Cognition and Acquired Language Disorders

366 Pages·2012·10.22 MB·English

Richard K. Peach, PhD
Professor
Department of Communication Disorders and Sciences
College of Health Sciences
Rush University
Chicago, Illinois
Lewis P. Shapiro, PhD
Professor
School of Speech, Language, and Hearing Sciences
College of Health and Human Services
San Diego State University
San Diego, California
3251 Riverport Lane
St. Louis, Missouri 63043
COGNITION AND ACQUIRED LANGUAGE DISORDERS: ISBN: 978-0-323-07201-4
AN INFORMATION PROCESSING APPROACH
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Dedication
To Patti and Kevin
For reminding me every day what’s important
Richard
To Mitzi, Joelle, and Dillon
My candles in the dark
Lew

CONTRIBUTORS
Alfredo Ardila, PhD, ABPN Bruce Crosson, PhD
Professor Department of Veterans Affairs
Department of Communication Sciences Brain Rehabilitation Research Center of
and Disorders Excellence
Florida International University Malcolm Randall VA Medical Center
Miami, Florida Department of Clinical & Health Psychology
College of Public Health and Health Professions
Kathleen Brumm, PhD pending University of Florida
SDSU/UCSD Joint Doctoral Program Gainesville, Florida
School of Speech, Language, and Hearing
Sciences G. Albyn Davis, PhD
San Diego State University Communicative Sciences and Disorders
San Diego, California New York University
New York, New York
Michael Cannizzaro, PhD, CCC-SLP
Assistant Professor Argye E. Hillis, MD, MA
Graduate Program Coordinator Executive Vice Chair and Professor
Department of Communication Sciences Co-director, Cerebrovascular Division
and Disorders Department of Neurology
The University of Vermont School of Medicine
Burlington, Vermont Johns Hopkins University
Baltimore, Maryland
Thomas H. Carr, PhD, MS
Professor Jacqueline J. Hinckley, PhD, CCC-SLP
Department of Psychology Associate Professor Emeritus
Michigan State University Department of Communication Sciences
East Lansing, Michigan and Disorders
University of South Florida
Carl Coelho, PhD Tampa, Florida
Professor and Department Head
Communication Sciences Department Susan Kemper, PhD
University of Connecticut Roberts Distinguished Professor
Storrs, Connecticut Department of Psychology
University of Kansas
Matthew L. Cohen, MS Lawrence, Kansas
Department of Clinical & Health
Psychology Swathi Kiran, PhD, CCC-SLP
College of Public Health and Health Associate Professor
Professions Speech Language and Hearing Sciences
University of Florida Sargent College of Health & Rehabilitation
Gainesville, Florida Sciences
Boston University
Assistant in Neurology
Massachusetts General Hospital
Boston, Massachusetts
v
vi Contributors
Tracy Love, PhD Liana S. Rosenthal, MD
Professor Department of Neurology
School of Speech, Language, and Hearing School of Medicine
Sciences Johns Hopkins University
San Diego State University Baltimore, Maryland
Center for Research in Language
University of California, San Diego Chaleece Sandberg, PhD Student
San Diego, California Speech Language and Hearing Sciences
Sargent College of Health & Rehabilitation
Nadine Martin, PhD, CCC-SLP Sciences
Professor Boston University
Department of Communication Sciences Boston, Massachusetts
and Disorders
College of Health Professions and Social Work Lewis P. Shapiro, PhD
Temple University Professor
Philadelphia, Pennsylvania School of Speech, Language, and Hearing
Sciences
Randi Martin, PhD, MS College of Health and Human Services
Elma Schneider Professor San Diego State University
Department of Psychology San Diego, California
Rice University
Houston, Texas L. Robert Slevc, PhD
Assistant Professor
Richard K. Peach, PhD Department of Psychology
Professor Program in Neuroscience and Cognitive Science
Department of Communication Disorders University of Maryland
and Sciences College Park, Maryland
College of Health Sciences
Rush University Leanne Togher, B App Sc (Speech Path), PhD
Chicago, Illinois NHMRC Senior Research Fellow
Associate Professor
Josée Poirier, PhD Discipline of Speech Pathology
Research Scientist The University of Sydney
Language Processes Laboratory Sydney, Australia
School of Speech, Language, and Hearing
Sciences Julie A. Van Dyke, MSc, PhD
San Diego State University Senior Research Scientist
San Diego, California Haskins Laboratories
New Haven, Connecticut
PREFACE
Clinical practice associated with acquired lan- of our higher mental processes. The study of human
guage disorders has evolved in important ways language provides a unique way to understand human
in the past 30 years as a result of advances in our nature, to do cognitive science, to dig deep into the
understanding of the cognition of language. In 1982, science of mental life (Boeckx, 2010). This is the goal of
the Committee on Language of the American Speech- psycholinguistics, the study of the mental processes and
Language-Hearing Association (ASHA) defined language types of knowledge involved in understanding and
as a rule-governed behavior that can be described by at producing language in both its oral and written forms.
