Adult Neurogenic Language and Cognitive-Communicative Disorders Chapter Case of teenager who had a stroke and has aphasia (“Connect” is an aphasia research and advocacy center in London)

(Adult) Neurogenic Language and Cognitive-Communicative Disorders Aphasia Aphasia Right-hemisphere disorder/syndrome (RHD) Right-hemisphere disorder/syndrome (RHD) Dementia Dementia Traumatic brain injury (TBI) Traumatic brain injury (TBI) ONSETDISTRIBUTION OF BRAIN DAMAGE APHASIATypically sudden (unless from tumor) Focal RHDTypically sudden (unless from tumor) Focal DEMENTIAInsidious/slowDiffuse TBISuddenTypically diffuse, but sometimes accompanied by focal damage

Aphasia Etiology: Focal damage (not diffuse damage), usually from stroke, in the cortex and/or subcortex of the dominant hemisphere, which is usually the left hemisphere (See figure 11-2 in W&A) Etiology: Focal damage (not diffuse damage), usually from stroke, in the cortex and/or subcortex of the dominant hemisphere, which is usually the left hemisphere (See figure 11-2 in W&A) –Stroke / cerebrovascular accident (CVA) Occlusive stroke: Occlusive stroke: Thrombosis or embolism Thrombosis or embolism Hemorrhagic: Hemorrhaged Hemorrhagic: Hemorrhaged aneurysm, or arteriovenous aneurysm, or arteriovenous malformation bleed malformation bleed –Tumor (neoplasm) –Focal penetrating head injury head injury

Aphasia (cont.) Definition: Change in ability to comprehend and express language. Crosses four modalities: Definition: Change in ability to comprehend and express language. Crosses four modalities: –Auditory comprehension (AC) and reading comprehension (RC) –Oral expression (OE) and written expression (WE) ORAL/AURALWRITTEN/VISUAL COMPREHENSIONAuditory comprehension (AC) Reading comprehension (RC) EXPRESSIONOral expression (OE) Written expression (WE)

Classification of Aphasia Types (Boston) FLUENT FLUENT Typically involves posterior regions of cortex Typically involves posterior regions of cortex Sometimes called sensory aphasia Sometimes called sensory aphasia Sometimes called receptive aphasia (even though the non-fluent types have problems with language reception, too!) Sometimes called receptive aphasia (even though the non-fluent types have problems with language reception, too!) NONFLUENT NONFLUENT Typically involves anterior regions of cortex Typically involves anterior regions of cortex Sometimes called motor aphasia Sometimes called motor aphasia Sometimes called expressive aphasia (even though the fluent types have problems with expression, too!) Sometimes called expressive aphasia (even though the fluent types have problems with expression, too!)

Classification of Aphasia Types (Boston) FLUENT FLUENT Wernicke’s aphasia * Wernicke’s aphasia * –Fluent OE (but full of jargon, and word substitutions); hyperfluent (logorrhea) –Relatively poor AC, so they have poor awareness of their errors Conduction aphasia Conduction aphasia –Sound substitutions and reversals are prominent, especially in repetition of longer words; good AC Anomic aphasia * Anomic aphasia * –Empty speech, lots of circumlocutions; good AC Transcortical sensory (#) Transcortical sensory (#) NONFLUENT NONFLUENT Broca’s aphasia * Broca’s aphasia * –Non-fluent, effortful OE, which is “telegraphic” / “agrammatic” –Relatively preserved AC Global aphasia * Global aphasia * –Poor abilities in all modalities (OE, AC, WE, RC) –Speech often consists solely of stereotypies Transcortical motor (#) Transcortical motor (#) Subcortical Subcortical * = the most common aphasic syndromes # = transcorticals very similar to their non-fluent or fluent counterparts, but with preserved ability to repeat

Localization of aphasia types: Left (dominant) hemisphere 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 (visual, auditory, tactile, motoric, spatial) Left neglect: lack of awareness of left side of reality (visual, auditory, tactile, motoric, spatial) –Mild form is unilateral inattention Prosopagnosia: inability to recognize familiar faces and facial expression Prosopagnosia: inability to recognize familiar faces and facial expression Anosagnosia: Lack of awareness of deficits. They will confabulate or rationalize the deficit away Anosagnosia: Lack of awareness of deficits. They will confabulate or rationalize the deficit away Expressive aprosodia (anterior) Expressive aprosodia (anterior) Receptive aprosodia Receptive aprosodia –Junction of temporal, parietal and occipital cortex on right Right Hemisphere Damage (Right hemisphere syndrome) (Same focal pathology as aphasia, but R)

Associated with diffuse damage to neurological system, and gradual onset Associated with diffuse damage to neurological system, and gradual onset Some common types Some common types –Dementia of the Alzheimer’s type (DAT): Recent memory declines before remote memory –Fronto-temporal dementia (FTD): Odd pragmatics and word-finding difficulties appear before memory problems Pragmatic problems from frontal lobe atrophy, associated with poor inhibition and planning in interpersonal communication Pragmatic problems from frontal lobe atrophy, associated with poor inhibition and planning in interpersonal communication Word-finding difficulties from temporal lobe atrophy Word-finding difficulties from temporal lobe atrophy –Primary progressive aphasia: Subtle word finding difficulty, which becomes progressively worse, is primary symptom. Only later is cognition (memory, attention) affected. Dementia

Traumatic brain injury Etiology: Diffuse axonal injury from acceleration/deceleration injury Etiology: Diffuse axonal injury from acceleration/deceleration injury Cognitive impairments that affect communication Cognitive impairments that affect communication –Attention –Perception –Memory and learning (encoding, storage, retrieval) –Organizing (analyzing, classifying, etc.) –Reasoning (e.g., drawing conclusions, inferring) –Problem solving (e.g., steps to solving problem)