Cognitive Communication Disorders Flashcards

Mild Traumatic Brain Injury (mTBI) / Concussion

• Attention & Processing Speed: Individuals experience reduced efficiency and endurance. Processing speeds typically slow down specifically when the person is under a heavy cognitive load or significant time pressure

• Memory & Learning: Characterized by inefficient encoding. The perceived "forgetfulness" in this population is more often driven by failures in attention rather than a loss of storage capacity (1, 3).

• Executive Function (EF) & Awareness: Awareness of deficits is typically intact (1). Executive function deficits are often subtle and may only emerge during complex decision-making tasks (3).

• Social Cognition & Language: Word-finding issues are common. Social difficulties tend to emerge primarily when the individual is under stress or experiencing fatigue (4, 5).

• ADL & IADL Impact:     * ADLs: Activities of Daily Living remain intact (1).     * IADLs: Difficulties arise with high-level tasks, such as reading complex legal documents (e.g., leases) or writing professional-grade emails (1, 6).

• Self-Care & Participation Impact:     * ADL (Self-Care): Intact, though overall efficiency is reduced by secondary factors like fatigue or headaches (16, 17).     * IADL & Participation: Impacted primarily under load. Difficulties include following multi-step directions, writing professional emails, and reading leases (8, 18).

• Primary Functional Barriers: Symptoms typically emerge or worsen under metabolic stress. The primary driver of "forgetfulness" remains attention failure (8, 17).

• Safety & Awareness Factors: Typically remains intact. However, cognitive endurance and the ability to sustain effort under load are notably limited (17).

Moderate–Severe Traumatic Brain Injury (TBI)

• Attention & Processing Speed: Acts as a foundational bottleneck for the individual. Widespread disruption of neural networks—specifically the Salience and Central Executive Network (CEN)—limits performance across all other cognitive domains (2, 7).

• Memory & Learning: There is a significant breakdown in the ability to facilitate new learning. Recognition memory typically remains stronger than free recall (3, 8, 9).

• Executive Function (EF) & Awareness: Awareness levels are variable. Hallmarks of this stage include impaired initiation, planning, and organizational skills (3, 9, 10).

• Social Cognition & Language: Social skills are fragile. Disruptions in communication reflect global capacity limits rather than a specific loss of linguistic knowledge (5, 10, 11).

• ADL & IADL Impact:     * ADLs: Ranges from being independent with support to being entirely partner-dependent (1, 9).     * IADLs: Global disruption occurs; significant barriers exist for returning to work or school (1).

• Self-Care & Participation Impact:     * Moderate TBI: Independent with support. Requires external aids such as alarms and planners to maintain consistency (19, 20).     * Severe TBI: Dependent; requires partners and structured environments for all daily needs.

• IADL & Participation Barriers:     * Moderate TBI: Reduced efficiency. Challenges arise in returning to school or work roles due to attention deficits (20, 21).     * Severe TBI: Global, long-term disruption. Challenges exist in maintaining any pre-injury roles within the community (20).

• Primary Functional Barriers:     * Moderate TBI: Network-level injury causes high-level skills to break down first under complexity (22, 23).     * Severe TBI: Limited initiation and global cognitive disruptions prevent participation in most IADLs (20).

• Safety & Awareness Factors:     * Moderate TBI: Variable awareness. Patients may recognize some but not all cognitive-communication limitations (20).     * Severe TBI: Patients often do not recognize limitations, making independent ADLs fundamentally unsafe (20).

Right Hemisphere Disorder (RHD)

• Attention & Processing Speed: Spatial neglect is the primary attention disorder. There is a frequent failure to orient toward or process contralesional information (1, 12).

• Memory & Learning: A breakdown occurs in contextual and visual memory. Information retrieval is often described as disorganized (13, 14).

• Executive Function (EF) & Awareness: Profound anosognosia (lack of awareness of deficits) is a key feature. Patients exhibit poor self-monitoring regarding pragmatic social rules (1, 15).

• Social Cognition & Language: Significant failure in inferencing and cognitive integration. Patients often miss implied meanings, sarcasm, and essential nonverbal cues (16-18).

• ADL & IADL Impact:     * ADLs: High safety risks during self-care tasks (1, 12).     * IADLs: Common outcomes include social withdrawal and a poorer rate of return to life roles (1, 19).

• Self-Care & Participation Impact:     * ADL: Anosognosia leads to unsafe attempts at self-care (25).     * IADL: Nonverbal cue interpretation failures cause significant relationship strain (11, 26).

• Primary Functional Barriers: Neglect negatively impacts the capacity to read, write, scan the environment, or interpret the cues of a communication partner (25).

• Safety & Awareness Factors: Profoundly impaired. There is a common reduced awareness of both pragmatic and safety breakdowns (25, 27).

Alzheimer’s Disease (Early-Mid Stages)

• Attention & Processing Speed: These functions are relatively spared in the early stages. Slowed processing begins to occur as the pathology spreads toward the frontal cortices (1, 20).

• Memory & Learning: Early and prominent breakdown in episodic memory and the formation of new declarative memories (1, 20, 21).

• Executive Function (EF) & Awareness: Awareness of memory loss gradually reduces as the disease progresses into its middle stages (1).

• Social Cognition & Language: The ability to engage socially is spared early on, but later progresses to frequent repetition and pauses for word-finding (21).

• ADL & IADL Impact:     * ADLs: Generally remain intact during the early stages (1).     * IADLs: Difficulty tracking appointments, following recipes, or navigating unfamiliar places (1).

• Self-Care & Participation Impact:     * ADL: Generally intact initially, but declines as semantic specificity is lost (3, 4).     * IADL: Difficulties with recipes, navigation, and appointment keeping become more pronounced (3).

