According to abbreviationfinder, CD stands for cognitive dysphasia. 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?
Dysphasia is particularly often the symptom of a stroke and can be traced back to a disruption in the cerebral blood supply.
Language is a behavior. Humans don’t just need their tongues and vocal cords to speak. The integrity of the neuromuscular structure of language is a prerequisite for speech, but it is by no means the only one. In order to be able to speak, people also need mental functions, for example, to control their behavior while taking environmental conditions into account.
This bundle of cognitive abilities is considered cognitive control. In this context, the ability to pay attention is also relevant. Only those who perceive their environment attentively can react to them appropriately. In addition, memory plays an important role for every kind of linguistic expression, in particular the memory of language or meaning.
If one of the functions described is impaired, so is speech behavior. People with dysphasia suffer from a reduction in the ability to speak, which corresponds to mild aphasia. The concept of cognitive dysphasia goes back to Heidler. It was first described in 2006. This type of aphasia is a language processing disorder associated with impairments in attention, memory, and executive function, often resulting in unintelligible speech.
However, a patient with dysphasia does not always have to be completely unable to express himself. Cognitive dysphasia is a symptom of lesions in the central nervous system. Usually, the condition is caused by focal-like lesions in the brain areas relevant to language memory, attention, or executive functions.
Causes
The primary cause of cerebral dysphasia lesions can be of different nature. Dysphasia is particularly often the symptom of a stroke and can be traced back to a disruption in the cerebral blood supply. With such a disorder, nerve tissue in the area of the brain perishes, so that there is a complete or partial failure of the functions in the affected areas.
Cognitive dysphasia can also occur in the context of accidents, especially in connection with cerebral hemorrhage. Cerebral hemorrhages often cause the intracranial pressure to rise alarmingly. As a result, the brain becomes compressed. Functional disorders in the affected areas are the result. In addition to strokes and bleeding, cerebral inflammation, tumors or degenerative diseases can also promote dysphasia.
In connection with inflammation, a bacterial cause is just as possible as an autoimmune cause. Areas for attention performance are mainly in the reticular formation of the brainstem, the thalamus and the frontal lobe. General alertness is in the right hemisphere of the brain. The left hemisphere of the brain accommodates specific concentration functions.
Memory functions are primarily located in the limbic system of the hippocampus and the amygdala. In addition, the frontal lobe and the long-term memory regions in the left hemisphere are relevant as word stores. The episode memory is in the right half. Speech-logical thinking, planning and initiating lies in the frontal lobe and its connections to other areas.
Depending on the symptoms in the individual case, there are different types of cognitive dysphasia. 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 the utterances.
Symptoms, Ailments & Signs
Cognitive dysphasia primarily manifests itself through the characteristic speech disorders. Those affected often have a sluggish or slurred speech, swallow syllables and have difficulty finding words. Furthermore, cognitive dysphasia can cause serious psychological problems.
The speech disorders represent a psychological burden from which long-term complications such as depressive moods, social phobias or inferiority complexes can develop. In severe cases, cognitive dysphasia or the condition that caused it leads to severe depression. The speech disorder usually comes on suddenly.
After a stroke, the changed way of speaking can be noticed immediately. The symptoms usually get worse in the first few days or weeks. If the cause of the disorder is treated early and professionally, the dysphasia can be alleviated in its severity. However, most patients suffer from permanent speech disorders and the resulting consequences for the rest of their lives.
If the disease is not treated, serious complications can develop. In addition to the psychological complaints that are noticeable in the majority of patients, speech problems can become worse. Depending on the cause, further physical and mental limitations and illnesses can occur.
Attentional selection disorders, on the other hand, lead to symptoms such as irrelevant verbal activity because it interferes with the filtering of information. With this variant, speech is hardly heard under noise conditions, since the filter is also overwhelmed by environmental noise. The variant of memory dysphasia are language system disorders that generally make it difficult to acquire new knowledge.
Common symptoms in this case are impoverishment of verbal expression, confabulation, spontaneous inventions and language comprehension problems. Cognitive dysphasia due to impaired executive functions leads to language drive disorders, language inhibition or language inhibition, streams of associations, incorrect choice of words and word salad.
Particularly severe cognitive dysphasia is often associated with a disorientation and manifests itself in confused, incoherent, confabulatory utterances and reduced understanding of language.