least five parameters—phonological, morphological, syn- Psycholinguistics examines “listening, speaking, read-
tactic, semantic, and pragmatic—for which “learning ing, and writing, trying to discover the cognitive
and use are determined by the interaction of biological, machinery and knowledge structures that underlie these
cognitive, psychosocial, and environmental factors” skills and what role they play in linguistic behavior”
(ASHA, 1983). The separation of language and cognition (De Groot, 2011, p. 2).
in this definition was reinforced in a subsequent report In the case of language, impairments to such intrinsic
by a subgroup of the same committee (the Subcommit- cognitive processes, whether they are attentional, memo-
tee on Language and Cognition) to address the roles rial, linguistic, or executive, can produce language disor-
of the speech-language pathologist in the habilitation ders. Breakdowns are not ones of processes that “interact”
and rehabilitation of cognitively impaired individuals with language abilities. Rather, such breakdowns occur in
(ASHA, 1987). In that report, cognition was described, processes that are fundamental to language itself. For this
using Neisser’s (1967) definition, as “the processes by reason, we use the term acquired language disorders in this
which sensory input is transformed, reduced, elaborated, text in lieu of the less desirable but well-entrenched term
stored, recovered, and used” and was considered sepa- cognitive-communication impairments to emphasize the
rately from language. In portraying “cognitive-language unity of cognition and language. From a cognitive neuro-
relationships,” the report went on to list the “specific psychological perspective, acquired language disorders
cognitive impairments that may affect language” by are but one example of the larger class of cognitive disor-
contributing “to deficits in the semantic, syntactic, pho- ders (Lezak, Howieson, & Loring, 2004; Rapp, 2002).
nologic, and/or pragmatic aspects of language.” The in- Identification of the processing impairments that con-
dependence of the communication problems arising tribute to different types of acquired language disorders
from these “cognitive” deficits from other types of lan- provides a basis for informed approaches to language
guage disorders was emphasized and thus gave rise to the intervention and rehabilitation.
category of so-called cognitive-communication impairments. Cognition and Acquired Language Disorders
Cognitive-communication impairments were defined as is designed to be used as a primary textbook in graduate
“communicative disorders that result from deficits in courses addressing the cognitive aspects of communica-
linguistic and nonlinguistic cognitive processes” (p. 54). tion. Information is assembled in a consistent frame-
The distinction between cognitive-communication and work composed of (1) normal cognitive processing for
language disorders was further highlighted in the scope language in adults, (2) the cognitive impairments un-
of practice for speech-language pathology (ASHA, 1990) derlying language disorders arising from a variety of
with statements partitioning the practice for language neurological conditions, and (3) current assessment and
versus cognitive-communication disorders. These dis- treatment strategies for the management of these disor-
tinctions continue to be upheld in more recent updates ders. The text is organized using an information pro-
of these clinical practice documents (ASHA, 2003, 2005, cessing approach to acquired language disorders and
2007). The descriptor cognitive-communication impair- thus can be set apart from more traditional syndrome-
ments has evolved in some quarters into the even more based approaches (e.g., stroke, dementia, and traumatic
problematic term cognitive-linguistic deficits. brain injury). In syndrome-based approaches, numerous
These approaches suggest, as Davis (this volume) neurological conditions that produce acquired language
explains, “that cognition plays a role in language and disorders (e.g., tumor, infection, degenerative diseases,
communication, or that it is related to language and com- and multiple strokes) are often ignored. In the current
munication, as if ‘language’ and ‘cognition’ are different processing approach, the language disorders that result
things.” They are not. Language is part of cognition, part from a variety of neurological conditions are treated as
vii
viii Preface
being more similar than the specific etiologies them- We want to express our thanks to the authors, all
selves. As just one example, working memory and atten- experts in their chosen areas, for agreeing to contribute
tion are considered “domain-general” operations that their work to this text. We are confident that the breadth,
are disrupted in several types of disordered populations. depth, and overall excellence of their work will make this
Similarly, the processing approach allows for the de- the most authoritative source available regarding cogni-
scriptions and treatments to be applied across multiple tion and acquired language disorders. Finally, we would
neurological groups who share specific cognitive deficits. like to thank Jolynn Gower, our managing editor at
The chapters of this text describe how attentional, Elsevier, for providing outstanding support and guidance
memorial, linguistic, and executive processes coalesce for the development of this text. We hope that you will
in language functioning. The language characteristics find it to be a helpful resource for the clinical manage-
of individuals presenting with a variety of neurological ment of acquired language disorders.
conditions that impair these processes are also addressed,
as well as the assessment and treatment of the resulting RKP
language disorders with reference to the specific types of LPS
underlying impairments. The intent is to provide an
advanced discussion of this material for both graduate
coursework in speech-language pathology and clinical REFERENCES
neuropsychology and to offer a reference for practicing
American Speech-Language-Hearing Association. (1983). Com-
clinicians in these disciplines.
mittee on Language: Definition of language. Asha, 24, 44.
