Barry is a 61-year-old male who suffered a (R) cerebrovascular accident (CVA). He spent 3 days in acute care, but then was released home by his physician due to “the patient having no significant residual effects from the CVA”. Once home, Barry’s wife began to notice that he was different. Though he could talk fluently and understand what people said to him, he now appeared to ramble on in conversation. Once a gripping storyteller, he now verbally wandered in telling stories, perseverating on details and not telling the overall story arc. In conversation, he is pragmatically awkward as shown by dominating conversations, ignoring hints and request from others for repairs, and lacking an ability to effectively use facial expression and emotion with others. In addition to all this, his wife reports he denies having any problems at all after his stroke.

1. Based on the limited information above, what cognitive-communicative diagnosis do you think is most likely in Barry’s case? What factors lead you to this conclusion?

2. What is the medical term for denial of deficits?

3. What would your counseling look like to Barry’s wife?

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