Adult Neurogenic Communication Disorders Exam 2

Ambiguity

meaning two or more things

Do people with RHD have aphasia

no

Presentation of cognitive-communication disorders after RHD stroke is

heterogenous

Cognitive-communication disorder has a strong effect on

social participation and functional gains in rehabilitation

Coarse Coding Hypothesis

semantic processing occurs in both hemispheres but there are differences in how semantic representations are activated, selected, and suppressed between the two hemispheres

both LH and RH occur in parallel and interact at every stage of processing

LH Semantic Processing (coarse code)

small set of dominant meanings for a word and limited subset of features that are related to the dominant meaning

RH Semantic Processing (coarse code)

broader activation of dominant and subordinate word meanings with more distant meanings and features

Graded Salience Hypothesis

initially to explain processing of literal vs nonliteral language

linked to differential hemispheric processing

dominant, literal meanings are activated first

LH activates both literal and dominant nonliteral

RH aids in interpretation of less-common

Production Affects Reception in Left Only (PARLO)

differential hemispheric processing related to use of context

LH uses context predictively to preactivate semantic representations most likely to complete the meaning

RH uses a wait-and-see approach and is important for reinterpretation

Suppression Deficit Hypothesis

activation of semantic representations can be enhanced by contextual support for specific semantic features or suppressed when contextual information supports an alternative meaning or interpretation

Theory of Mind

ability to understand that others have thoughts, feelings, ideas, and knowledge that differ from one's own, and that those impact or drive their behaviors

ToM Impairments Impact...

interpretation of intended meaning, efficiency and effectiveness of discourse production, and use of referential language

Aprosodia

deficit in the ability to discriminate, identify, or classify prosodic patterns that signal emotion/affect, grammar, or pragmatics and/or manipulate prosodic patterns to convey emotion/affect, grammar, or pragmatics

(comprehension component and production component)

Prosody

involves the manipulation of rhythm, timing, pitch, and loudness to convey emphasis, linguistic or syntactic meaning, emotion, or attitude

Indexical Prosody

that makes a person unique

Affective Prosody

feelings

Grammatical Prosody

form

Pragmatic Prosody

social context

Lexical Semantics

RHD may produce fewer emotional words or less-intense emotional words or differ from adults without brain injury on word fluency tasks in terms of the organization or number of typical vs atypical exemplars

Reading and Writing

effects of RHD on reading and writing haven't been studied but visuospatial neglect has

alexia has been reported and deep dyslexia

take longer to write story summaries and have more spelling errors

neglect dyslexia/peripheral alexia

Pragmatics

deficits in determining intended meaning, discourse that is tangenital, overpersonalized, and/pr disorganized

deficits in discourse-level recall, generating inferences and comprehending nonliteral language

Neglect Alexia

attentional disruptions of neglect syndrome

symptoms: initial letter substitutions, deletions, omission of whole words at the beginning of a line or the entire left side of a page

Spatial Agraphia

large gaps between written words and not able to write in a straight line

Cognitive Domains and Constructs

attention, memory, executive function

Attention

foundation of other cognitive domains

Sustained Attention

focus on a stimulus over a period of time

Selective Attention

focusing on a stimulus while filtering out competing stimuli

Alternating Attention

shifting focus from one task to another and then back

Divided Attention

focus on two stimuli at the same time

Memory

Short-term and long-term

Long-term Memory

declarative and non-declarative memories

working memory as the gateway to and from LTM

Episodic Memory

memory of episodes of your life

Declarative Memory

what you are aware of

stored between cortical areas, parahippocampal and rhinal cortices (limbic cortex), and hippocampus

Executive Functioning

high-level, interrelated, supervisory skills responsible for generating, selecting, organizing, and monitoring goal-directed and premeditated responses

Dementia

an acquired and persistent impairment of multiple cognitive domains severe enough to limit competence in activities of daily living, occupation, and social interaction

symptoms may be reversible or irreversible

Irreversible Dementias

alzheimer's, vascular, dementia with lewy bodies, frontotemporal lobar degeneration, mixed

Alzheimer's Disease

loss of neurons and synapse in the cerebral cortex and select subcortical regions

cortical thinning resulting in much bigger sulci

Stages of Dementia

preclinial AD, mild cognitive impairment, and dementia due to AD

Preclinical

persons are asymptomatic yet have measurable changes in brain, blood, and CSF biomarkers

Mild Cognitive Impairment

subtle cognitive deficits

impairment in one or more cognitive domains

not all MCI is AD but all AD comes from MCI

To be AD...

insidious onset, clear history of worsening of cognition, initial and most prominent cognitive deficits that are either amnestic or nonamnestic

MCI Subtypes

amnestic (most common): memory

single-domain: language ability, executive function, or visuospatial function

multiple-domain: multiple cognitive domains and can include memory but not always

Language Expression Characteristics of AD

decline in semantics, sparing of phonological and syntactic components, anomia, difficulty with creative tasks, written language impaired

Language Comprehension Characteristics of AD

difficulty comprehending at discourse level, drawing inferences, and reading comprehensions

can follow short directions and answer concrete questions until the middle stages of the disease

Vascular Dementia

multi-infarct or poststroke dementia (small or unnoticed ischemic strokes)

presentation can be diverse or vary depending on where stroke occurs

multiple cognitive deficits

hyperactive reflexes and weakness

acute onset with stepwise progression

Multi-infarct dementia

small infarcts to various areas of the brain

Cortical multi-infarct dementia

small recurrent ischemic strokes to cortex

Lacunar state

multiple subcortical thrombotic ischemic strokes in the brain stem, basal ganglia, and other subcortical structures

Frontotemporal Lobar Degeneration (FTLD)

umbrella term

constellation of neurodegenerative diseases resulting from progressive, circumscribed degeneration of the frontal and anterior temporal lobes

isolated speech and language impairments

4 variants of FTLD

behavioral, semantic, progressive nonfluent aphasia, and logopenic

Behavioral FTLD

executive function impairments, behavioral changes, impulsiveness, distractible, spared episodic memory, prefrontal cortex

Primary Progressive Aphasia

semantic, progressice nonfluent aphasia, and logopenic

Semantic FTLD

temporal lobe, fluent aphasia, gradual deterioration of conceptual knowledge

Progressive nonfluent aphasia

progressive onset, broca's like aphasia

Logopenic FTLD

damage is distributed and variety with patients

nonfluent, reduced verbal output and speech rate, grammar is simple but correct, auditory comprehension impaired, anomia

Lewy Body Disease

relationship to Parkinson's, starts in hippocampus and gets into amygdala, primarily cortical

insidious onset, rapid progress, tremors, rigidity, delusions/hallucinations, bradykinesia, more severe executive function