Cognitive Communication Disorders 101: Because it's not normal to lose the remote (kidding)
- Gina Britt
- Dec 17
- 9 min read
I once worked with a woman in a nursing home who was the picture of clarity during the day. She remembered names, told stories, and always asked how everyone else was doing before talking about herself. But every evening, right around the time the sun slid behind the parking lot trees, something shifted.
Her eyes would brighten in a different way and she would clasp her hands together like she was about to tell a secret. Then she would take off down the hallway with a little skip in her step, stopping at the tiny square windows and saying, look, look, I am on a cruise ship. Is'nt is wonderful here? The whole hallway became her deck, the handrails her safety rails, the tile floor the ocean she was gliding through. She was happy. Free.
And I was not going to take that away from her. I did not reorient her. I just let her be. Full of joy.
And that is where cognitive communication disorders often begin. Not with slurred speech but with small changes in how someone processes the world, how they follow conversations, how they connect, and how they make sense of things.
This guide will help you understand what those changes look like, why they happen, and what you can do to support someone you care about.
But the impact on daily life? Anything but subtle.
What Are Cognitive Communication Disorders?
Cognitive communication disorders happen when problems with thinking skills like attention, memory, problem-solving, or organization affect someone's ability to communicate effectively.
Think of it this way: communication isn't just about forming words or understanding vocabulary. It's about organizing thoughts, remembering what was just said, staying on topic, reading social cues, problem-solving in conversations, and managing the mental energy it takes to engage with others.
When any of these thinking processes break down, communication breaks down too, even if the person's speech sounds perfectly clear.
Who Gets Cognitive Communication Disorders?
These disorders can affect anyone, but they're especially common after:
Brain Injuries: Whether from a car accident, fall, sports injury, or other trauma, brain injuries frequently cause changes in how people communicate. Even mild concussions can have lasting effects.
Stroke: Many stroke survivors develop cognitive communication challenges, particularly after strokes affecting the right side of the brain. These often go undiagnosed because people assume if someone can talk, they're fine.
Neurological Conditions: Progressive disorders like Parkinson's disease, multiple sclerosis, and dementia frequently cause cognitive communication changes that worsen over time.
Developmental Differences: Some teens and young adults have cognitive communication challenges that stem from how their brain developed, affecting how they learned to process and use language socially.
The Hidden Impact: Why These Disorders Matter
Here's what frustrated me during my years in hospitals and nursing homes: cognitive communication disorders often fly under the radar in medical settings. Someone walks out of the hospital able to talk, so professionals assume communication is fine. Referrals to speech therapy get overlooked.
But the real-world consequences are heartbreaking:
Relationships erode because family members feel like they're talking to a different person
Jobs are lost when workplace communication demands become overwhelming
Social isolation increases as people withdraw from conversations that feel impossible
Mental health suffers as frustration and anxiety build
Independence decreases because people can't manage the communication demands of daily life
Without proper support, these challenges don't just go away on their own. They continue affecting every area of life, year after year.
What Does a Cognitive Communication Disorder Actually Look Like?
The signs vary widely depending on what caused the disorder and which thinking areas are affected. Here's what you might notice:
In Conversation:
Difficulty staying on topic or rambling off on tangents
Trouble finding words (even though they know what they want to say)
Getting lost in their own story or losing the thread mid-sentence
Missing jokes, sarcasm, or subtle social cues
Interrupting others or dominating conversations without realizing it
Struggling to follow rapid back-and-forth exchanges
Taking everything literally when others are being figurative
With Memory:
Forgetting what was just discussed minutes ago
Repeatedly asking the same questions
Unable to recall important details from earlier in the day
Difficulty remembering names or recent events
With Organization and Planning:
Difficulty explaining things in a logical order
Trouble following multi-step directions
Getting overwhelmed when asked to problem-solve during a conversation
Challenges with written communication (texts, emails, notes)
Starting tasks but unable to see them through to completion
With Attention:
Losing focus during longer conversations
Difficulty filtering out background noise in busy environments
Struggling to maintain eye contact or appearing distracted
Unable to shift attention when the topic changes
Emotionally and Socially:
Increased frustration during communication
Withdrawing from social situations they used to enjoy
Anxiety about being misunderstood or not keeping up
Missing emotional cues from others
Saying things that seem inappropriate without realizing it
Difficulty reading the room or adjusting to different social situations
Why Diagnosis Is So Hard
One of the biggest challenges I faced in my clinical work was that traditional speech and language tests often miss these disorders entirely. Standard assessments focus on isolated skills, like naming objects or repeating sentences. These tests don't capture what happens during real-world conversations when someone needs to juggle multiple thinking demands at once.
