When it comes to language and cognition, there are a lot of mixed messages.

We know that aphasia affects language, not intelligence.

But we also know that language is a cognitive process, and many of the strokes that cause aphasia also damage other parts of the brain beyond the language centers.

So is aphasia a cognitive disorder? How do we address this potential overlap of language impairments AND cognitive impairments?

Let's look at the research

The research literature is filled with articles investigating just this topic. It turns out that many people with aphasia also have executive functioning problems (1, 2, 3). And attention deficits (4, 5, 6). And memory impairment (7, 8). Their cognitive skills are often lower than non-aphasic control subjects. (Not everyone mind you - but many.)

In many cases, their cognitive skills lag behind those without aphasia. Why? Perhaps it’s because our internal monologue, that little voice inside our head, plays a role in many cognitive tasks. Or maybe, strokes causing aphasia aren’t always laser-focused to damage only the dedicated language center. Regardless of the ‘why’, our priority is the ‘how’ - how we tackle it.

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Taking action

Our roadmap should be clear:

• Assessments that evaluate both language and cognitive abilities. Opt for non-verbal or low-language tests to uncover any cognitive disorders masquerading behind language barriers.
• Integrated treatment that pairs language and cognitive training. A weakness in attention or reasoning skills can often be the roadblock in language progress. Sharpening skills like self-awareness, self-monitoring, and self-correction can pave the way for better communication.
• Start with attention and simple cognitive exercises before moving to language-based tasks, especially in severe or global aphasia. Building up basic analytical skills will only help when it comes to communication therapy.

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Through all this, two guiding principles remain:

1) Presume competence. Our clients, regardless of their impairments, are the same individuals with their unique personalities, aspirations, and experiences. They deserve our respect and confidence in their abilities.

2) Focus on communication. Even with impairments in memory, attention, or executive functioning, communication is the core of what we treat as speech pathologists. Everyone has needs and ideas to express, and communication is how we connect with others. Tie cognitive treatment into communication goals so the outcomes are more tangible and applicable to daily life.

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Warmly,

-Megan

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P.S. We're hard at work on bringing you more cognitive treatments that can be used with people of all diagnoses and severities. Watch for an announcement soon! In the meantime, here's how to use our apps for cognitive-communication therapy.​