Cognitive Impairment and Dementia

In this episode of Brain Friends, we delve into the complexities of cognitive function and its disorders. 

Angie shares her personal journey with cognitive impairment following a stroke, highlighting the challenges of aphasia and adapting to a "new normal."

 Dr. Seles provides insights into the differences of cognitive testing, explaining why certain tests are designed for specific populations and the importance of normalized testing.

What you'll learn:

• How strokes, TBIs, and dementia affect the brain differently
• Learn about the key indicators and testing differences that help diagnose cognitive impairments.

Tune in to gain valuable knowledge for individuals facing cognitive challenges.

https://www.cognitiverecoverylab.com/seles

https://aphasia.org/stories/announcing-the-davetrina-seles-gadson-health-equity-grant-program/

Our beloved colleague, Dr. Davetrina Seles Gadson, passed away January 11, 2025. Dr. Gadson was an extraordinary speech-language pathologist and neuroscience researcher who devoted her energy to studying health disparities in aphasia recovery. She was a fierce advocate for improving services for individuals with aphasia, particularly Black Americans. Her research transformed our understanding of these health disparities and shed light on how we can address them. We were privileged to have Dr. Gadson as a cherished member of our lab community for four years, first as a postdoctoral fellow and then as an Instructor of Rehabilitation Medicine. She was still a close collaborator and friend to many of us at the time of her passing. Dr. Gadson was an incredible person—compassionate, inspiring, and full of life. Her dedication to advancing equity in aphasia recovery and her profound impact on our community will never be forgotten. We are committed to honoring her memory by continuing to push our field forward and fight for equitable services for all people with aphasia. 

Transcript

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SPEAKER_03 0:00

Welcome to Brain Friends, where two neuronerds talk all things aphasia, language recovery, culture, and community. I am Dr. Datrina Celeste Gatson, a clinical speech language pathologist and neuroscientist.

SPEAKER_02 0:13

And I am Angie Cawthorn, stroke survivor and aphasia advocate.

SPEAKER_03 0:19

Welcome to our show. Welcome to Brain Friends. We want to thank all of our listeners for downloading the podcast. We appreciate everyone listening, so please tell a friend to tell a friend that we are here. And we are.

SPEAKER_02 1:31

For real. And we took Chuck Brown's beat from busted. Love Chuck Brown. And he was so cool. We called him, right? Because we took the album. We made the album first. We didn't ask for permission to sample his music. And so we were like, if it goes well, we'll we'll deal with that on the back end. Because we'll rather ask for forgiveness than ask for permission. And we ain't had no money anyway. So when we finally caught up with him, or he caught up with us, he was like, Look, I gotta do my voice.

SPEAKER_00 1:58

Look, look here, girl, look here. I'll tell you what. Give me a thousand dollars, we'll call it easy. Look here, girl.

SPEAKER_02 2:05

We could not wait to pay Mr. Brown. So we gave him a thousand dollars. He let us use the beat or he didn't fight us on it. And when they play his song, when they play his song, they play our song, or vice versa. So it's pretty cool. So it helped him a lot too. Shout out to uh the Mr. Mr. Go Go, Mr. DC himself, Mr. Chuck Brown. Hooked this up. But my best time in my career, the most fun I've had, was running those streets for the record company. They used to call me Roadrunner. Wow. Yeah, yeah. And the reason I had to stop is because Roadrunner is not nobody's wife. So I wanted to be a wife more than I wanted to be known as Roadrunner in these streets. Wow. I bet that was so fun. Anyway, what about you? What is your most fun thing? The fun thing in your career? And you've had uh this is gonna be good.

SPEAKER_03 3:01

So I would say the best time that I had in my career is when I worked as a travel speech language pathologist. Really? Yes. Oh my gosh, it was so much fun. So I would pack up whatever fit in my car and just drive to a new location every three months. Unless the location was dope, I would stay um for six months. And I lived in Dallas uh when they won the um NBA championships. I lived in South Padre Island during the dead of winter, and that was like so fun on the beach in Chicago. I just I learned so much doing that. I made a lot of money too. That's generally the best part. Yeah, it was it was so much fun. I met so many different people. I was able to see how people practice therapy differently, and it was just one of the most amazing experiences that I've ever had in my career.

SPEAKER_02 4:09

I have a question. So if you so you they would pretty much you were almost deployed. It sounds like a deployment almost.

