Cognitive Communication and Associated Disorders (W6)

Question 1

Which of the following is not an aspect of cognition?

Answer 1

A. Memory 
B. Reasoning and problem solving 
C. Pragmatics 
D. Orientation 
E. Executive Functions 

ANSWER: C. Pragmatics

Question 2

The decreased ability to perform language-based activities because of impairment in
one or more of the cognitive functions that underlie communication is called?

Answer 2

Cognitive communication disorder

Question 3

Comprehension deficits during discourse include all of the following except?

Answer 3

A. Difficulty understanding others’ emotions
B. Difficulty with gist comprehension
C. Difficulty interpreting information in multiple ways
D. Difficulty understanding abstract language
E. Decreased accuracy of information provided

ANSWER: E. Decreased accuracy of information provided

Question 4

Reduction or absence of normal variations in pitch, loudness, intonation, and rhythm of speech to express meaning or emotion?

Answer 4

Aprosodia

Question 5

When a patient can see all of the visual field, but somehow ignores objects on one side?

Answer 5

Neglect

Question 6

These language abilities require the use of language and cognitive skills beyond simple use of information?

Answer 6

Macrolinguistics

Question 7

Which of the following is not a type of discourse?

Answer 7

A. Description 
B. Narration 
C. Argumentation 
D. Metacognition 
E. Exposition 

ANSWER: D. Metacognition

Question 8

Making a plan, acting it out, evaluating success, & adjusting are examples of?

Answer 8

Executive functioning

Question 9

Perceptual deficit in which patients fail to recognize stimuli in a sensory modality while perception in the unaffected modality is preserved?

Answer 9

Agnosia

Question 10

Skills need for reading include?

Answer 10

A. Attention 
B. Comprehension 
C. Vision 
D. Decoding for word recognition 
E. All of the above 

ANSWER: E. All of the above

Question 11

It is possible to predict reading ability based on spoken language?

Answer 11

FALSE

Question 12

Impairment in spelling, semantics, syntax, and construction of the physical features of a written word?

Answer 12

Agraphia

Question 13

Difficulty positioning speech muscles and sequencing of muscle movements for volitional production of speech.?

Answer 13

Apraxia

Question 14

A speech disorder in which the muscles of the mouth, face, and respiratory system become weak, move slowly, or do not move at all?

Answer 14

Dysarthria

Question 15

A person with this agraphia has greater difficulty writing abstract nouns and verbs than concrete nouns and verbs?

Answer 15

Deep agraphia

Question 16

Microlinguistic Abilities

Answer 16

Sentence level or below

• Aphasia results in impairments in these abilities

Question 17

Macrolinguistic abilities

Answer 17

Requires the use of language and cognitive skills beyond simple use of information

• Cognitive communication disorder results in impairments in these abilities

Question 18

Communicative Competence

Answer 18

Successful communicative competence is important for return to previous activities (school, work, home, etc.) or highest achievable level of ability

Question 19

Discourse

Answer 19

Verbal exchange of ideas and information. Unit of language longer than a sentence.

Conversation: Form of interactive, spontaneous communication b/w 2 or more people who are following rules of etiquette

Person with Cog. Com. Disorder has difficulty w/ discourse.

Question 20

4 Types of Discourse

Answer 20

1. Description - paint a verbal picture
2. Narration - tell a story
3. Argumentation - to convince the listener using logic
4. Exposition - inform the audience (multiple types)
   
   • Compare and Contrast
   • Problem and Solution
   • Process Analysis

Question 21

Linguistic behaviors/Conversational Skills (Pragmatics)

Answer 21

• Topic selection and maintenance
• Gist comprehension
• Verbal productions (too much/too little/just right)

Question 22

Extralinguistic behaviors (Pragmatics)

Answer 22

• Eye gaze
• Affect
• Gestures

Question 23

Paralinguistic behaviors (Pragmatics)

Answer 23

• Tone
• Intonation
• Rhythm

ALL PART OF PROSODY

Question 24

Inhibition (Pragmatics)

Answer 24

Instinctional or impulsive tendencies (inhibit from doing something…control yourself..)

