What is a Cognitive Communication Disorder?

What are cognitive communication disorders?

Communication is a complex process. We have to work out what, when, and how we should communicate and how others may interpret it. This requires us to understand what other people are saying, what we and others are thinking, and what the situation requires us to say (or not say). We use our ‘cognitive’, skills to do this, such as attention, memory and problem-solving. We also use a set of cognitive skills known as ‘executive functions’ that allow us to monitor and co-ordinate our behaviour.

Brain injury and neurological conditions can affect our cognitive skills, which in turn can affect all aspects of communication including listening, understanding, speaking, reading, writing, and conversation. The term ‘cognitive communication disorders’ is used to describe these communication changes.

What are the signs of cognitive communication disorders?

There is great diversity in communication styles across different people, cultures, and languages. However, changes to a person’s individual communication style due to brain injury or a neurological condition are common.

Every person with a cognitive communication disorder is different, but symptoms may include:

• difficulty concentrating during conversations
• forgetting what they or others have said
• difficulty processing what they have heard or read
• difficulty thinking of things to say or write
• difficulty finding the right word to say
• difficulty speaking, understanding, reading, and writing when there are distractions such as background noise or movement
• missing out important information when speaking or writing
• difficulty putting their thoughts into words in a logical order
• saying too much or too little without realising
• making comments they would not normally say
• going off on a tangent
• repeatedly talking about the same topic
• needing extra time to respond
• acting overly friendly, affectionate, blunt or rude
• facial expressions not matching what they are saying or thinking
• difficulty recognising emotions in themselves and others
• difficulty seeing things from someone else’s point of view
• missing social cues that indicate sarcasm, humour, etc.

Other people may be able to see these difficulties more than the person with a cognitive communication disorder. This is because people with cognitive communication disorders may have little or no awareness of the changes.

A person’s communication skills may change and get worse at different times of the day, with different people, and in different situations. This can be due to fatigue, anxiety, pressure, or feeling overloaded.

Cognitive communication disorders can occur at the same time as other communication difficulties such as dysarthria (when speech is unclear because speech muscles are weak or hard to control) or aphasia (which is the term used to describe a communication disorder that results from damage to the areas of the brain responsible for language, rather than cognition). However, they are not the same as being neurodivergent, which is a broad term but includes autism, ADHD, and dyslexia. A person with a cognitive communication disorder may also be living with these diagnoses though. These issues can make cognitive communication disorders harder to detect.

What problems can cognitive communication disorders cause?

Communication is important to all aspects of life. Nearly everything we do at home, in the community, and at school or work requires spoken or written communication in some way.

If communication becomes harder due to a cognitive communication disorder, there can be a devastating impact for the person, their family, friends, and carers. It could affect any part of family, social, school, and work life.

Common difficulties include:

• difficulty having conversations as it’s more challenging to stay on track
• difficulty forming and maintaining relationships with family, friends, peers, carers or colleagues
• difficulties in work, such as following meetings, understanding and writing emails, delivering presentations, or reading and writing reports
• difficulties in school, college or university such as understanding classes, answering questions, or writing coursework and taking exams
• difficulty with leisure activities including watching films, reading books, or using social media
• difficulty with tasks such as filling out forms and learning new processes
• avoiding social events as it is hard to follow group conversations, answer people’s questions, or think of things to say
• difficulty revealing their competence, skills and knowledge in school, work, and family life
• greater role of everyday communication partners in following and supporting interactions with a person with cognitive communication disorder.

Children and young people with cognitive communication disorders face additional challenges. The human brain undergoes rapid development throughout older childhood and young adulthood, with cognitive skills becoming increasingly refined and sophisticated over time (Mousely et al, 2025). Cognitive communication disorders in children and young people can therefore evolve or emerge over time, as cognitive processes fail to mature as expected, with difficulties not becoming evident until they are older (including into adulthood). The impact can worsen over time as children and young people fall away from the expected developmental trajectory. This delayed onset and impact can make it difficult to relate current difficulties to a past brain injury.

For all, such changes can affect the following in both the person with cognitive communication disorder and their families:

• sense of self
• social contact
• confidence
• quality of life
• educational attainment
• employment status

People with cognitive communication disorders, and their family members, can end up feeling sad, isolated, frustrated or worried.

What can cause cognitive communication disorders?

Cognitive communication disorders can be hard to detect so it is difficult to be certain about the number of adults and children affected. However, research suggests that cognitive communication disorders are experienced by:

• significant numbers of people with a traumatic brain injury (MacDonald, 2017)
• people who have experienced a mild traumatic brain injury or concussion (O’Brien et al, 2022), although their symptoms are typically expected to improve within six months
• people who have had a stroke (Hewetson et al, 2017)
• people with Parkinson’s disease (Swales et al, 2020)
• people with multiple sclerosis (Carotenuto et al, 2018).

