Neuro-Based Comm. Disorders

Brain area associated w/ tactile agnosia

Parietal lobe

Brain area damaged w/ VISUAL agnosia

Bilateral occipital lobe or posterior parietal lobe

Brain area damaged w/ Auditory Verbal agnosia

Bilateral temporal lobe lesions that isolate Wernicke’s area

Auditory Verbal agnosia - what is intact what is not?

Damaged - spoken words

Intact - 1. peripheral hearing, 2. recognition of nonverbal sounds, 3. recognition of printed words, and 4. (relatively) normal verbal expression and reading

Auditory agnosia - what is impaired what is intact?

Impaired: understanding of the meaning of auditory stimuli, and matching objects with their sound

intact: peripheral hearing, visual recognition of objects

What brain area is damaged in Auditory Agnosia?

Bilateral damage to the auditory association area

Types of agnosia

1. Auditory

2. Auditory Verbal

3. Visual

4. Tactile

5. BONUS: Prosopagnosia

3 Main Sub-types of Aphasia?

1. Fluent

2. Non-Fluent

3. Sub-cortical

6 Main treatment areas of aphasia?

1. Auditory comprehension

2. Verbal expression (naming)

3. Verbal expression (expanded utterances)

4. Alexia (reading)

5. Agraphia (writing)

6. Agnosia

Alexia (definition) + pure alexia (definition and brain area)

Broad definition: a loss of previously acquired reading skills due to brain damage

Pure definition: reading problem when wiring and other language skills are intact. Lesion in inferior occipitotemporal region

Agraphia (definition plus brain area damaged)

Def: loss of normally acquired writing skills

Brain damage: lesions in the medial frontal gyrus also called Exner’s writing area

Dementia prevalence rates + rates of early onset vs late onset Alzheimer’s Dementia

As high as 25% in ppl over 65 years old. After the age of 65, it doubles every 5 years

Only 6% of AD is Early Onset. Rest is in 70’s or 80’s

Areas of Cognition affected by dementia

1. Complex attention

2. Executive function

3. Learning

4. Memory

5. Language

6. Perceptual-motor

7. Social cognition

Alzheimer’s Dementia - types of neuropathology that cause it

1. Neurofibrillary tangles (literally tangled, twisted, thickened structures in nerve cells, dendeites and axons)

2. Neuritic plaques aka amyloid plaques (abnormal deposits of amyloid protein - cortical and subcortical tissue degeneration especially the hippocampus and cerebral cortex)

3. Granulovacuolar degeneration (cavities of granular debris in hippocampus)

4. Neuronal loss or general neuronal atrophy - brain shrinkage

5. Neuro-chemical changes (depleted neurochemicals that help transmit messages across the brain)

Symptoms of EARLY STAGE DAT (dementia of Alzheimer’s type)

1. Subtle memory problems

2. Difficulty with new leaning and visuospatial problems

3. Behavior changes - self neglect and avoiding routines

4. Indifference, irritability, depression

5. Slight disorientation in new surroundings

6. Subtle language changes

** motor functions are normal

Symptoms of MID-LATE STAGE DAT

1. Severe problems recalling remote and recent events

2. Visuospatial problems

3. Intellectual deterioration

4. Hyperactivity, restlessness, wandering, Agitation

5. lack of affect, tact and judgement, loss of initiative, indifference

6. Problems with math

7. Can’t manage daily routines

8. Profound disorientation to place, time, and person

9. Paranoid delusions and hallucinations

10. Aggressive disruptive

11. Inappropriate humor/laughter

12. Sun downing (worse at night)

13. Latest stage: seizures, myoclonic jerks, incontinence, dysphagia, physical deterioration, severe decline in motor function

LANGUAGE symptoms of DAT (plus aside about the FINAL stages)