Ex: If friend gets ugly haircut you control yourself and don’t say it is ugly aloud

Question 25

Emotional Stability (Pragmatics)

Answer 25

Displaying emotional responses proportionate to external stimuli Ex: If it is a joke you laugh, but you do not roll on the floor and laugh excessively

Question 26

Cognitive Abilities

Answer 26

- Attention (selective concentration) - Memory (recall of facts, procedures, and past & future events) - Perception (interpretation of sensory information) - Insight & judgement (understanding one's own limitations & what they mean) - Organization (arranging ideas in a useful order) - Orientation (knowing where, when, & who you are, as well as why you're there) - Language (words for communication) - Processing speed (quick thinking & understanding) - Problem-solving (finding solutions) - Reasoning (logically thinking through solutions) - Executive Functioning (making a plan, acting it out, evaluating success, & adjusting) - Metacognition (thinking about how you think)

Question 27

Cognitive Communication Disorder

Answer 27

Problems with communication that have an underlying cause in a cognitive deficit rather than a primary language or speech deficit - Language rule system intact, but cognitive challenges cause them to be inefficient and ineffective in their communicative performance.

Question 28

Right Hemisphere Disorder

Answer 28

An acquired brain injury, usually secondary to stroke or TBI, that causes impairments in language and other cognitive domains that affect communication Typically refer to cognitive communication disorder since damage may not just be located in the right hemisphere depending on the cause

Question 29

Cognitive Communication Deficits

Answer 29

A decrease in a single aspect of cognition or psychosocial functioning can negatively affect communicative competence - Additional complications arise because aspects of cognition are interdependent on one another Ex: Problem w/ Focused Attention - The ability to respond discretely to specific visual, auditory or tactile stimuli, can also affect memory, orientation, executive functioning, and problem solving. - A person with a cognitive-communication disorder may have difficulty paying attention to a conversation, staying on topic, remembering information, responding accurately, understanding jokes or metaphors or following directions.

Question 30

Cognitive Communication Deficits (Discourse Comprehension Deficits)

Answer 30

- Difficulty understanding abstract language, figurative language, lexical ambiguities, or information that can be interpreted in multiple ways - Difficulty making inferences and understanding the global meanings of discourse such as topic, gist, and big picture (comprehension) - Semantic Processing deficits, particularly at higher levels of functioning - Difficulty understanding jokes, irony, and sarcasm - Difficulty understanding others' emotions

Question 31

Cognitive Communication Deficits (Discourse Production Deficits)

Answer 31

- Reduction in the amount and accuracy of information provided - Verbosity: A lot of talking - Egocentric, tangential comments, and digressions from the topic - Focus on irrelevant details - Impulsive, poorly organized responses - Difficulty conveying meaning - Decreased speaking rate and fluency - Impairment in the distribution and organization of information - Confabulation (making information up!!)

Question 32

Pragmatic Communication Deficits

Answer 32

Aprosodia: Reduction or absence of normal variations in pitch, loudness, intonation, and rhythm of speech to express meaning or emotion (all comm. is flat) Flat Affect: Reduced emotional expressiveness, May speak in a monotonous voice (aprosodia) and have diminished facial expressions, - Poor eye contact - Poor turn taking - Reduced conversation initiation (reduced ability to control self) - Reduced recognition of facial expression

Question 33

Cognitive Deficits

Answer 33

- Reduced sustained attention - Reduced selective attention (easily distracted) - Reduced attention to detail - Unilateral visual neglect - typically the left side - Reduced memory - working and short-term - Reduced reasoning and judgement - Difficulty with sequencing and problem solving - Impaired executive functioning skills - Decreased or no awareness of deficits (anosognosia)

Question 34

Visual Neglect

Answer 34

Visual Perceptual Skills: Brain's ability to interpret and process incoming (sensory) information, specifically visual, and generate functional activity as an outcome Ex: You see someone throw a ball at you.. you react by catching it or moving away Visual Neglect: Patient can see all of the visual field binocularly, but somehow ignores objects on one side (attention deficits) - Caused by lesion of the brain, most often in the right cortex, and the patient, although conscious of objects in the left visual field does not pay attention to them (not always the case though, sometimes right aphasia and right neglect) - Impairment occurs in posterior parietal lobe, which receives projections from the primary visual cortex. - Neglect = Safety Issue