The text is divided into four sections. The first section
American Speech-Language-Hearing Association. (1987). The
provides an overview of cognition and language, as well role of speech-language pathologists in the habilitation and
as tutorials describing the effects of aging on normal lan- rehabilitation of cognitively impaired individuals: A report
guage processing and the neurological conditions that of the subcommittee on language and cognition. Asha, 29,
are associated with acquired language disorders. The sec- 53–55.
ond section provides an in-depth discussion of normal American Speech-Language-Hearing Association. (1990). Scope
processing for attention, memory, language, and execu- of practice, speech-language pathology and audiology. Asha,
32 (Suppl. 2), 1–2.
tive functioning and serves as a foundation for the subse-
American Speech-Language-Hearing Association. (2003). Eval-
quent discussion of language disorders. The third section
uating and treating communication and cognitive disorders:
examines the cognition of acquired language disorders,
Approaches to referral and collaboration for speech-language
and the fourth section provides guidance for the clinical
pathology and clinical neuropsychology [Technical Report].
management of these disorders. Assessment and treat- Available from www.asha.org/policy.
ment protocols that are provided are based on a review of American Speech-Language-Hearing Association. (2005). Roles
current evidence so that students and clinicians will have of speech-language pathologists in the identification, diagnosis,
a ready clinical resource for managing language disorders and treatment of individuals with cognitive-communication
due to deficits in attention, memory, linguistic opera- disorders: Position Statement [Position Statement]. Available
tions, and executive functions. from www.asha.org/policy.
American Speech-Language-Hearing Association. (2007). Scope
Following the introductory material, the text pro-
of practice in speech-language pathology [Scope of Practice].
vides three chapters—one on normal processing, one on
Available from www.asha.org/policy.
disorder characteristics, and one on clinical approaches—
Boeckx, C. (2010). Language in cognition: Uncovering mental struc-
for each of the cognitive domains associated with lan-
tures and the rules behind them. Chichester, West Sussex, UK:
guage functioning and acquired language disorders. Wiley-Blackwell.
Although each of the chapters of this text can be studied Davis, G. A. (2012). The cognition of language and communica-
independently of the others, the structure of the text is tion. In R. K. Peach & L. P. Shapiro (Eds.), Cognition and acquired
designed to encourage instructors to complete the read- language disorders (p. 1). St. Louis: Elsevier Mosby.
ings for normal processing across all cognitive domains De Groot, M. B. A. (2011). Language and cognition in bilinguals and
before proceeding to discussions of their applied coun- multilinguals: An introduction. New York: Psychology Press.
Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsy-
terparts (i.e., disorders and interventions). This approach
chological assessment (4th ed.). New York: Oxford University
allows readers to fully appreciate the relations among
Press.
cognitive domains (e.g., attention and working mem-
Neisser, U. (1967). Cognitive psychology. New York: Appleton,
ory, working memory, and the central executive)
Century, Cross.
before proceeding to discussions of deficits within Rapp, B. (2002). The handbook of cognitive neuropsychology: What
these domains in acquired language disorders due to deficits reveal about the human mind. Philadelphia: Psychology
neurological impairments. Press.
SECTION  IntroductIon
ONE
1
CHAPTER 
The Cognition of Language
and Communication
CHAPTER OUTLINE G. Albyn Davis
Assumptions in the Study  Memory Executive Function
of Cognition  Long-Term Memory Language and Communication
Approaches to the Study  Working Memory A Closing Editorial
of Cognition  Information Processing in Working Conclusions
Attention Memory
For a long time, language has had a curious relationship This first chapter introduces cognition and how
to cognition in the vocabularies of rehabilitation practitio- it is studied, mainly in cognitive psychology. For
ners, as well as laypersons. Diagnosticians have neatly the study of language processes, psycholinguists and
divided and packaged disorders into separate categories. many speech-language pathologists use the methods
“Language” has been viewed descriptively with assistance to be discussed. Then, the chapter provides an orienta-
from linguistics (e.g., phonology, morphology, syntax), tion to later topics of attention, memory, executive
whereas “cognition” has been identified broadly with function, and language. Subsequent chapters will be
“intelligence” and specifically with mental functions more specific and expansive as to how cognition fuels
such as attention, perception, and memory. In some language comprehension, formulation, and communi-
quarters, morphology and memory have been considered cation. Mainly, the present chapter sets up the think-
to be two separate entities, despite the reality that we ing behind the investigation of cognition.
store morphology in our memory. To assess memory, we
use tests of cognition; to assess morphology, we use tests ASSUMPTIONS IN THE STUDY 
for aphasia.
