Adult Neurogenic Language and Cognitive-Communicative Disorders

1. Adult Neurogenic Language and Cognitive-Communicative Disorders Chapter 19 http://www.youtube.com/watch?v=1aplTvEQ6ew http://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)

2. (Adult) Neurogenic Language and Cognitive-Communicative Disorders • Aphasia • Right-hemisphere disorder/syndrome (RHD) • Dementia • Traumatic brain injury (TBI)

3. 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) • Stroke / cerebrovascular accident (CVA) • Occlusive stroke: Thrombosis or embolism • Hemorrhagic: Hemorrhaged aneurysm, or arteriovenous malformation bleed • Tumor (neoplasm) • Focal penetrating head injury

4. Aphasia (cont.) • 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)

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

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

7. 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”) Localization of aphasia types: Left (dominant) hemisphere 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!

8. Right Hemisphere Damage(Right hemisphere syndrome)(Same focal pathology as aphasia, but R) • 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 • Anosagnosia: Lack of awareness of deficits. They will confabulate or rationalize the deficit away • Expressive aprosodia (anterior) • Receptive aprosodia • Junction of temporal, parietal and occipital cortex on right

9. Dementia • Associated with diffuse damage to neurological system, and gradual onset • 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 • 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.

10. Traumatic brain injury • Etiology: Diffuse axonal injury from acceleration/deceleration injury • 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)