Neurologically Based Communication Disorders

Define transcortical sensory aphasia (TSA)

A variety of fluent aphasias caused by lesions in the temporoparietal region of the brain, especially in the posterior portion of the middle temporal gyrus

T or F: Traumatic brain injuries include damage due to strokes, tumors, or progressive transient neuropathologies

False

____ skills may be assessed by administering selected tests of memory and general intelligence

Intellectual

Contrast open-head brain injuries and closed-head brain injuries

• Open-head brain injuries involve a fractured or perforated skull, torn or lacerated meninges, and an injury that extends to brain tissue

• Closed-head brain injuries involve no open wound in the head, no penetration of a foreign substance into the brain, and a damaged brain within the skull

What is left neglect?

Reduced awareness of the left side of the body and generally reduced awareness of stimuli in the left visual field

What does RHD stand for?

Right Hemisphere Disorders

List the neuropathologies of Huntington’s disease (HD)

• A loss of neurons in the basal ganglia; significant loss of neurons in the caudate nucleus, putamen, and substantia nigra

• Possible atrophy in the prefrontal, temporal, and parietal lobes

• Reduced level of inhibitory neurotransmitters, especially GABA and acetylcholine

What is the cause of ischemic strokes?

A blocked or interrupted blood supply to the brian

When there is a collection of material that blocks the flow of blood it is known as a

Thrombus

Strokes are also known as ___ accidents

Cerebrovascular

What are the two different types of strokes?

• Ischemic

• Hemorrhagic

T or F: Less than 50% of those who survive a stroke have aphasia

False

T or F: Treatment of aphasia is concerned with verbal expression, auditory comprehension, reading, writing, and nonverbal modes of communication

True

Name the 3 different types of aphasia

• Fluent

• Nonfluent

• Subcortical

List the cognitive domains that are affected due to dementia

• Complex attention

• Executive function

• Learning and memory

• Language

• Perceptual-motor

• Social cognition

What is atherosclerosis?

A condition in which cholesterol and other fatty substances build up in the blood, narrowing arteries and obstructing blood flow

What is the neuropathology of Dementia of the Alzheimer Type (DAT)?

• Neurofibrillary tangles

• Neurotic plaques (amyloid plaques)

• Granulovacuolar degeneration

• Neuronal loss (general neuronal atrophy)

• Neurochemical changes

A mass of arterial debris or a clump of tissue from a tumor that originates somewhere else in the body, travels to the brain, and gets lodged in a smaller artery, and thus, blocks the flow of blood

Embolus

What are the 3 variants of primary progressive aphasia (PPA)?

• Nonfluent

• Semantic

• Logopenic

TIA stands for what?

Transient ischemic attacks

What are the onsets of he following diseases:

1. Alzheimer’s

2. Parkinson’s

3. Huntington’s

• Typically 70-80 years, but early onset type can occur up to age 60-50

• Typically 50-56 years

• 35-40 years

T or F: Single transient ischemic attacks may not cause permanent deficits, but repeated attacks may

True

List and describe 3 of the available screening and diagnostic tests for dementia

• Mini-Mental State Examination-Secnd Edition: screens for naming, attention, and calculation

• Saint Louis University Mental Status Examination: screens orientation, recall, calculation, backward number recitation, and answering questions about a story told to the patient

• Montreal Cognitive Assessment, Version 3: screens several skills including naming, memory, attention, verbal fluency, and sentence repetition

What are hemorrhagic strokes caused by?

Bleeding in the brain due to ruptured blood vessels, with hypertension being a major risk factor

T or F: Treatment for right hemisphere disorders (RHD) is targeted at impaired attention, behaviorism pragmatic communication problems, impaired reasoning and inference, and visual neglect

True

Hypertension refers to what kind of blood pressure?

