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Neuropsicologia Latinoamericana

On-line version ISSN 2075-9479


GENTIL, Bruna Caon  and  PEREIRA, Natalie. Dissociation between executive functions and communicative competence: a case study of traumatic brain injury. Neuropsicologia Latinoamericana [online]. 2014, vol.6, n.2, pp. 25-34. ISSN 2075-9479.

Case studies have traditionally been used to enhance the comprehension of clinical conditions, since they allow for the evaluation of associations and dissociations between observed and expected performance. Communicative impairments, especially in discourse, are common consequences of traumatic brain injury (TBI). However, it is not known whether these are primary communication deficits, or if they are secondary to cognitive impairments such as executive dysfunction. The present study sought to describe the cognitive and communicative performance of a patient with mild TBI. The patient was evaluated with a neuropsychological assessment battery consisting of the following instruments: the Montreal Communication Evaluation battery, the Wisconsin Card Sorting Test, The Hayling Test, the Oral Word Span in Sentences subtest of the NEUPSILIN Battery, the Mini-mental State Examination, the Trail-making Test, and the Rey Auditory Verbal Learning Test. Dissociations were observed between discourse and executive function impairments, as well as between impairments in different executive functions. Overall, the patient had the greatest difficulty in less ecological tasks with complex executive demands, involving processing speed, inhibition and planning. However, performance in non-specialized executive function tests was satisfactory. No impairments were observed in discourse tasks. Although D.R. presented tangential, disorganized and confused speech, these features were not severe enough to cause deficits. We hypothesized that, in language-based tests, executive deficits were compensated by language abilities, so that executive dysfunction was only evident in more complex tasks. Additionally, the patient's high educational level and the length of time since lesion onset (ten months) may have contributed to the compensation of functional losses following TBI. To address the limitations of the present study, future research should consider multiple case studies and the use of cluster analysis to evaluate communicative versus executive performance in patients with lesions of different severity and different frequencies of reading and writing habits.

Keywords : Neuropsychological assessment; Mild TBI; Discourse processing; Executive tasks.

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