SPEAKER_03 4:18

Right. Yeah. So they would call and then they would say, you know, can you go to this location? And oftentimes you were either covering for a maternity leave or just the facility didn't have didn't have, you know, staffing. I remember even when I was getting my PhD, I connected back with my travel agency and traveled to like Rome, Georgia during the summertime to to do therapy. It was just, it was just so much fun. And and I also remember it was so funny. I was l living in Baltimore, so Baltimore was my home base, and I had taken a job in Texas, South Padre Island, Texas, and I didn't have lodging yet. And so it was a 30-hour drive from Baltimore to South Padre, Texas. And so my mom, you know, said that she would drive me, drive with me down there. And we're probably about two hours or three hours from the location. And she's like, So tell me about the place that you're staying in. And I was like, Oh, I figure we find it once I get there. You driving 30 with mom's in the car. Oh, she was like, Oh my god, like, of course, now that's why I just think it's so amazing how like the older you get, there are just some things that you're not gonna do. But just being younger, I was just like, Oh, I'll find a place once I get there. It's fine. And it was a beautiful place, too. So it worked out. Oh, it worked out. Of course it did. Of course it did.

SPEAKER_02 6:01

Yeah, I need to know where I'm staying. I want to do a BB, but I feel like I'm always afraid, like, I've I feel like people know I'm a visitor and I don't feel as safe as I would at a hotel.

SPEAKER_03 6:15

I like, I mean, so sometimes I think Airbnbs are good. Like when I went to um Mikanos, Greece, we had a beautiful Airbnb. Oh my gosh, it was so gorgeous. Yes, but then sometimes I want to be catered to. So that's where I want to stay in a hotel, right?

SPEAKER_02 6:36

Because as beautiful as it is in Airbnb, you gotta break breakfast yourself, right?

SPEAKER_03 6:42

Well, we hired we hired chefs, but you did. Yeah, you did. Okay, come on, girls. You're like, whoa, I mean, if I be an artist, we had a butler in our B. I mean, I I want to hear about that trip, and I may or may not take this part out. I want to hear about this trip. Oh my gosh, it was, I mean, it was when I graduated with my PhD. I did an Athens to Athens. So it was Athens, Georgia, to Athens, Greece. And so we did Athens, Greece, Mikano, Santorini. It was just everything I knew I needed. I will, yeah, it was it was so much fun.

SPEAKER_02 7:23

Was it? Yeah. I'm missing out on I go into Greece.

SPEAKER_03 7:27

Oh, you definitely want to go to Greece. Oh, I need to know. Yeah, uh missing out.

SPEAKER_02 7:32

I need to know.

SPEAKER_03 7:33

Oh, yeah, you definitely want to go. It's so beautiful. And you know, whether you do it couples or friends, I mean, I would definitely go back. Greece is the only trip that I actually lost weight because they don't put a lot of preservatives in their food. So the food was so healthy, like everybody on the trip lost weight in Greece because all of the food was so natural, so healthy.

SPEAKER_02 7:56

Yeah, they let us just they they don't our government doesn't protect our food in the way you would think.

SPEAKER_03 8:02

That's an episode, and you know, unless Oh, that's definitely we could talk about how food influences the brain.

SPEAKER_02 8:11

Oh my goodness. It yeah, it makes you certain food makes you foggy. And it's like it causes it makes it worse. Yeah. And then you have to kind of go through this ritual of kind of figuring that out for yourself. And so then you're like, is it the food I'm eating? Is it just mild cognitive impairment? Or is it dementia? Like, you know what I mean? Or can I help some of these things with food? Right. Speaking of which, today we're going to be talking about the I don't want to, well, the differences and the similarities of dementia, aphasia, and mild cognitive impairment.

SPEAKER_03 8:53

Well, when we think about mild cognitive impairment, it it has to be severe enough changes in your cognition to where it affects your ability to do activities of daily living. So you have a significant um decrease in the ability to concentrate or the ability to find words. You're noticing a significant decrease in your short-term memory, so much so that it's starting to affect your ability to navigate what you normally do. So your activities of daily living, um, challenges recalling detail conversations or writing. But again, it has to be to the point where it's really, really noticeable.

SPEAKER_02 9:44

So by the time it's really, really noticeable, it's I I feel like at that point it's already too late, though.

