Cognitive-Communication Disorders: Assessment Tools and Treatment Approaches for Movement Disorders

Cognitive-communication disorders are a critical yet often overlooked consequence of movement disorders such as Parkinson’s disease and progressive supranuclear palsy. While symptoms like tremors, rigidity, and bradykinesia are widely recognized, the cognitive changes accompanying these conditions can be equally debilitating—disrupting speech, comprehension, and the ability to engage in meaningful conversations. 

As a clinician, recognizing these deficits early and implementing targeted assessment and intervention strategies is essential to preserving communication and quality of life.

In this article, we’ll explore the connection between movement disorders and cognitive-communication disorders, the most effective assessment tools, and evidence-based treatment approaches—so that you can confidently identify communication challenges, apply the latest therapeutic strategies, and empower your patients to maintain their independence for as long as possible.

Understanding the impact of movement disorders on cognitive-communication

Cognitive-communication disorder refers to difficulties with speech, language, and social communication caused by underlying cognitive deficits. In movement disorders such as Parkinson’s disease (PD), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP), cognitive changes can make it harder to process information, retrieve words, and organize thoughts—all skills that are essential for effective communication. 

Cognitive decline is a common non-motor symptom of movement disorders. In Parkinson’s disease, 20 to 50 percent of individuals experience mild cognitive impairment (MCI), and up to 80 percent develop dementia in advanced stages.¹ 

As these conditions progress, they can interfere with essential communication skills, making it increasingly difficult for individuals to engage in conversations, follow discussions, or express themselves clearly.  The most commonly affected cognitive domains in movement disorders include:²

• Attention and processing speed: Difficulty maintaining focus in conversations or following rapid exchanges.

• Memory: Forgetting recent discussions, leading to breakdowns in topic maintenance.

• Executive functioning: Struggles with problem-solving, organizing thoughts, and shifting between topics.

• Language impairments: Word-finding difficulties, reduced sentence complexity, and impaired comprehension.

• Visuospatial skills: Challenges with interpreting visual cues, which can affect reading and written communication.

As cognitive-communication difficulties worsen, individuals may find it increasingly challenging to maintain workplace interactions, social relationships, and everyday responsibilities such as managing finances or medication schedules. Without proper assessment and intervention, these difficulties can lead to social withdrawal, frustration, and a decline in quality of life.

Key assessment tools for cognitive-communication disorders

Accurately identifying cognitive-communication disorders in individuals with movement disorders requires a comprehensive evaluation that examines multiple domains. You can use several standardized assessments to measure these cognitive and communication abilities and guide clinical decision-making. Commonly used tools include:

Montreal Cognitive Assessment (MoCA)

The MoCA is a quick, sensitive screening tool for mild cognitive impairment. It evaluates attention, memory, executive function, and visuospatial abilities, making it particularly useful for detecting early cognitive decline in Parkinson’s disease.

Scales for Outcomes in Parkinson’s Disease-Cognition (SCOPA-COG)

This Parkinson’s-specific cognitive test assesses verbal fluency, memory, and executive function. It helps differentiate between PD-related cognitive decline and dementia, offering valuable insights into disease progression.

Functional communication measures

These assessments evaluate how cognitive-communication impairments impact real-world interactions, providing a broader understanding of a patient's challenges beyond structured testing.

• Craig Hospital Inventory of Environmental Factors (CHIEF): Assesses how environmental factors influence communication ability.

• Cognitive-Communication Checklist for Acquired Brain Injury (CCCABI): Screens for functional communication impairments related to cognitive deficits.

Patient-reported outcome measures

Patient-reported outcome measures capture the individual's perspective on how cognitive-communication difficulties affect their daily life, helping clinicians align interventions with patient priorities.

The Communication Participation Item Bank (CPIB) is one valuable example, evaluating how communication difficulties impact social participation and quality of life. Using patient-reported insights like the CPIB can help you tailor intervention plans by identifying cognitive strengths and weaknesses that affect communication, ensuring treatment approaches are both functional and patient-centered.

Intervention strategies for cognitive-communication disorders

Effective treatment for cognitive-communication disorders should be functional, individualized, and compensatory rather than restorative. Given that many movement disorders are progressive, therapy should focus on preserving and maximizing existing communication abilities for as long as possible. 

Following a structured, life-integrated approach to intervention can improve functional outcomes for individuals with cognitive-communication challenges:³ 

1. Compensatory communication strategies

These strategies help individuals bypass cognitive difficulties by relying on external support and structured communication methods. Teaching patients how to integrate these tools into daily routines can reduce frustration and improve functional independence.

