Cognitive dysphasia is a language disorder. It is caused by lesions in areas of attention, memory, or executive function. Targeted speech therapy is used for treatment.
What is cognitive dysphasia?
Language is a behavior. To speak, a person needs more than just his or her tongue and vocal cords. While the integrity of neuromuscular language structures is a prerequisite of speech, it is far from the only one. For example, in order to speak, humans also need mental functions to control their behavior in light of environmental conditions. This bundle of cognitive abilities is considered cognitive control. In this context, attentiveness is also relevant. Only those who perceive their environment attentively can react to it appropriately. In addition, memory plays an important role for any kind of linguistic expression, so especially language or meaning memory. When any of the described functions is impaired, so is language behavior. People with dysphasias suffer from a reduction in the ability to speak, equivalent to mild aphasia. The term cognitive dysphasia goes back to Heidler. First described in 2006, this type of aphasia is a language processing disorder associated with impaired attention, memory, and executive function, often resulting in unintelligibility in speech. However, a patient with dysphasia does not always have to be completely unable to express themselves. Cognitive dysphasia is a symptom of lesions in the central nervous system. Usually, the condition is caused by focal-looking lesions in areas of the brain relevant to language memory, attention, or executive functions.
Causes
The primary cause of cerebral dysphasia lesions can vary in nature. Particularly often, dysphasia is a symptom of stroke and, as part of that, results from a disturbance in cerebral blood supply. In the case of such a disturbance, nerve tissue in the area of the brain perishes, so that there is a complete or partial loss of function in the affected areas. Cognitive dysphasia can also occur in the context of accidents, especially in connection with cerebral hemorrhages. Cerebral hemorrhages often cause an alarming increase in intracranial pressure. As a consequence, the brain is compressed. Functional disorders in the affected areas are the result. In addition to strokes and hemorrhages, cerebral inflammation, tumors or degenerative diseases can also promote dysphasia. In connection with inflammations, a bacterial cause is just as likely as an autoimmunological cause. Areas for attentional performance are mainly located in the formatio reticularis of the brainstem, the thalamus and the frontal brain. The right hemisphere of the brain houses general alertness. The left hemisphere of the brain houses specific concentration functions. Memory functions reside primarily in the limbic system of the hippocampus and amygdala. In addition, the frontal brain and long-term memory regions in the left hemisphere are relevant as word memory. The episodic memory is located in the right hemisphere. Language-logical thinking, planning, and initiating lie in the frontal brain and its connections to other areas. Depending on the symptoms in the individual case, different types of cognitive dysphasia exist. One type of dysphasia is due to impaired attention, which results in a slowdown in information processing. Speech processing is delayed and the flow of speech seems slow. Breaks in coherence occur in utterances.
Symptoms, complaints, and signs
Cognitive dysphasia is primarily manifested by the characteristic speech disturbances. Affected individuals often have slurred or slurred speech, swallow syllables, and have word-finding difficulties. Furthermore, cognitive dysphasia can cause serious emotional distress. The speech disorders represent a psychological burden, from which long-term secondary disorders such as depressive moods, social phobias or inferiority complexes can develop. In severe cases, cognitive dysphasia, or the causative condition, can lead to severe depression. The speech disorder usually appears quite suddenly.After a stroke, the change in speech may be noticed immediately. In most cases, the symptoms intensify in the first days to weeks. If the cause of the disorder is treated professionally at an early stage, the severity of the dysphasia can be alleviated. However, most patients suffer from permanent speech disorders and the resulting consequences for the rest of their lives. If the condition is not treated, serious complications can develop. In addition to the psychological symptoms experienced by the majority of patients, speech problems may be exacerbated. Depending on the cause, further physical and mental limitations and illnesses may result. Attention selection disorders, on the other hand, lead to symptoms such as irrelevant verbal activity, as they impair the filtering of information. Speech is hardly perceived under noise conditions in this variant, as the filter is also overloaded with environmental sounds. The variant of memory dysphasia are language system disorders, which make it difficult to acquire new knowledge in general. Common symptoms in this case are impoverishment of linguistic expression, confabulation, spontaneous inventions, and language comprehension problems. Cognitive dysphasias due to impaired executive functions results in language drive disorders, language inhibition or disinhibition, association streams, incorrect word choice, and word salad. Particularly severe cognitive dysphasias are often associated with orientation disorder and manifest in confused incoherent, confabulated utterances as well as decreased language comprehension.