Diagnosis & History
Dysphasia is detected by Heidler screening. The screening corresponds to an attention and memory diagnostics that tests the executive functions using verbal and non-verbal information processing.
Attention and memory are also tested through visual recognition of object images and verbal reproduction of narrative texts. In addition to the screening, a neurological diagnosis is carried out, which is primarily intended to identify the primary cause of the dysphasia by means of imaging.
When should you go to the doctor?
In the case of speech disorders, a doctor must be consulted in any case. Depending on the severity of the symptoms, the family doctor or a speech therapist or neurologist can be consulted first. The person concerned should seek medical advice if speech problems occur without apparent reason and persist after a week. It may be due to an untreated stroke or there is an autoimmune cause that needs to be clarified. The risk groups also include people who have already had cancer or cerebral inflammation.
People with degenerative diseases should also have the symptoms mentioned quickly clarified. Children should be taken to the pediatrician if they show the symptoms mentioned. Cognitive dysphlasia must always be examined by a doctor to rule out complications and to ensure a speedy recovery. Continuous medical supervision is required during treatment. In addition, the medication must be regularly adjusted to the current state of health of the patient. Other contacts are the neurologist or a specialist in speech disorders.
Treatment & Therapy
Cognitive dysphasia is treated by a neuropsychologist who specializes in training attention, memory, and executive function. As an alternative, because of the few neuropsychologists in the office, patients are referred to a speech therapist who performs a specially designed cognitive speech therapy.
Treatment must be disorder-specific, targeting the cognitive functions that have been damaged. The patient’s speech processing should be improved until it hardly affects his everyday life anymore. The top priority of treatment is to generate an adequate level of activity, as can be achieved by training executive functions, selective attention, attentional focus, and mental resilience.
The therapy is often lengthy and difficult, since the ability of the patient to learn is limited in the case of severe brain damage. In addition to treating the symptom, the primary cause is also treated, as far as this is possible. Inflammations in the brain must be brought to a halt with cortisone or antibiotics. If necessary, increased intracranial pressure is surgically reduced and tumors are surgically removed.
Since the central nervous system is not particularly capable of regeneration due to its specialization, brain lesions are often associated with permanent damage. A complete restoration of the functions in the affected tissues can only be achieved if the individual functions can be transferred to the surrounding nerve tissue through targeted training.
Outlook & Forecast
The prognosis of cognitive dysphasia depends on the extent of the damage and the underlying disease. Improvements can be achieved in a large number of patients through the use of targeted language training. However, complete healing does not always occur.
In the event of a stroke, irreparable tissue damage in the brain is identified as the cause of the speech disorder. The greater the extent of the damaged brain areas, the less likely it is that natural language skills will be restored prior to the initiating event. If only a small area of the brain is damaged by a stroke or a cerebral hemorrhage, the affected person can regain their ability to speak with a lot of discipline and cooperation with therapy.
In the case of a tumor disease, the prognosis depends on the type of tumor, its extent and the possibility of completely removing the mutated tissue. The more aggressive and the larger the tumor, the worse the prognosis. There is a possibility that the tumor will grow to such an extent that the symptoms will increase significantly and ultimately lead to the premature death of the affected person. If the tumor cannot be removed, the prognosis is unfavorable in most cases. There is also a risk that further diseases will develop due to the psychological stress of possible further tissue damage.
Prevention
Cognitive dysphasia can only be prevented by preventing stroke, cerebral inflammation, brain degenerative diseases, brain tumors, hemorrhage and trauma.
Aftercare
Medical follow-up examinations diagnose the extent of the damage and impairments that can be attributed to cognitive dysphasia. The appropriate therapeutic measures are then derived from this. Logopedic therapy is geared to the resources and skills in language and communication. In this way, medical and logopedic treatment will be based on common objectives.
An early start will contribute significantly to the preservation of the language and the ability to communicate. In addition, the improvement in the patient’s linguistic performance means that his cognitive performance does not deteriorate. In addition, strategies are shown with which the patient can correct the word-finding difficulties. Participation in community life is thus maintained. During the follow-up care, the involvement of the relatives with regard to the impaired communication with the patient is an important part of the therapy.
The duration of treatment is based on the success of the treatment and the needs and social environment of the patient. If goals have been achieved and there is no further therapeutic approach that could lead to improvements for the time being, the treatment is not continued. It may be necessary to have another follow-up examination by a specialist or speech therapist at a later point in time.