Hight blood pressure

Non-acceleration injuries occur when a restrained head is hit by a move object

True

Name and describe the two kinds of blood vessel ruptures

• Intracerebral - within the brain

• Extracerebral - within the meninges, resulting in subarachnoid, subdural, and epidural varieties of stroke

T or F: Varieties of fluent aphasia are characterized by relatively intact fluency but generally less meaningful, or even meaningless, speech. The speech is generally flowing, abundant, easily initiated, and well-articulated

True

T or F: Hemorrhagic strokes tend to have a gradual onset characterized by severe “thunderclap” headache

False

What is aphasia?

A neurologically based language disorder caused by various types of neuropathologies (most commonly, stroke)

What is paraphasia?

An expressive language error that is not the result of a motor deficit

Reversible dementia is similar to

Delirium

___ speech is when there is a substitution of such general words as this, that, stuff, and thing in place of more specific words

Empty

Frontotemporal dementia is due to degeneration of what two lobes?

• Frontal

• Temporal

What is agrammatic speech?

The omission of grammatical features in speech; speech that consists mostly content words and lacks function words

What disease is associated with the most common form of dementia?

Alzheimer’s disease

T or F: Anomia is related to naming difficulty and word-finding deficits with varying severity

True

Parkinsonism refers to a group of neurological disorders that include hypokinesia, tremor, and musical rigidity

True

Define automatic language (preserved language) and provide a few examples

• Language that is rote or overlearned and thus spared

• Examples: reciting the alphabet, counting numbers, and singing a familiar song

T or F: Certain infectious diseases do not cause dementia

False

T or F: Among the available definitions for aphasia, some are non typological and others are typological, and some are even cognitive funtion-based.

True

What are the 6 key parts of a dementia assessment?

• Case history

• Clinical examination

• Interview of the family and other caregiver

• Neurological assessment (including brain imaging and lab tests)

• Communication assessment

• Assessment of intellectual (cognitive) function

What are the characteristics of nonfluent aphasia?

Limited, agrammatic, effortful, halting, and slow speech with impaired prosody

T or F: Helping family members and caregivers cope with the progressively deteriorating dementia, for which there is no cure, in an additional major concern of clinicians

True

What is the classic nonfluent variety of aphasia?

Broca’s aphasia

The left hemisphere (LH) controls most aspects of

Language

List the two subtypes of Alzheimer’s disease (AD)

• Early-onset Alzheimer disease

• Last-onset Alzheimer disease

List 6 communicative deficits associated with RHD

• Impaired communicative effectiveness

• Prosodic deficits

• Impaired (disorganized) discourse and narrative skills

• Confabulation and excessive speech

• Difficulty understanding implied, alternate, or abstract meaning

• Pragmatic deficits

Define transcortical motor aphasia (TMA)

A nonfluent variety caused by lesions in supplementary motor cortex and or the area anterior to Broca’s area, which is not affected

Name the 4 kinds of brain injury

• Open-head (penetrating)

• Closed-head (nonpenetrating)

• Mild traumatic brain injury (mTBI or concussion)

• Blast (multisystem) injuries

T or F: The characteristics o transcortical motor aphasia tend to resemble those od Broca’s aphasia but with intact repetition skill

True

What is the leading cause of traumatic brain injuries in students and professional atheletes?

Sports-related concussions

What is mixed transcortical aphasia (MTA) caused by?

Lesions in the watershed area or the arterial border zone of the brain (between the areas supplied by the middle cerebral arteries and the anterior and posterior arteries)

Name the 3 parts of a traumatic brain injury assessment

• Initial bedside assessment

• Assessment of memory impairments

• Assessment of executive functions

What is the most sever form of nonfluent aphasia?