Diagnosis and course
Dysphasia is diagnosed using Heidler’s screening. The screening corresponds to an attention and memory diagnostic that tests executive functions using verbal and nonverbal information processing. Attention and memory are also tested by visual recognition of object mapping and verbal reproduction of narrative texts. In addition to screening, neurologic diagnosis is performed using imaging primarily to identify the primary cause of dysphasia.
When should you see a doctor?
With speech disorders, a doctor must be consulted in any case. Depending on the severity of the symptoms, the family doctor or directly a speech therapist or neurologist can be consulted first. The affected person should seek medical advice if the speech disorders appear without apparent cause and still persist after a week. There may be an underlying untreated stroke or an autoimmunological cause that needs to be clarified. Risk groups also include people who have a history of cancer or cerebral inflammation. People with degenerative diseases should also have the symptoms mentioned clarified quickly. Children should be taken to a pediatrician if they show the above signs of illness. In any case, cognitive dysphlasia must be clarified by a physician in order to exclude complications and to ensure a rapid recovery. Continuous medical monitoring is necessary during treatment. In addition, the medication must be regularly adjusted to the patient’s current state of health. Other contacts are the neurologist or a specialist in speech disorders.
Treatment and therapy
Treatment of cognitive dysphasia is provided by a neuropsychologist who specializes in training attention, memory, and executive function. Because of the small number of neuropsychologists in branch offices, patients are alternatively referred to a speech therapist who provides speech therapy that is specifically cognitively oriented. Treatment must be disorder-specific, and thus precisely targets the cognitive functions that have been damaged. The patient’s speech processing should be improved to the point where it barely affects his or her daily life. The top priority of treatment is to generate sufficient activity levels, as can be achieved through training of executive functions, selective attention, attentional focusing, and mental switching skills. Therapy is often prolonged and difficult, as the learning capacity of patients with severe brain damage is limited. In addition to the therapy of the symptom, a therapy of the primary cause is also carried out, as far as this is possible. Inflammations in the brain must be brought to an end by means of cortisone or antibiotics.Increased intracranial pressure is lowered surgically if necessary, and tumors are removed surgically. Since the central nervous system is not particularly capable of regeneration due to its specialization, brain lesions are often associated with permanent damage. Complete recovery of functions in affected tissues can only be achieved if the individual functions can be transferred to surrounding nerve tissue through targeted training.
Outlook and prognosis
The prognosis of cognitive dysphasia depends on the extent of damage as well as the underlying disease present. In a large number of patients, improvements can be achieved through the use of targeted language training. However, complete recovery does not always occur. If a patient suffers a stroke, irreparable tissue damage in the brain is found to be the cause of the speech disorder. The greater the extent of the damaged areas of the brain, the less likely it is that natural speech will be restored prior to the triggering event. If only a small area of the brain is damaged by the stroke or by a brain hemorrhage, the affected person can regain his or her ability to speak with a lot of discipline and cooperation with therapy. In the case of tumor disease, the prognosis depends on the type of tumor, its size, and the possibility of complete removal of the mutated tissue. The more aggressive and the larger the tumor, the worse the prognosis. There is a possibility that the tumor will reach an extent that will lead to a sharp increase in symptoms and ultimately to the premature death of the affected person. If the tumor cannot be removed, the prognosis is unfavorable in most cases. In addition, there is a risk that further diseases will develop due to the psychological stress of possible further tissue damage.
Prevention
Cognitive dysphasia can be prevented only to the extent that strokes, cerebral inflammation, degenerative brain disease, brain tumors, hemorrhage, and trauma can be prevented.
Follow-up
Medical follow-up evaluations diagnose the extent of damage and impairment attributable to cognitive dysphasia. Appropriate therapeutic interventions are then derived from this diagnosis. Speech therapy is focused on resources and abilities in language and communication. Thus, medical and logopedic treatment will be based on common goals. An early start will contribute significantly to the preservation of speech and communication skills. In addition, improving the patient’s language performance will lead to preventing his or her cognitive performance from declining. It also identifies strategies that the patient can use to correct word-finding disorders. Participation in community life is thus maintained. During follow-up, the involvement of relatives regarding impaired communication with the patient is also an important part of the therapy. The duration of treatment is determined by the success of the treatment and the needs and social environment of the patient. If objectives have been achieved and there is no further therapy approach that could lead to improvements for the time being, treatment is not continued. If necessary, a new follow-up examination by the specialist or speech therapist may then be required at a later date.