It is also known that people with other neurological conditions can potentially experience cognitive communication disorders, such as:

• motor neurone disease (Fisher et al, 2017)
• adult and childhood dementia (Harciarek & Cosentino, 2013; Morison et al, 2024),
• leukodystrophies (Rush et al, 2023)
• long COVID (Cummings, 2023).

What can people with a cognitive communication disorder do to help their communication?

Everyone with a cognitive communication disorder will have different needs and symptoms. Different strategies will help different people. Some things to try are detailed below. It is important to try and incorporate these strategies into daily life to enable self-management of the cognitive communication disorder.

Preparation and planning

• When meeting family and friends, prepare things you want to tell them and questions you want to ask
• It may help to make a note of the things you want to say and the questions you want to ask
• Try to have conversations in quiet and calm space
• Where possible, consider keeping groups to a small number of people
• Prepare for the impact of fatigue, e.g. by resting before important conversations and plan how to take breaks
• If you are going to be with someone you trust, speak to them beforehand about ways they can help, e.g. agree a signal for when you need a break or need to leave, agree that they can step in to help if you are struggling.

Speaking clearly and concisely

• Take your time when talking
• Stop, think and check before speaking
• Ask for a minute to gather your thoughts if you need to
• If you cannot think of the word you need, try to think of a different word or describe it
• Try to be concise and relevant.

Staying on track

• Try to stay focused on the current conversation topic
• Check that people are following what you are saying
• Let people know if you’ve lost track of the conversation
• Ask people to repeat information or write it down
• Make notes on your phone, tablet or laptop or take a photo
• Try to monitor other people’s facial expression and body language. If they look like they want to say something, invite them to do so.

How can others help a person with a cognitive communication disorder?

The key principles are:

• people with a cognitive communication disorder will have different support needs
• there is a balancing act between being supportive and being respectful
• do not assume you know what the person wants to say or that you know how to help
• be patient and keep listening
• ask the person how best to support them eg holding up a hand if they are dominating the conversation and not turn-taking
• do not exclude them or make them feel different
• if they become defensive, reassure them with respectful and kind words
• follow any strategies that have been provided
• ask the person if it is a good time for them to speak and try to ensure that the environment is quiet and calm.

You can help when you are speaking by:

• taking your time
• depending on the topic, provide useful information in advance
• talking at a speed which allows the person to follow what you are saying
• explaining yourself clearly and in concrete terms that the person is familiar with
• talking in shorter sentences to make it easier for the person to process what you’ve said
• allowing time and silence to enable the person to consider what you are saying
• checking back that you have been clear and understood
• reading aloud complex written information
• giving written or visual versions of information that the person can take with them
• remembering that these communication changes are due to their neurological changes, not their personality
• allowing the conversations to be revisited once the person has had time to process the conversation and think of what they want to say.

You can help when the person with a cognitive communication disorder is speaking by:

• ensuring time and silence to give the person time to gather their thoughts
• approaching the conversation with a positive manner by smiling and showing an interest in them and conversational topics they are interested in
• finding the right time and place to ask for clarification or to offer help if they seem stuck
• recount stories and events together, ie you tell a bit, they tell a bit
• double checking if you think they’ve used the wrong word
• gently highlight if they’ve gone off topic
• checking back that you have understood
• be aware that open questions are harder to answer
• be prepared to ask closed questions or give options
• you may need to dictate notes for their compensatory memory aid (phone, laptop or computer) or remind them to take a photo of an event.

How can speech and language therapy help?

Speech and language therapists have the specialist knowledge and skills to support communication difficulties, including cognitive communication disorders.

Speech and language therapists can:

• work with the person, family, and professional teams to assess and identify if and how communication has changed and the impact it has on their daily lives
• support people with cognitive communications disorders, their family and friends, and the professionals working with them to understand the condition, its impact, and how to help
• support the person, family and professional teams to identity what they want to achieve (their goals)
• collaborate with the person, family and professional teams to provide the best possible treatment and strategies to help the person achieve their goals and improve family, social, school or work life
• support people with cognitive communication disorders to participate in decision-making about their lives, rehabilitation, and care
• provide communication partner training to families, friends, and professionals
• help people with cognitive communication disorders, and their family and friends, regain confidence, self-identity, and quality of life.

How and when to refer to speech and language therapy

GPs, healthcare professionals, social worker or teachers can make a referral to NHS speech and language therapy. The process may vary between areas, so check with your local healthcare provider regarding appropriate referral procedures. If the person has worked with speech and language therapy in the community before, they may be able to make a re-referral themselves.

If a person wishes to access support privately, they can identify independent speech and language therapists via the Association of Speech and Language Therapists in Independent Practice.

Referrals and re-referrals can be made at any time in the person’s journey if they have communication problems that they would like help with. This can include new or increased problems that are noticed further down the line; when life changes; or when symptoms do not improve as expected.