SPEAKER_03 9:51

No, because some of the things that people also have to realize is that aging is gonna create some of its challenges, just your normal aging. And so when we think about normal aging that begins in adults over 50, you know. When we think about normal aging things, you're gonna see a slight decline in your selective attention. So your ability to talk on the phone while driving, or your ability to, you know, multitask, having some of those divided attention types of ability. So you're doing one thing and then going to do another. You might have some of those tip of the tongue experiences, but that's all considered normal aging because you're still able to go throughout your day.

SPEAKER_02 10:56

So the stuff that you lose stuff that happens naturally, is there a way to let's just say, like for myself, I have the problems I have mild cognitive, right? How would a doctor, if I know it runs dementia runs in my family, would I know the difference? If there is a difference, how would I know that, oh, this is something, this is just my normal my new normal versus this is something that might be more on a hereditary side?

SPEAKER_03 11:35

Well, there are tests, so there's there are different tests that one can do, um, whether it's a speech language pathologist or going into going to a neuropsychologist. And so a neuropsychologist can also do some of these tests, but um, some of the tests might be a uh Alzheimer's disease assessment scale, or one of the tests that speech language pathologists can give is the Arizona battery for communication disorders of dementia.

SPEAKER_02 12:11

Oh, well, I was thinking you were gonna like throw the WAB in there. And I know we talked about that on a previous episode, but would the WAB be something that they could take as a just an assessment for Alzheimer's as well?

SPEAKER_03 12:28

No, because the Western aphasia battery, when you look at those tests, they have to be normalized within a certain group. And so the Western aphasia battery was normalized in individuals that have had stroke. And that's why that test is appropriate for people with aphasia or I'm sorry, people with stroke as a result of aphasia is looking specifically at language versus your dementia related test, are looking at individuals that may not have had any type of neurological episode, an acute episode, something that just happened, but they're experiencing some of these difficulties. Also, it's going to the dementia type tests, are going to look at like cognition in addition to naming.

SPEAKER_02 13:29

Right. You might be able to name it, but your cognition is off, it's really jumbled.

SPEAKER_03 13:39

Right. Right. Because when we think about language as a cognitive function, it's more than just your ability to name words or have your vocabulary as a cognitive function. You're also thinking about, and I think you've talked about this sometime, the the sound, like the perception. Um you're also looking at the prosody, so the the how someone's um intonation or expression goes into you understanding what's going on. So if I'm, you know, happy, happy, hey, right, I can it when language really functions solely as a cognitive part, you might not be able, the person might not be able to pick up that the way I'm saying something is giving a more happy tone. They're like, Well, why is she smiling?

SPEAKER_02 14:41

Right, right, right. No, and that that actually sounds legit within what I'm going through, what I went through with the stroke. Um, but I think they call that emotional live, emotional, what did it help me out? Throw me a bone.

SPEAKER_03 14:56

Emotional liability.

SPEAKER_02 14:58

Liability.

SPEAKER_03 14:58

I always like when you're emotionally labal. Do that emotionally label, not liability.

SPEAKER_02 15:04

Not liability and not libations. Libation is a drink. Yeah, you're emotionally labeled, right? Okay, and I think I did because it was definitely my emotions were trash, right? My emotions were trash. That's I don't even I can't even trash. Uh took me a while to kind of get them under under wraps. But with the and that affects if you have brain damage, the Alzheimer's would affect you emotionally more so than a stroke would.

SPEAKER_03 15:43

Sometimes it depends on where the stroke occurs, because if the stroke is in the frontal lobe, which can deal with behavior and emotion, then that could be why someone can be more emotional. And the same thing with, you know, when we think about a dementia or any other type of progressive disease, that's kind of just going, no territory is off limits.

SPEAKER_02 16:14

Okay, so we can hit any part of the brain.

SPEAKER_03 16:17

Right.

SPEAKER_02 16:19

Right now, if it and but if it affects the back base of the brain, the cortex, then it's right, is that did I say something wrong?

SPEAKER_03 16:29

No, the the um the like the occipital lobe, not the occipital lobe.

SPEAKER_02 16:35

Um, oh man, I don't have my um like the back of the very back of the brain that holds like if you had a major stroke there, you're probably not gonna walk again. Like oh the cerebellum. Cerebellum. I what did I say? I said something else. The cerebellum. If you would have it like dementia in the cerebellum, then is that a thing?