Global

In communication training for a TBI, the goal should be ____

Functional

The most common sites of damage for global aphasia are supplied by the ___ cerebral artery

Middle

Name and describe 3 types of paraphasia

• Semantic paraphasia - substitution of one word for another; may be related or unrelated in meaning

• Phonemic (or literal) paraphasia - error at the sound level; phonemes in the intended word may be substituted, omitted, or transposed

• Neologistic paraphasia (or neologism) - nonwords a person creates; they are unintelligible, unrelated to the intended word, and more than 50% of the word’s phonemes are incorrect

Name the 4 different varieties of fluent aphasia

• Wernicke’s Aphasia

• Transcortical Sensory Aphasia

• Conduction Aphasia

• Anomic Aphasia

List the neuropathological factors of Parkinson’s disease (PD)

• Basal ganglia and brainstem degeneration

• Presence of abnormal structures called Lewy bodies, small pathological spots typically found in substantia nigra (a structure at the top of the brainstem)

• Frontal lobe atrophy resulting in widened sulci

• Reduced inhibitory dopamine due to loss of cells in the substantia nigra (a midbrain structure)

• Neurofibrillary tangles and plaques similar to those found in Alzheimer’s disease

What are the lesions located for Wernicke’s aphasia?

Wernicke’s area

T or F: Dementia is an acquired neurological syndrome associated with persistent or progressive deterioration in intellectual functions, emotions, and behaviors

True

List the common characteristics of Wernicke’s aphasia

• Incessant, effortlessly produced, flowing speech with normal, or even abnormal, fluency (logorrhea) with normal phase length

• Rapid rate of speech, but normal prosodic features and good articulation

• Intact grammatical structures

• Severe anomia

• Paraphasic speech containing semantic and literal paraphasias, extra syllables in words, and neologism

• Circumlocution

• Empty speech

• Poor auditory comprehension

• Impaired repetition skills

• Impaired conversational turn taking

• Reading and writing problem

• Generally poor communication in spite of fluent speech

• Anosognosia

• Generally free from neurological symptoms

In ___ cognitive impairment, the deficits are more severe than those produced by normal aging but are not severe enough to significantly affect activity participation

Mild

What is the major distinction factor for Wernicke’s aphasia versus transcortical sensory aphasia?

Patients with transcortical sensory aphasia sound similar to those with Wernicke’s aphasia; however, repetition is intact in patients with transcortical sensory aphasia, whereas it is impaired in patients with Wernicke’s aphasia

What kind of dementia is Alzheimer’s disease?

Cortical

T or F: Conduction aphasia is a rare and controversial variety of fluent aphasia caused by lesions in the region between Broca’s area and Wernicke’s area, especially in the supramarginal gyrus in the inferior parietal lobe and the arcuate fasciculus

True

Involves worsening of Alzheimer’s symptoms in the evening

Sundowner’s syndrome

What is the main difference between crossed aphasia and Wernicke’s aphasia?

Unlike patients with Wernicke’s, those with crossed aphasia have good normal auditory comprehension

Dementia takes various forms; some are reversible, but most are progressive

True

What is the distinguishing feature of anomic aphasia?

Generally, most language function, except for naming, are relatively unimpaired

T or F: The symptoms of RHD do not vary depending upon the site lesion

False

When there is extensive subcortical damage, with or without the involvement of the cortical areas of the brain, this is known as ___ aphasia

Subcortical

List the 6 langauge problems associated with Frontotemporal Dementia

• Dominant language problems with somewhat better-preserved memory and orientation, contrasted with patients who have dementia of the Alzheimer type

• Anomia, more pronounced with temporal lobe atrophy

• Progressive loss of vocabulary and consequent paraphasia and circumlocution

• Difficulty defining common words and problems reciting category-specific words

• Limited spontaneous speech, echolalia, and nonfluent speech

• Impaired comprehension of speech and printed material

Define crossed aphasia

Aphasia that occurs due to a right hemisphere (RH) brain lesion in right-handed individuals

____ disease is a single neurodegenerative disease entity

Parkinson’s

In a persons who are bilingual and have aphasia, clinician should analyze ____ patterns, not just known patterns

Individual

A malformed protein called ___ kills the brain cells that control movement

Huntingtin

What are the 5 skills assessed during an aphasia assessment?