Resources

The following organisations also offer support and information on cognitive communication disorders in different conditions:

• The Brain charity (a charity for people with neurological conditions and their family, friends, and carers) provide practical help, emotional support, and social activities
• The Brain tumour charity (a charity for people with brain tumour) provided support and information to people with a brain tumour and their families and carers.
• The Children’s Trust (a charity for children with brain injury) provide information on speech, communication, and talking with children with an acquired brain injury
• Headway (a charity for people with brain injury and their families and carers) offer information on cognitive communication disorders
• Headway can also provide an individualised brain injury information card (brain injury will require verification from a professional)
• MND association (a charity for people with motor neurone disease) provide information on how changes to thinking and behaviour can impact communication in their guide on changes to thinking and behaviour with MND
• MS Society UK (a charity for people with multiple sclerosis) supply information on speech and communication problems in multiple sclerosis
• Parkinson’s UK (a charity for people with Parkinson’s disease) share information on speech and communication problems in Parkinson’s disease
• The Silverlining brain injury charity (a charity for people with brain injury and their families) offer a community to connect with others through online activities, local meetings, and collaborative projects.
• The Social Brain Toolkit has training for people with a cognitive communication disorder and their families and friends to improve knowledge on and strategies for communication after a brain injury (interact-ABI-lity) and to use social media safely (social-ABI-lity)
• Stroke Association (a charity for people who have experienced a stroke) have a downloadable leaflet on communication problems after stroke
• The United Kingdom Acquired Brain Injury Forum (a charity that promotes better understanding of brain injuries) offer support for survivors, families, and professionals across the UK.

References

• Carotenuto, A., Arcara, G., Orefice, G., Cerillo, I., Giannino, V., Rasulo, M., Iodice, R., and Bambini, V. (2018) Communication in Multiple Sclerosis: Pragmatic Deficit and its Relation with Cognition and Social Cognition. Archives of Clinical Neuropsychology. 33 (2) pp194–205. https://doi.org/10.1093/arclin/acx061
• Cummings, L. (2023) Long COVID: The impact on language and cognition. Language and Health. 1 (1) pp2-9. https://doi.org/10.1016/j.laheal.2023.05.001
• Fisher, F., Philpott, A., Andrews, S.C., Maule, R., and Douglas, J. (2017) Characterizing social communication changes in amyotrophic lateral sclerosis. International Journal of Language & Communication Disorders. 52 (2) pp137-142. https://doi.org/10.1111/1460-6984.12267
• Harciarek, M., & Cosentino, S. (2013) Language, executive function and social cognition in the diagnosis of frontotemporal dementia syndromes. International Review of Psychiatry. 25 (2) pp178–196. https://doi.org/10.3109/09540261.2013.763340
• Hewetson, R., Cornwell, P., and Shum, D. (2017) Cognitive-communication disorder following right hemisphere stroke: exploring rehabilitation access and outcomes. Topics in Stroke Rehabilitation. 24 (5) pp330–336. https://doi.org/10.1080/10749357.2017.1289622

• MacDonald, S. (2017) Introducing the model of cognitive communication competence: A model to guide evidence-based communication interventions after brain injury. Brain Injury. 31 (13-14) pp1760-1780. https://doi.org/10.1080/02699052.2017.1379613 

• Morison, L.D., Whiteman, I.T., Vogel, A.P., Tilbrook, L., Fahey, M.C., Braden, R., Bredebusch, J., Hildebrand, M.S., Scheffer, I.E. and Morgan, A.T. (2025) Speech, Language and Non-verbal Communication in CLN2 and CLN3 Batten Disease. Journal of Inherited Metababolic Disease. 48 (1), e12838. https://doi.org/10.1002/jimd.12838

• Mousley, A., Bethlehem, R. A. I., Yeh, F. C., & Astle, D. E. (2025). Topological turning points across the human lifespan. Nature Communications. 16, Article 10055. https://doi.org/10.1038/s41467-025-65974-8

• O’Brien, K. H., Wallace, T., Kemp, A. M. and Pei, Y. (2022) Cognitive‑communicative complaints and referrals for speech‑language pathology services following concussion. American Journal of Speech‑Language Pathology. 31 (2) pp790-807. https://doi.org/10.1044/2021_AJSLP-21-00254

• Rush, B. K., Tipton, P. W., Strongosky, A., and Wszolek, Z. K. (2023) Neuropsychological profile of CSF1R-related leukoencephalopathy. Frontiers in neurology, 14, 1155387. https://doi.org/10.3389/fneur.2023.1155387

• Swales, M., Theodoros, D., Hill, A. J., and Russell, T. (2020) Communication and swallowing changes, everyday impacts and access to speech-language pathology services for people with Parkinson’s disease: An Australian survey. International Journal of Speech-Language Pathology. 23 (1) pp70–82. https://doi.org/10.1080/17549507.2020.1739332