Question 35

Agnosia

Answer 35

- Perceptual deficit in which patients fail to recognize stimuli in a sensory modality while perception in the unaffected modality is preserved - Lose the ability to recognize familiar ojects or stimuli usually as a result of brain damage. - Confined to a single modality (ex: vision, auditory)...if person has multiple areas affected we would say it is cognitive disorder, different from agnosia - In agnosia a lesion disconnects the sensory/perceptual regions (single modality) from the multimodal (transmodal) association areas. - Local info. = provides us with details - Global info. = provides us with whole picture - When diagnosing agnosia, a sensory deficit, (hearing loss, vision loss, or proprioceptive loss) must be ruled out first. - An alert, attentive patient without aphasia, who has normal perception gives evidence of not knowing or not recognizing a stimulus (this happens even when patient has normal vision and normal hearing) - Different types of Agnosias

Question 36

Types of Agnosia

Answer 36

Visual Agnosias - Prospagnosia: Face blindness (See person, but can't recognize their face) - Object Agnosia: Inability to recognize objects (Apple, can describe.. but cant put together that it is an apple...but if they touch it or you describe it then they will know it is an apple) Auditory Agnosias - Phonoagnosia: Disturbance in voice recognition - Auditory Agnosia: Inability to recognize or differentiate sounds (telephone ringing.. or fire engine) - Pure Word Deafness: Inability to comprehend the meaning of speech, but still being able to hear, speak, read, and write Tactile Agnosias : Inability to recognize objects by touch (less of a problem than visual and auditory) Assess if lang. ability, cognitive ability, physical ability of vision and hearing is normal...may be diagnosed with agnosia.

Question 37

Reading Comprehension in Alexia is affected by...

Answer 37

``` Word Frequency Parts of Speech (nouns, verbs) Emotionality Personal Relevancy Syntactic Complexity Length (utterance vs. paragraph) Degree of inference required for interpretation ```

Question 38

Types of Alexia

Answer 38

Deep Alexia: Loss of grapheme to phoneme decoding system, but relative preservation of the system for deriving whole words (most common in aphasia) - Substitution of semantically related words (semantic paralexias) Ex: cry/weep - Problems reading aloud grammatical functor words that are omitted or substituted for other functor words. Ex: The/this - Tendency to omit endings Ex: Sing/singing, her/hers - More accurate reading of nouns than verbs or adjectives - Poor ability to match homophonic real words Ex: flour/flower - Poor ability to select a word from a semantically related list Ex: tulip, rose, daisy Surface Alexia: Reverse of deep alexia in that there is no access to meaning on a whole word basis - Meaning is gained through strict grapheme to phoneme mapping - Works for words with regular spelling, but not for irregular words. - Attempts to understand the words are made by sounding out the letters. Ex: "t i m e" - Good ability to read aloud pseudowords (made-up words). Ex: Flang Phonological Alexia: Continuum from deep to surface Alexia. - Poor ability to apply grapheme to phoneme rules to read pseudowords. - Occasional difficulty reading grammatical functor words. - Does not produce semantic paralexias Pure Alexia: Pure alexia without agraphia - aka: Pure word blindness (visual agnosia) - Cannot read; CAN write - Preserved recognition of oral spelling and preserved spelling of words orally - Letter by letter readers - Gets info. to the brain through the ears not the eyes.

Question 39

Variables that affect written expression

Answer 39

- Word frequency - Length - Part of Speech - Emotionality - Personal Relevancy - Syntactic Complexity - Spelling (regularly spelled words are easier than irregularly spelled words)

Question 40

Types of Agraphia

Answer 40

Apraxic Agraphia: Inability to use a writing tool to form graphic symbols (Not motor weakness, just has difficulty holding tool) - Impaired ability to form letters, even when copying - Better ability to spell with anagrams, a computer, or spell aloud!!! Deep Agraphia: The route b/w word meaning and its written form are affected - Produces spelling errors that are semantically related (ex: meal/breakfast) - Best at writing concrete nouns - Greater difficulty writing abstract nouns and verbs than concrete nouns and verbs. Ex: peace, believe - Almost incapable of writing grammatical functor words. Surface Agraphia: Correlates with Surface Alexia - Makes phonetic spelling errors (ex: sirkal for circle) - Can write psudowords (ex: blug) Phonological Agraphia: Impaired capacity to use phoneme to grapheme conversion rules - Relative preservation of ability to write real words. - Almost total inability to write pseudowords - Some preservation of the visual contours of the target is misspelled words (ex: happy/baggy