• External memory aids: Using written reminders, visual schedules, and electronic alerts to support recall and task completion.

• Simplified instructions: Breaking down complex information into shorter, clear steps to reduce cognitive load.

• Strategic pauses: Encouraging the patient to slow down and organize thoughts before speaking to enhance clarity and coherence.

2. Environmental modifications

Optimizing the patient's environment minimizes cognitive overload and promotes successful communication. Small adjustments can make a significant difference in reducing frustration and increasing participation in conversations.

• Reducing distractions: Minimizing background noise, adjusting seating arrangements, and optimizing lighting to support visual and auditory processing.

• Structured routines: Encouraging predictable daily schedules to enhance cognitive efficiency, reduce decision-making burden, and improve task initiation.

3. Speech and language therapy techniques

Traditional speech-language therapy techniques can be adapted to support cognitive challenges and enhance communication effectiveness. These approaches help maintain verbal expression while reducing frustration with word retrieval difficulties.

• Conversational coaching: Training caregivers and family members to use supportive communication techniques, such as speaking at a slower pace, simplifying questions, and allowing extra processing time.

• Word-finding strategies: Teaching circumlocution (describing words instead of retrieving them directly), using gestures, or leveraging semantic cueing to facilitate communication.

4. Cognitive-linguistic exercises

Engaging patients in structured cognitive-linguistic exercises can strengthen neural pathways involved in language processing and executive function. These tasks promote mental flexibility and improve verbal fluency in real-world contexts.

• Dual-task training: Practicing conversation while engaging in motor tasks (e.g., walking, buttoning a shirt) to simulate real-life cognitive demands.

• Category naming and fluency tasks: Strengthening semantic networks and improving lexical access by listing words within a category (e.g., "fruits").

5. Assistive technology for communication

Technology can be a game-changer for individuals with cognitive-communication impairments, offering alternative ways to express thoughts, compensate for impairments, and enhance social engagement.

• Voice amplification devices:  Enhancing speech audibility for patients with reduced vocal intensity, a common issue in PD, to improve communication in social settings.

• Speech-to-text apps: Providing individuals with severe dysarthria the ability to type messages instead of speaking, reducing frustration during communication.

• Augmentative and alternative communication (AAC): Using picture-based communication systems, text-to-speech apps, or personalized communication boards when verbal expression becomes too difficult.

The role of interdisciplinary collaboration

Effective management of cognitive-communication disorders requires a holistic, team-based approach, with speech-language pathologists working closely alongside neurologists, occupational therapists, physical therapists, and caregivers. Given the profound impact these impairments have on daily living, interdisciplinary collaboration ensures that treatment strategies address communication and overall functional abilities.

A key aspect of this collaboration is medication optimization, where SLPs work with physicians to manage medications that may influence cognition and speech. Additionally, caregiver training plays a crucial role in equipping family members and care partners with effective communication strategies and cognitive support to enhance daily interactions. Finally, therapy integration ensures that cognitive-communication interventions align with movement and functional goals, requiring close coordination with occupational and physical therapists to promote independence and maximize overall patient function.

Optimizing assessment and treatment for movement disorders

Cognitive-communication disorders in movement disorders affect far more than speech—they disrupt independence, relationships, and overall quality of life. As clinicians, our role extends beyond assessment; we must implement functional, patient-centered interventions that empower individuals to maintain communication for as long as possible. By integrating compensatory strategies, environmental modifications, and interdisciplinary collaboration, we can positively impact patient outcomes in meaningful, lasting ways.

Speech-language pathology continuing education and clinical growth in speech-language pathology are essential to addressing the complexities of movement disorders. If you're ready to expand your expertise on the topic, my Medbridge course, Assessment Strategies for Movement Disorders, provides a comprehensive framework for speech and voice assessment, swallowing assessment, and the cognitive-communication assessment we've discussed in this article.

There are also two additional courses in my Movement Disorder series:

• Understanding Movement Disorders: This course provides you with the knowledge and clinical skills to assess and treat movement disorders using an interdisciplinary, evidence-based approach.

• Interventions and Treatment Planning: This course equips you with research-backed strategies to develop tailored intervention plans for speech, language, swallowing, and motor deficits.

By completing these courses, you’ll gain a well-rounded, interdisciplinary approach to assessment and treatment—helping you elevate your clinical practice and provide the highest quality care to individuals with movement disorders.

References

1. https://pubmed.ncbi.nlm.nih.gov/38277303/

2. https://www.mdsabstracts.org/abstract/evaluation-of-cognitive-assessment-tools-in-parkinsons-disease/

3. https://pubs.asha.org/doi/10.1044/2024_AJSLP-24-00112