What is Cognitive-Communication?

Cognition is made up of nine main skills. These are: information processing, attention, memory, problem solving, flexibility, planning and organising, reasoning, self monitoring, and insight. Cognitive skills are usually controlled by the brain’s frontal lobe.

When a person has impaired cognitive skills, one or more of the above areas can be affected. Our brains are unique, so damage to one person’s brain will present differently to another person.

A cognitive impairment will impact many aspects of a person’s life. For this article, we are focusing on communication. So, let’s look at each area of cognition. Behind each tile you’ll find examples of communication changes that occur as a result of problems with that cognitive skill. All of the communication changes on this page are examples of cognitive-communication impairment.

NOTE! It is rarely this clear-cut. A person often has impairments in more than one cognitive skill. Which means that if conversation with a person is disjointed and hard to follow, that could be related to multiple cognitive skills including memory, attention, planning, or reasoning.

A cognitive-communication impairment is caused by neurological (brain) damage. The most common causes are:

• traumatic brain injury (TBI)
• stroke
• tumour
• progressive diseases such as dementia

Cognitive-communication disorders are common after severe TBI, with over 70% of people experiencing some level of communication disability as a result of their injury.

In progressive diseases such as dementia, cognitive-communication changes are subtle in the beginning. For example, some word finding difficulties or going over the same ground in conversation. Changes often take place slowly, and can creep up on you. Suddenly you realise that communication with your loved one with dementia is not the same, and you can look back and recognise situations of communication breakdown that you can later attribute to a dementia diagnosis.

Regardless of the cause, cognitive-communication disorders can have significant effects on employment, friendships, school, and community life. When a person has difficulty explaining or understanding information in a way that is logical, efficient, friendly, and/or helpful, that can be a real barrier to successful work and personal relationships.

Speech pathologists are the professionals responsible for assessing and diagnosing a cognitive-communication impairment. When assessing a person’s cognitive-communication skills, we must be clear about the purpose of the assessment. We never assess a person just to highlight all the things that are wrong with them! We have a range of tools available so that we can get an accurate picture of a person’s strengths and areas of weakness, and so that we get the information we need to help that person in their life.

An an example of the different ways we assess cognitive-communication:

• If a person tells us that conversations with family are a problem, we might ask for an audio or video recording of the person in conversation with their family, which we can then use to complete a discourse analysis.
• If a person tells us that explaining things at work is an issue, we can assess the person’s ability to tell stories and procedures, then use standardised assessments which include problem solving, verbal explanation, and verbal reasoning tasks.

Wherever possible, we will be in touch with members of the multi-disciplinary team to get a comprehensive picture. Often the person has already completed a Neuropsychological Assessment and this report is extremely useful to the speech pathologist when diagnosing a cognitive-communication impairment.

Here are some of my favourite assessment tools:

In addition to conducting an assessment, speech pathologists are the professionals responsible for treating cognitive-communication impairments.  We will design a treatment plan to meet an individual’s goals and situation

Fortunately we can turn to high quality publications for treatment advice, such as the INCOG 2.0 Guidelines for Cognitive Rehabilitation Following Traumatic Brain Injury, Part IV: Cognitive-Communication and Social Cognition Disorders. This excellent paper, published in 2023, provides a framework for treating cognitive-communication impairments. There is renewed focus on cultural responsiveness, interprofessional practice, meaningful outcomes, and personal identity, as part of cognitive-communication treatment.

Here is the INCOG 2.0 list of recommended treatments for cognitive-communication impairment after brain injury:

These interventions can be delivered in different formats. Treatment sessions might take place one-to-one, in a group, in person, or online using telepractice. All of these formats are effective.

If you are interested in online treatments, you MUST check out Social-ABI-lity. In 2022, the University of Sydney released this online treatment program for people with acquired cognitive-communication impairments and it is free and backed by research. You can find it here: Social-ABI-lity

For cognitive-communication impairments associated with dementia, we might take a slightly different approach. We have a separate article on our website which summarises evidence-based interventions in dementia. You can find that article here: https://wollongongspeech.com.au/speech-pathology-intervention-in-dementia/