• Primary Functional Barriers: Episodic memory loss leads to conversational repetition and a loss of topic maintenance (3, 5).

• Safety & Awareness Factors: Insight into deficits is reduced and typically declines as the pathology enters the middle stages (4).

Vascular Dementia

• Attention & Processing Speed: Pathological slowing of mental processing and significant deficits in mental flexibility (1, 22).

• Memory & Learning: Memory impairment is often secondary to executive retrieval deficits rather than a loss of actual storage (22).

• Executive Function (EF) & Awareness: Primary breakdown in executive function. Characteristics include prominent planning and sequencing deficits that fluctuate day-to-day (1, 22, 23).

• Social Cognition & Language: The form of language is often preserved, but communication fails due to disorganized discourse and slow processing (22).

• ADL & IADL Impact:     * ADLs: Performance is fluctuating (1, 23).     * IADLs: Significant interference with multi-step community tasks (1).

• Self-Care & Participation Impact: Performance in basic routines varies day-to-day (6, 7). Multi-step community tasks are hindered by executive dysfunction (1, 6).

• Primary Functional Barriers: Slowed mental processing makes it difficult to follow real-time conversations or multi-step directions (6, 8).

• Safety & Awareness Factors: Awareness is variable, and performance depends on the "stepwise" progression of cerebrovascular events (6).

Dementia with Lewy Bodies

• Attention & Processing Speed: Marked fluctuations in alertness and attention occur across scales of minutes, hours, or days (1, 24).

• Memory & Learning: Performance is variable; memory declines progressively but is heavily influenced by the patient's current attentional state (1, 23).

• Executive Function (EF) & Awareness: Prominent visuospatial and executive dysfunction. Recurrent visual hallucinations create significant barriers to safe actions (23, 24).

• Social Cognition & Language: Pragmatic breakdown occurs due to fluctuating engagement. Motor features of the disease may also limit communication abilities (24).

• ADL & IADL Impact:     * ADLs: Inconsistent performance (1, 24).     * IADLs: High safety risks in driving or navigating due to hallucinations (1).

• Self-Care & Participation Impact: Daily performance is tied to fluctuating alertness and motor features (9). Visual hallucinations and visuospatial deficits make driving or navigating unsafe (9).

• Primary Functional Barriers: Marked cognitive variability. Task performance is not tied to effort but rather to neurological state (9).

• Safety & Awareness Factors: Impaired. Recurrent visual hallucinations create significant and immediate safety risks (9).

Frontotemporal Dementia (FTD)

• Attention & Processing Speed: Attention often appears impaired, but this is typically due to profound apathy or distractibility rather than a true capacity limit (1, 25).

• Memory & Learning: Remains a relative strength early on, but inefficient retrieval eventually occurs due to frontal lobe degeneration (26).

• Executive Function (EF) & Awareness: Severely impaired awareness and judgment. Manifests as disinhibition and a loss of behavioral regulation (1, 26).

• Social Cognition & Language: Early loss of empathy (Theory of Mind). Personality changes eventually lead to social isolation and relationship strain (1, 17).

• ADL & IADL Impact:     * ADLs: Hygiene may suffer, primarily due to apathy (1).     * IADLs: High financial and legal risks result from poor judgment (1).

• Self-Care & Participation Impact: Poor hygiene from apathy (10). Social and financial risks arise from disinhibition (10).

• Primary Functional Barriers: Pragmatic breakdowns and personality changes directly lead to social isolation and relationship strain (10, 11).

• Safety & Awareness Factors: Severely impaired early in the disease. A hallmark of FTD is the lack of empathy and insight into one's social behavior (10, 12).

Primary Progressive Aphasia (PPA)

• Attention & Processing Speed: These systems are spared initially; attention and non-language systems remain strengths early in the disease (1, 27).

• Memory & Learning: Spared initially. Individuals can often remember appointments and learn non-verbal routines (1, 27).

• Executive Function (EF) & Awareness: Insight is preserved early on. Individuals experience high frustration as language fails despite otherwise intact cognition (1, 27).

• Social Cognition & Language: Progressive language degradation. Primary failure occurs in syntax, word retrieval, or comprehension (1, 27).

• ADL & IADL Impact:     * ADLs: Physical self-care remains a strength (1).     * IADLs: Language-heavy tasks such as banking or phone calls become impossible (1).

• Self-Care & Participation Impact: Preserved. Physical self-care remains a strength while language declines (12, 13). Progressively limited; language-heavy tasks (phone calls, emails) become impossible (13).

• Primary Functional Barriers: Functional communication declines despite initially intact memory and non-language cognition (13, 14).

• Safety & Awareness Factors: Insight is preserved early on. High frustration is common as the ability to participate in communication fails (13, 15).

Mild Cognitive Impairment (MCI)

• Attention & Processing Speed: Noticeable slowing or decline in selective attention depends on the specific subtype (1, 28).

• Memory & Learning: Decline in new learning that goes beyond normal aging expectations (1, 29).

• Executive Function (EF) & Awareness: Awareness is preserved. The individual recognizes changes and finds compensation to be more effortful (1, 28, 29).

• Social Cognition & Language: Social skills are intact, although word-finding issues may become more noticeable to the individual (29, 30).

• ADL & IADL Impact:     * ADLs: Intact (1, 30).     * IADLs: Strained; requires significantly more compensatory effort to manage (1, 30).

• Self-Care & Participation Impact: Basic self-care and independence are preserved (1, 2). Managing finances or medications requires significant compensatory effort (1).

• Primary Functional Barriers: Decline in new learning or processing speed makes complex tasks "noticeably" harder for the individual (1, 2).

• Safety & Awareness Factors: Preserved. The individual typically recognizes changes and actively uses strategies to compensate (2).