1. General word finding

2. Naming

3. Verbal and literal paraphasias

4. Circumlocution

5. Difficulty comprehending abstract meanings

6. Hard to do a picture description, generate a list of words

7. Echolalia, palilalia, logoclonia

8. Empty speech, jargon, hyper fluency, inappropriate

9. Incoherent, slurred, rapid speech

10. Reading and writing difficulties

11. Inattention to social conventions, initiating and maintaining conversation

12. FINAL FINAL: no meaningful speech, mutism, complete disorientation to time, place, AND self

Echoalia vs Palilalia vs. Logoclonia

Echoalia - repeating other people’s speech

Palilalia - repeating your own utterances

Logoclonia - repeating the final syllable of words

Pick’s Disease (aka FTD)

(Onset, neuro damage/disease, impairments)

Type of front-temporal dementia. Fairly common. Earlier onset (40-60 yrs.)

Caused by degeneration of left and right frontal lobe, temporal lobes, or both.

Presence of a Pick bodies or Pick cells (atrophied, gliosed, swollen brain cells)

results in behavior changes (especially in right atrophy) and language loss (left sided atrophy)

Behavior changes: uninhibited and inappropriate, compulsive, emotional disturbances, impaired judgement/reasoning/insight

Language changes: impaired comprehension, word finding, paraphasia, circumlocution, difficulty defining words/remembering category words, limited spontaneous, Echolalia

PPA (primary progressive aphasia)

Progressive neuropathology (unlike sudden onsent of symptoms with CVA - stroke), language impairment and relatively intact cognitive skills until 2 years post onset

3 TYPES (tho not everyone fits neatly)

****mneumonic: SNL****

1. Nonfluent variant (NfvPPA): limited to the left perisylvian language area including Broca’s, sometimes ppl also show Parkinsonian features, 2nd most common variant, slow progression, relatively intact cognition and memory/ADL’s /job for 2 years, behavior changes within 2 years. Language is earliest signs: Anomia, word-finding, paraphasias, apraxia, reduced fluency, slow rate, agrammatism, impaired repetition, mimics Broca’s, prosody issues

2. Semantic Variant (SvPPA): more rare variant, temporal lobe atrophies first then frontal lobe. Behavior changes in later stages. Language: progressive loss of word meaning, anomia, semantic paraphasias, intact fluency and repetition skills, intact phonological and motor skills (no apraxia), logorrhea, impaired turn-taking, short phrases/eventual mutism, Visual agnosia + prosopagnosia (right temporal lobe)

3. Logopenic Variant (lvPPA): ~controversial~ left posterior superior temporal and middle temporal gyri and the inferior parietal lobe, most common variant (35%), behavior changes, language: only moderate naming difficulties in earlier stages, slow speech, word-finding pauses like non-fluent but unlike non-fluent NO agrammatism, motor issues, telegraphic speech or prosody issues, severely impaired repetition, impaired comprehension

Parkinson’s Disease (dementia + other symptoms)

Big symptoms: hypokinesia, tremor, and muscular rigidity. Only 35-55% of pt’s have dementia. Areas affected - basal ganglia, brainstem, lewy bodies in the substantia nigra, frontal lobe atrophy.

Other symptoms:

Neuro - slow movements (bradykinesia), tremor, muscular rigidity, blunted affect, festination gate, freezing, cogwheel rigidity, swallowing disorders

Speech Symptoms - reduced volume, mono pitch, monoloudness, pausing speech, slow/fast/festinating speech rate, dysarthric speech, memory problems/abstract reasoning/problem solving, naming and language comprehension, micrographia

Athetosis

Involuntary writhing

Example disorder - Creutzfeldt-Jakob disease

Infectious Dementias (2)

1. AIDS-related or HIV-encephalopathy: slow onset and rapid progression, gait, tremor, seizures, ataxia, rigidity, weakness, paralysis, poor memory/concentration, apathy/psychiatric symptoms

2. Creutzfeldt-Jakob disease: infectious agent called a PRION causes widespread spongiform state in the brain. Motor symptoms like cerebellar ataxia, memory, reasoning, sleep issues, psychiatric issues

Both = final stage of mutism