• Speech skills

• Language skills

• Reading skills

• Writing skills

• Cognitive functions

Name the speech, language, and cognitive-linguistic problems associated with Huntington’s disease (HD(

• Deterioration in intellectual functions, including memory, attnetion, concentration, and executive functioning skill s

• Impaired word-list generation

• Naming problems

• Dysarthria

• Incontinence, sleep disturbances, sleep reversal, and dysphagia

• Muteness in the final stages

What are the 3 main goals of assessment for aphasia?

• Determine whether the client has apasphia

• If so, the type of aphasia

• Whether the client has any coexisting disorder

Dementia due to HIV infection is subcortical and is known as ___

AIDS dementia complex or human immunodeficiency virus encophalopathy

T or F: Screening and standardized tests are not used in aphasia assessment

False

List some of the other common forms of dementia in addition to Alzheimer’s disease, Parkinson’s disease, and Huntington disease

• Vascular dementia

• Dementia associated with multiple cerebrovascular accidents

• Lewy body dementia

• Dementia associated with TBI

• Wernicke'-Korsakoff syndrome

What does a functional communication assessment target?

Daily living skills and communication in everyday settings

When assessing dementia, what are the 6 skills or domains that are typically sampled?

• Awareness and orientation to surroundings

• Mood and affect, to assess depression or lack of emotional responses

• Speech and language

• Memory, executive functions, and other cognitive variables

• Abnormal thinking (ex: hallucinations or delusions)

• Visuospatial skills

What are the 12 assessments used to assess specific speech and language skills relevant for a diagnosis of aphasia?

Assessment of

• repetition skills

• naming skills

• sentence production, narration, and discourse

• speech fluency

• function communication

• auditory comprehension of spoken language

• comprehension of single words

• comprehension of sentences, paragraphs, and discourse

• reading skills

• writing skills

• gestures and pantomime

• automated speech and singing

When offering intervention for dementia, what are the 3 main clinician concerns?

• Slowing the progressing of dementia

• Sustaining communication and other skills to the extent possible

• Improving daily communication and living skills

Name and describe the 3 kinds of aphasia treatment

• Restorative

• compensatory

• Social

What are the earliest symptoms for the following diseases: Alzheimers

• Alzheimer’s

• Parkinson’s

• Huntingtons

• Short term and recent memory, visuospatial deficits, behavior change; changes are often initially mistaken as normal aging

• Motor deficits, especially pill-rolling tremor

• Movement disorders (rigidity, bradykinesia), then personality changes

For a client with dementia, family members and caregivers need counseling and support. What are 5 of the most important parts of this process?

• Education about dementia

• Urge then to monitor their emotional reactions, including depression

• Offer counseling and other support services

• Offer respite care of patient

• Train them to use effective communicative strategies to better manage dialy-living skills

What are 3 structure structural differences between the LH and the RH of the brian?

• Left hemisphere is slightly larger in diameter

• The lateral sulcus in the LH is slightly longer than that in the right hemisphere

• The left planum temporale (a part of the superior surface of the superior temporal gyrus) is also larger than the right

Why is anomic aphasia controversial?

Because it may be caused by lesions in various regions of the brain

What are the two deficits that dominate the symptoms complex of RH disorders?

• Perceptual

• Attentional

List some of the reasons prognosis for aphasia treatment might be better for some individuals

• Younger and healthier

• Better educated and in verbally demanding occupations

• Smaller lesions

• No other medical or behavioral disorder

• Good hearing acuity

• Normal of adequately corrected vision

• Better motor skills

• Preserved lang skills

Facial recognition deficits are related to ___

Prosopagnosia

What is the sequence for auditory comprehension therapy?

Comprehension of single words, comprehension of spoken sentences, and discourse comprehension

T or F: Assessment of RHD can only be client specific or standardized; it cannot be both

False

T or F: Naming is the most frequently targeted expressive verbal skill

True