Cognitive-Communication Referral Guidelines for Adults:

Most Common Etiologies

• Alzheimer's disease

• Brain tumors

• Stroke

• Traumatic brain injury (TBI)

Potential Consequences/Impact of Cognitive-Communication Impairment Can Include:

• Reduced awareness and ability to initiate and effectively communicate needs

• Reduced awareness of impairment and its degree (i.e., loss of ability to assess one's own communication effectiveness)

• Reduced memory, judgment, and ability to initiate and effectively exchange routine information

• Difficulty performing personal lifestyle management activities effectively (i.e., pay bills)

• Reduced ability to anticipate potential consequences, with reasonable judgment and problem solving

• Reduced social communication skills and/or ability to manage emotions, often causing loss of relationships

• Disruption of ability to fulfill educational or vocational roles, including potential loss of employment

• At risk for injury due to inability to communicate in an emergency and/or anticipate the consequences of own actions

Behaviors that should trigger an SLP referral:

Difficulty functioning independently due to:

• unresponsiveness to all external stimuli

• may open eyes, suck, and/or yawn

• does not attend to others

• no purposeful speech

• extremely impaired attention and memory with impulsivity

• extremely limited communication:

  • 1. 1. difficulty responding to and/or saying name

       2. difficulty expressing basic needs to others using simple words and/or gestures (i.e., yes/no, head nod)

       3. difficulty saying greetings (i.e., "hi" and "bye") on own

• difficulty remembering spouse/caregiver's name

• difficulty counting to 10

• becomes agitated when needs are not met

• limited eye contact

• limited social behaviors (i.e., expressions of courtesy and facial expressions)

• very limited communication:

  • 1. 1. difficulty paying attention while speaking (i.e., does not complete sentences or take turns speaking during conversation)

       2. difficulty responding appropriately to message of other individual (i.e., delayed, perseverative, or off-topic responses, including inappropriate words)

       3. limited ability to provide biographical information

       4. difficulty understanding abstract information; very concrete responses

Difficulty functioning independently due to:

• difficulty anticipating consequences of own actions

• poor organization, with limited problem solving and judgment

• limited awareness of extent of difficulties; exhibits socially inappropriate behavior

• difficulty with concepts of time and money

• difficulty self-disciplining and self-monitoring to follow rules

• difficulty changing routine or schedule; difficulty learning new rules

• limited communication:

  • 1. 1. difficulty selecting appropriate words and remembering names

       2. limited memory and/or knowledge of current events and/or personal history

       3. responses in conversation may be verbose, redundant, or tangential

       4. elaborates on information provided from questions, but cannot appropriately change topic, initiate, or end a conversation

       5. missing or misunderstanding humor

       6. difficulty understanding nonverbal communication (i.e., facial expressions and/or body language)

       7. difficulty understanding abstract information

Difficulty managing home or maintaining a job or business due to:

• difficulty planning and completing necessary daily activities

• difficulty following directions

• difficulty comprehending or applying abstract written information

• difficulty analyzing personal and/or business problems, identifying and applying solutions

• difficulty assessing own strengths and weaknesses, developing effective plans to improve weaknesses

• difficulty managing multiple responsibilities simultaneously

• difficulty managing emotions (especially anxiety, frustration, or anger) related to performance difficulties

• difficulty making, following, and modifying plans as needed

• difficulty understanding and managing personal legal or financial matters (i.e., taxes, buying or refinancing a home, etc.)

• difficulty effectively communicating with colleagues and/or customers, especially initiating effective responses, interpreting combined verbal and nonverbal responses during conversations to determine strategic communication action; modifying responses when feedback indicates it has not been successful