I'd have patients pass every single test I gave them in the therapy room, but then I'd watch them struggle to order lunch in the hospital cafeteria or get completely lost trying to explain their morning to a family member.
That's why proper evaluation needs to look beyond test scores. It should include:
Watching how someone communicates in real-life situations
Listening to how they tell stories or explain things
Observing social interactions with different people
Talking with family members about day-to-day communication challenges
Understanding the person's specific life roles and what communication skills they need
What Treatment Actually Looks Like
The good news? Effective interventions exist, and they work. Treatment typically combines three approaches:
1. Restoring Function
Working directly on the thinking skills that support communication:
Memory exercises and strategies like creating mental pictures, using repetition techniques, and building associations to help information stick.
Attention training through activities that gradually increase in complexity, teaching the brain to filter distractions and maintain focus longer.
Executive function tasks that practice planning, organizing, and problem-solving in structured ways before applying them to real conversations.
Conversation skills practice focusing on staying on topic, taking turns, reading social cues, and organizing thoughts before speaking.
2. Compensation Strategies
Teaching practical workarounds for daily life:
External memory supports like using notebooks, phone reminders, calendars, or recording important conversations to review later.
Breaking down information into smaller, manageable chunks instead of trying to process everything at once.
Establishing routines to reduce the mental load and create predictable patterns that require less cognitive energy.
Creating checklists for multi-step tasks so nothing gets forgotten or skipped.
Using visual supports during conversations, like writing down key points or drawing simple diagrams to track the discussion.
Slowing down the pace to allow more processing time without feeling rushed.
3. Environmental Modifications
Adjusting the communication environment to set people up for success:
Reducing distractions like background noise, visual clutter, or multiple conversations happening at once.
Allowing extra time for processing and responding without pressure.
Providing written information alongside verbal explanations so people can review it later.
Educating family and friends about supportive communication strategies.
Making workplace adjustments like quieter office spaces, written meeting notes, or modified job responsibilities.
The Real-World Approach to Therapy
During my years treating patients, I learned that the most effective therapy doesn't just work on isolated skills in a quiet room. It focuses on helping people participate in their actual lives.
Instead of just practicing memory exercises, we'd work on remembering the steps to make coffee the way they like it. Instead of generic attention tasks, we'd practice filtering out noise in the hospital cafeteria where they'd actually need to eat lunch.
The goal isn't perfect performance on therapy activities. The goal is helping people engage meaningfully in their lives, maintaining their relationships, doing their jobs, managing their homes, and participating in their communities.
What You Can Do at Home
If you're supporting someone with a cognitive communication disorder, here are practical strategies that make a real difference:
During Conversations:
Minimize distractions by turning off the TV, reducing background noise, and having conversations in quieter spaces
Give them time to process and respond without rushing or finishing their sentences
Ask yes/no questions when they seem overwhelmed by open-ended ones
Break complex information into smaller parts and check understanding as you go
Use visual aids when explaining multi-step tasks (write it down, draw it, show pictures)
Confirm understanding by asking them to summarize in their own words
Stay on one topic at a time instead of jumping between subjects
Be direct and clear rather than using hints or subtle suggestions
For Memory Support:
Keep a shared calendar visible in a central location where everyone can see it
Use voice memos or a small notebook to capture important information immediately
Create consistent routines to reduce memory demands
Take photos of important locations, items, or information as reminders
Write down key points during important conversations or appointments
Set phone alarms with specific labels for tasks or reminders
Use a whiteboard for daily schedules or important information that changes
For Organization:
Use checklists for daily activities, breaking tasks into clear steps
Create visual schedules showing what happens when
Establish predictable routines for morning, bedtime, and other regular activities
Color-code items by category (medications, bills, appointments)
Keep frequently used items in the same place always
Prepare the night before for the next day's activities
Use timers to help with time management
Emotional Support:
Acknowledge their frustration because it's real and valid
Celebrate small wins rather than focusing only on what's still hard
Maintain patience during communication breakdowns without showing irritation
Educate others about their needs to reduce judgment or misunderstanding
Connect with support groups where they can meet others with similar challenges
Protect their dignity by having private conversations about strategies rather than correcting them in front of others
Remember who they are beyond this disorder
The Importance of Early Support
Here's what I learned from watching hundreds of patients and families: the earlier someone gets appropriate support, the better their outcomes.