SPEAKER_03 16:59

Um, I haven't necessarily heard of that. Not to say, don't come for me, don't come for me, not to not to argue with her in these comments.

SPEAKER_02 17:10

We need these comments. You can let them argue with you.

SPEAKER_03 17:13

All right, fine. Come for me if you must. I haven't necessarily heard of it going um in that way. Most of the time, is it can be, you know, well, I guess if it vascular, it can, you know, maybe affect your your gait, your ability to like walk and and structure. Wow.

SPEAKER_02 17:40

It the brain is so fascinating.

unknown 17:42

Isn't it?

SPEAKER_02 17:43

It really is, and the way it it heals itself, how much is known, how much is still not known, right? It's kind of what blows me away as I uh avail myself to research and just being in the room with much, much smarter people. Uh, and shout out to uh the NAA. I met your friend Peter. Oh, Peter Turkletov. He is an amazingly smart, nice, kind man.

SPEAKER_03 18:12

We got to get you down to Georgetown. They're actually doing an Alexia study right now, so a reading study, which I think is top-notch. Isn't well, I'm a little biased, but yes. I think it's I think it's one of those areas that we're still trying to understand, like how people read, what systems are they depending on when they read. When I think about dementia or even like Alzheimer's disease, which is like a later state, in those later stages, you do lose motor function. And so, you know, that could be because it's target, you know, it's it's trickling down. But again, dementia is a cognitive impairment where Alzheimer's disease is diagnosed after death because there's like a specific neuropathology that goes with Alzheimer's disease. So I know we're saying I'm a little interchangeable, but I I just learned that.

SPEAKER_02 19:14

So I'm gonna ask you to say that again because I did not know that. So wait a minute, let me make sure I understand you, and then you can correct me from there. So if you have dementia, you can have dementia in the doctor's office, but I can't have Alzheimer's until post-mortem.

SPEAKER_03 19:31

Right. Well, so oftentimes, and again, this isn't this would be uh a better question for like a neurologist, but oftentimes yes, Dr. Turkletov, Dr. Um Roy Hamilton. So when we think about dementia, it's primarily associated with memory loss, but it's caused by a variety of diseases, not just Alzheimer's, because the main the main thing that is dementia, how aphasia is a loss of language and a loss of you know words. Dementia is the memory loss piece, is its hallmark feature.

SPEAKER_02 20:15

Right, and Alzheimer's is the end result of uh some of what a dementia could have been caused by.

SPEAKER_03 20:27

Alzheimer's is a type of dementia, right? That's what I'm trying to say. It's a subcategory of exactly because dementia can be due to like Huntington's disease or you know, some of the other diseases, but Alzheimer's is a type of dementia that is usually fully able to say this is Alzheimer's after death, because then they have to see, you know, if you have what they call plaques and tangles and all the things that are not something that I study.

SPEAKER_02 21:10

Okay, all right. That that makes sense. That makes perfect sense. I didn't know about it being um that you needed an autopsy. I'll I'll uh you had the uh post-mortem cut to see in the brain for Alzheimer's. That I didn't know. Um, because it runs uh insanely heavy on my uh my mother. I know she was showing signs, but she passed away before it got bad. Uh shout out to mom. Uh oh. Yeah, she was showing signs, but uh my aunt had it uh terribly bad, and my father uh experienced problems with it as well. But um my aunt it hit her really, really hard. And it was like I I realized after she had kind of gone through part of it, there was a part of it that was actually aphasia. That when I had my stroke, I called my cousin, and I'm like, she has aphasia. Or she did. Now she might be far along now. She was too far along for me to come up with my, you know, my grand um uh diagnosis at that point. But I felt terrible that when I remember asking her, you know, who's this TT? And she would want to say the name, or you say, Do you know who this is? She's like, Yeah, I know who that is. Well then who is it? And she couldn't say it. Well, then you don't know it. Because again, like I've said in numerous times, if you only know you're not judged by what you know, you're judged by what you can prove you know. And either you know this is who I said this is in the picture, or you don't. And if you don't, then you don't know. And see, she has Alzheimer's when it was actually the beginning stages, so it was really just aphasia or presenting as what I know as to be aphasia now. But before I didn't know there was a thing that you could look at a picture, know who the person was, and couldn't say the name. I experienced that in the very beginning of my stroke, and I remember going back to I was still in my first therapy, and uh my niece asked me, Yeah, Aunt Angie, you know, who's this in the picture? And I went to go tell her who it was, and I couldn't say the person's name, and I knew who it was, and it was like, Oh, well, what we're not saying pancake no more. We need to work on the fact that I can't call my family's names in these pictures. That's more of a concern to me than saying pancake or saying whatever dump um whatever stuff they had me saying that I felt to be not only remedial, not only insulting, but at that point not helpful in what I really needed. What I needed to do was be able to call my family members in my in this picture on demand, because I could do it if it wasn't on demand, right?

