Neurogenic and Acquired Communication and Swallowing Disorders in Adults
Domain 3 tests adult acquired disorders: aphasia, dysarthria, apraxia of speech, right-hemisphere cognitive-communication disorder, dementia-related communication change, and dysphagia. The exam emphasizes lesion-based reasoning, differential diagnosis, safety, and functional goals.
Core rules
- Aphasia is a language impairment affecting comprehension, expression, repetition, naming, reading, or writing. Dysarthria is a motor speech execution disorder; apraxia is impaired planning/programming with inconsistent errors and groping.
- Right-hemisphere damage often affects pragmatics, prosody, attention, insight, and discourse rather than core phonology or grammar. Dementia affects cognition and communication progressively.
- Dysphagia assessment considers alertness, oral control, cough, voice change, residue signs, and nutrition. Instrumental assessment is needed when aspiration risk or physiology is unclear.
Worked example
A 72-year-old with a left frontal stroke has effortful, nonfluent speech, agrammatic output, relatively preserved yes/no comprehension, and impaired repetition. This pattern fits Broca’s aphasia rather than dysarthria because language formulation and grammar are affected, not just articulation. The plan should include supported conversation, auditory comprehension tasks, naming/word-retrieval work, and a swallow screen before oral intake.
Traps
Do not call aphasia “confusion.” Do not miss silent aspiration because a cough is absent. Do not treat apraxia as muscle weakness. Do not ignore depression, fatigue, hearing, or cultural/language background. Do not write goals for impairment alone without functional communication or swallowing outcomes.