability to comprehend and : Change in ability to comprehend and

express language. Crosses four modalities:express language. Crosses four modalities:– Auditory comprehension (AC) and reading Auditory comprehension (AC) and reading

comprehension (RC)comprehension (RC)– Oral expression (OE) and written expression Oral expression (OE) and written expression

(WE)(WE)ORAL/AURAL WRITTEN/

VISUAL

COMPREHENSION

Auditory comprehension (AC)

Reading comprehension(RC)

EXPRESSION Oral expression (OE)

Written expression (WE)

Classification of Aphasia Types Classification of Aphasia Types (Boston)(Boston)

• FLUENTFLUENT

• Typically involves Typically involves posterior regions of posterior regions of cortexcortex

• Sometimes called Sometimes called sensory aphasiasensory aphasia

• Sometimes called Sometimes called receptive aphasia receptive aphasia (even though the non-(even though the non-fluent types have fluent types have problems with problems with language reception, language reception, too!)too!)

• NONFLUENTNONFLUENT

• Typically involves Typically involves anterior regions of cortex anterior regions of cortex

• Sometimes called motor Sometimes called motor aphasiaaphasia

• Sometimes called Sometimes called expressive aphasia expressive aphasia (even though the fluent (even though the fluent types have problems types have problems with expression, too!)with expression, too!)

Classification of Aphasia Types Classification of Aphasia Types (Boston)(Boston)

• FLUENTFLUENT

• Wernicke’s aphasia *Wernicke’s aphasia *– Fluent OE (but full of jargon, and word substitutions); hyperfluent (logorrhea)Fluent OE (but full of jargon, and word substitutions); hyperfluent (logorrhea)– Relatively poor AC, so they have poor awareness of their errorsRelatively poor AC, so they have poor awareness of their errors

• Conduction aphasia Conduction aphasia – Sound substitutions and reversals are prominent, especially in repetition of Sound substitutions and reversals are prominent, especially in repetition of

longer words; good AClonger words; good AC

• Anomic aphasia *Anomic aphasia *– Empty speech, lots of circumlocutions; good ACEmpty speech, lots of circumlocutions; good AC

• Transcortical sensory (#)Transcortical sensory (#)

• NONFLUENTNONFLUENT

• Broca’s aphasia *Broca’s aphasia *– Non-fluent, effortful OE, which is Non-fluent, effortful OE, which is

“telegraphic” / “agrammatic”“telegraphic” / “agrammatic”– Relatively preserved ACRelatively preserved AC

• Global aphasia *Global aphasia *– Poor abilities in all modalities (OE, AC, WE, Poor abilities in all modalities (OE, AC, WE,

RC)RC)– Speech often consists solely of stereotypiesSpeech often consists solely of stereotypies

• Transcortical motor (#)Transcortical motor (#)

• SubcorticalSubcortical

* = the most common aphasic syndromes# = transcorticals very similar to their non-fluent or fluent counterparts, but with preserved ability to repeat

Localization of aphasia Localization of aphasia types: Left (dominant) types: Left (dominant) hemispherehemisphere

Broca’s: Anterior, 44, 45 (circled in red)

Wernicke’s: Posterior 22 (circled in blue)

Global: Whole perisylvian area (usually massive LH stroke, proximal MCA)

Conduction: Arcuate fasciculus

Anomic: hard to localize, often posterior (e.g. 39/40)

Transcorticals: Watershed regions (“border zones”)

Different aphasia types are not “found” in certain area of the brain. Damage to certain brain areas can be commonly associated with certain kinds of aphasia, but this is not a 1:1 association!

• Left neglect: lack of awareness of left side of reality Left neglect: lack of awareness of left side of reality (visual, auditory, tactile, motoric, spatial)(visual, auditory, tactile, motoric, spatial)– Mild form is unilateral inattentionMild form is unilateral inattention

• Prosopagnosia: inability to recognize familiar faces Prosopagnosia: inability to recognize familiar faces and facial expressionand facial expression

• Anosagnosia: Lack of awareness of deficits. They will Anosagnosia: Lack of awareness of deficits. They will confabulate or rationalize the deficit away confabulate or rationalize the deficit away

• Expressive aprosodia (anterior)Expressive aprosodia (anterior)

• Receptive aprosodia Receptive aprosodia – Junction of temporal, parietal and occipital cortex Junction of temporal, parietal and occipital cortex

on righton right

Right Hemisphere DamageRight Hemisphere Damage(Right hemisphere syndrome)(Right hemisphere syndrome)

(Same focal pathology as aphasia, but (Same focal pathology as aphasia, but R)R)

• Associated with diffuse damage to neurological system, and Associated with diffuse damage to neurological system, and gradual onsetgradual onset

• Some common typesSome common types– Dementia of the Alzheimer’s type (DAT): Recent memory Dementia of the Alzheimer’s type (DAT): Recent memory

declines before remote memorydeclines before remote memory– Fronto-temporal dementia (FTD): Odd pragmatics and Fronto-temporal dementia (FTD): Odd pragmatics and

word-finding difficulties appear before memory problemsword-finding difficulties appear before memory problems

•Pragmatic problems from frontal lobe atrophy, Pragmatic problems from frontal lobe atrophy, associated with poor inhibition and planning in associated with poor inhibition and planning in interpersonal communicationinterpersonal communication

•Word-finding difficulties from temporal lobe atrophyWord-finding difficulties from temporal lobe atrophy– Primary progressive aphasia: Subtle word finding difficulty, Primary progressive aphasia: Subtle word finding difficulty,

which becomes progressively worse, is primary symptom. which becomes progressively worse, is primary symptom. Only later is cognition (memory, attention) affected.Only later is cognition (memory, attention) affected.

DementiaDementia

Traumatic brain injuryTraumatic brain injury• Etiology: Diffuse axonal injury from Etiology: Diffuse axonal injury from

acceleration/deceleration injuryacceleration/deceleration injury

• Cognitive impairments that affect Cognitive impairments that affect communicationcommunication– Attention Attention – PerceptionPerception– Memory and learning (encoding, storage, retrieval)Memory and learning (encoding, storage, retrieval)– Organizing (analyzing, classifying, etc.)Organizing (analyzing, classifying, etc.)– Reasoning (e.g., drawing conclusions, inferring)Reasoning (e.g., drawing conclusions, inferring)– Problem solving (e.g., steps to solving problem)Problem solving (e.g., steps to solving problem)