OF COGNITION
It has been suggested that cognition plays a role in
language and communication or that it is related to Cognition is “an umbrella term for all higher mental
language and communication, as if “language” and processes . . . the collection of mental processes and
“cognition” are different things. However, if cognition activities used in perceiving, remembering, thinking,
is identified with information processing and we think and understanding” (Ashcraft & Radvansky, 2010, p. 9).
of language use as information processing, then it is In contemplating their history, “cognitive psychologists
consistent to think of language functions as embedded generally agree that the birth of cognitive psychology
in cognition. Language comprehension and formula- should be listed as 1956” (Matlin, 2009, p. 7). Around
tion are part of the cognitive system. When linguists this time, key publications and conferences steered
characterize what we know about language, they are psychology away from behaviorism. This change was
speaking of something in memory. driven by the Skinner-Chomsky debate over nurture
1
2 Chapter 1 n The Cognition of Language and Communication
versus nature, George Miller’s measure of short-term imaging) was not matching the constructs for measure-
memory as being around seven units, and interest at ment of mental operations. Now, with the emerging
Carnegie-Mellon University in the computer as an anal- fine-tuned technologies of functional neuroscience
ogy for human information processing. The shift was (Cabeza & Kingstone, 2006; Gazzaniga, Ivry, & Mangun,
complete when the Journal of Verbal Learning and Verbal 2008), current editions of texts on cognition include
Behavior became the Journal of Memory and Language in chapters on the brain and sometimes are regaled with
the early 1980s. Essentially, psychologists admitted that colorful pictures from brain imaging (e.g., Ashcraft
mental processes exist. & Radvansky, 2010). Nevertheless, one can conduct
This section introduces three of four assumptions experimental cognitive psychology without consider-
underlying the study of mental processes. They are pre- ing the brain and, as a result, can restrict theory
sented as a hierarchy of dichotomies in Figure 1-1. First, to functional matters (e.g., how memory works, as
there is a working distinction between behavior (as evidence) opposed to how the brain works).
and what happens in our heads (as theory). Similarly for In our everyday vocabularies, “brain” and “mind”
clinical diagnosis, we consider the relationship of what often refer to the same thing. Yet, saying that someone
we can observe (symptoms) to what we cannot observe has “lost his mind” does not mean that he has misplaced
(diagnosed impairment). Scientists avoid writing state- his brain (Box 1-1).
ments like “comprehension is a behavior” so that they In his text for speech-language pathologists, Davis
do not think carelessly and confuse one for the other. (2007a) encouraged clear thinking by recommending
Now that we are thinking inside the box, the second that we keep what happens to the brain (e.g., stroke,
assumption differentiates the brain as a material thing from trauma) logically distinct from what happens to cogni-
cognition as a mental thing. Because cognition is what tion (e.g., aphasia, amnesia). We can say that stroke
the brain does and, therefore, is not truly independent causes aphasia (not that aphasia causes stroke). Neuro-
of the brain, this dualism is largely a contrivance that is surgeons treat the brain, speech-language pathologists
reflective of a research strategy. Cognitive psychologists treat cognition, and so on. Whether cognitive-language
approached their work as if “the mind can be studied therapy re-wires the brain is a current question. At least,
independently from the brain” (Johnson-Laird, 1983). to understand the nature of aphasia, we should have
Through the 1980s, cognitive psychology texts barely some idea of what happens to cognition.
mentioned the brain. At that time, Flanagan (1984) Putting aside the brain, the third assumption focuses
stated that cognitive psychologists “by and large, sim- on cognition. Cognition consists of a fairly stable knowl-
ply seem not to worry about the mind-brain problem.” edge base and fleeting processes. This distinction was
This dualistic approach was necessary, because tech- helpful when clinical pioneer Hildred Schuell pro-
nology for observing the brain (e.g., fuzzy structural claimed that what we do about aphasia depends on
what we think aphasia is (Sies, 1974). A frequent ques-
tion has been whether aphasia is an erasure of language
Behavior Our heads knowledge or a disruption of language processing
(while knowledge remains intact). The answer informs
the broad approach to therapy, namely, whether it
involves teaching words anew (because of a “loss” of
Brain Cognition
Box 1-1
Dialogue from a 1988 Episode of Miami
Vice
Knowledge Process
Interrogator: What about the fact that he can’t
remember any of his actions? Isn’t that a
convenient lapse of memory?
Physician: The answer to your question is that I’m a
neurosurgeon. You’re questioning Detective Crockett’s
Automatic Controlled
mental capacities. That determination should be
Figure 1-1  A hierarchy of increasingly specific assumptions made by a psychiatrist.
underlying the study of cognition.