SPEAKER_03 24:12

I think that that's why it's so important for individuals, whether they're treating aphasia. And I definitely know that this is something that they do, you know, with dementia therapy, which is using objects that are familiar to the person. So objects, pictures, you know, what have you. So then the individual is able to participate in some of these one-on-one conversations or just feel a part of the things because they know they know. I think the other thing that is different between when we think about dementia and some types of aphasia is that with aphasia, if it's not in your, excuse me, with aphasia, if it's not in your temporal lobe, then you, or sometimes your frontal lobe, you can catch yourself if you say something that's wrong. Like, so you might say, Joe, no, no, it's not Joe. It's you recognize that, versus sometimes with dementia, because of the widespreadness of the the I don't know if that's the word widespreadness, but because it's so wide, the widespread. Yeah, widespread widespread. Widespreadness. Um like you could call you Joe, and then it's like, oh well, I don't know what's coming out.

SPEAKER_02 25:52

Right, you Joe. You Joe. Today you are you you're gonna be Joe today, right?

SPEAKER_03 25:59

So that's why a lot of times with dementia therapy, they they talk about, and again, I'm not super well versed in in this part, but they talk about being careful of bringing the person back to where they are, meaning, let me clarify, meaning, like, if someone keeps referring to their parent that might be deceased, not to continually be like, you know, she did, but to say, oh, well, she's not here right now, or you know, to help kind of come into their world, because in a couple of minutes they might be out of that, out of that stage.

SPEAKER_02 26:46

And one thing I can say is when you do that, if you tell them that the person has passed on, they'll be hurt and they'll relive all of that as if it just happened, and then they'll be sad in five minutes. They'll forget what you told them, but they won't re won't forget that they're sad. And now you have somebody who's depressed, they don't know why they're so sad because they've forgotten the the stimuli that made them depressed or hurt their feelings, but five minutes later, they still know that they're hurting, right? So absolutely be careful with that. And I definitely noticed that. Uh, again, shout out to TT. I noticed that with her as well. Um, and yeah, go into the cave with your person, right? Try to get them coaxing them out because sometimes you have to go in and just sit with them where they are, not where you want them to be.

SPEAKER_03 27:43

Exactly, where they are, not where you want them to be. I think that we need so much more research on dementia, and I have a really close girlfriend of mine whose mom has dementia, and the caring, how caring she is, and how patient she is, is just something that I didn't learn, and what she's going through with her mother is something that I feel like I didn't really learn in school, to the point of I really can't tell her different things to do. Like she really knows more than me as the caregiver. And I think that the research that needs to be done has to involve the patient, the caregiver advocate. It cannot just be I'm the expert and let me do this dementia research because the family is dealing with so many more, and I think that they could really help us understand, better understand dementia.

SPEAKER_02 28:48

Absolutely, and bringing people in um to help tell their stories in the more stories, the more we can help those people that are coming down the road behind us. Yeah, you know, because it's not it is what it is where I stand. Um, but if I can help somebody else, why not help?

SPEAKER_03 29:14

Yeah, well, Angie, this has been so great. I am just so excited to have this platform with you, and thank you.

SPEAKER_02 29:28

You are the Dr. Z. This has been an absolutely phenomenal thank you for everything that you do, and you teach me so much every time on the mic, I learn something new that I can take out and and share with my friends and my community here. So thank you so much for that.

SPEAKER_03 29:46

Oh, thank you, Angie. Bye. Peace, y'all. We hope you enjoyed this episode of Brain Friends. Please leave us a five-star review on Apple Podcasts for your favorite streaming platform. Also, make sure you subscribe to our YouTube channel.

SPEAKER_02 30:08

Brain Friends the Podcast.