People who receive cognitive communication therapy early after brain injury or stroke tend to make more progress. They maintain better relationships. They return to work or meaningful activities more successfully. They experience less depression and anxiety.
But many people don't get referred for speech therapy because medical teams focus on whether someone can talk, not on whether they can communicate effectively in their daily life.
That's where you come in as an advocate.
When to Seek Help
Consider getting a speech-language pathology evaluation if you notice:
Communication changes after a brain injury, stroke, or diagnosis of a neurological condition
Difficulty with conversations that seems worse than general aging
Problems at work or school related to communication, organization, or memory
Social withdrawal or relationship problems tied to communication challenges
Frustration or anxiety about communication that's affecting quality of life
Others commenting that the person "seems different" but can't quite explain how
Don't wait for a doctor to suggest it. Request an evaluation specifically for cognitive-communication skills, not just speech clarity or word-finding.
Your Loved One's Voice Matters
After ten years of this work, here's what I want you to know: cognitive communication disorders don't mean someone has lost their intelligence or personality. It means their brain is processing information differently now, and they need support and strategies to navigate communication in this new way.
With the right support, people with these disorders can improve their functional communication, maintain meaningful relationships, and participate fully in the life roles that matter most to them.
I've seen it happen countless times. The daughter who felt like she'd lost her mother after her stroke, then learned how to connect with her in new ways. The young man with a brain injury who thought his career was over, then returned to work with appropriate accommodations. The husband who felt invisible when his wife couldn't follow conversations anymore, then discovered strategies that brought them closer.
These disorders are real. They're challenging. But they're also treatable when people get the right support.
Don't wait for someone else to notice. Trust what you're seeing. Seek evaluation. Ask questions. Advocate fiercely.
Your loved one's voice, their ability to connect, share, and be understood, is worth fighting for.
Finding the Right Support
Looking for a Speech-Language Pathologist?
Seek out clinicians with experience in:
Brain injury rehabilitation
Stroke recovery
Adult cognitive-communication disorders
Neurological conditions
Questions to Ask:
Do you have experience treating cognitive communication disorders?
What does evaluation typically include?
How do you incorporate real-world practice into therapy?
Can you involve family members in the treatment process?
What should we expect in terms of progress and timeline?
Support for Caregivers:
Remember that you need support too. Look for:
Caregiver support groups (in-person or online)
Family counseling to adjust to changes
Respite care to prevent burnout
Educational resources about the specific condition
You don't have to navigate this alone. The right team of professionals and support systems can make all the difference.
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This post is all about cognitive communication disorders
References
Blake, M. L. (2024). Cognitive-communication disorders following right hemisphere stroke: A call to action. American Journal of Speech-Language Pathology, 33(5), 1923-1938.
Cruice, M., Lam, B., Mihai, A., Gonçalves, P., MacDonald-Wicks, L., & Moffatt, K. (2024). Assessment practices for people with cognitive communication disorder: An international survey. International Journal of Language & Communication Disorders, 59(5), 1829-1850.
Hawkins, R., Jowett, S., Godfrey, M., Medina, J., McKevitt, C., & VERSE Collaborative Group. (2021). Poststroke trajectories: The process of recovery over the longer term following stroke. Global Qualitative Nursing Research, 8.
Rapolti, A., Bognár, P., Óvári, T., Valálik, I., & Folyovich, A. (2024). Measuring cognitive impairment in Parkinson's disease within 5 minutes: Comparison of three short cognitive scales. Parkinsonism & Related Disorders, 121, 106035.
Russell, C., McDonald, S., O'Brien, B., McDonald, E., Rushworth, N., Allen, S., & Togher, L. (2022). Measuring communication ability after right hemisphere stroke: A systematic psychometric review of 44 communication measures. International Journal of Speech-Language Pathology, 24(5), 490-525.
Weir, N., Warren, N., Doyle, C., Pittman, J., McDonald, S., Winkler, D., Douglas, J., & Togher, L. (2022). "It's been bloody tough": A qualitative study exploring how individuals with acquired brain injury and their families experience community-based rehabilitation over the longer term. Disability and Rehabilitation, 44(24), 7506-7518.
