Relationship Between Qualitative Differences in Discourse Impairment and Theory of Mind in Patients With Right Hemisphere Damage: A Case Series

This case series examined qualitative differences in discourse impairment in two elderly right-handed female patients (one in her 60s and another in her 70s) with right hemisphere damage (RHD) and explored the potential involvement of theory of mind (ToM). Patients with RHD often present with discourse-level communication disorders despite relatively preserved basic language abilities. However, the nature of such discourse impairments is not uniform. Discourse performance was assessed using a four-frame cartoon description task, and ToM was evaluated using the Strange Stories test. Case A demonstrated relatively preserved inferential discourse despite making errors in event-related statements, whereas Case B showed prominent impairments in inferential discourse accompanied by marked ToM deficits. These contrasting profiles suggest that discourse impairment following RHD may arise through different underlying mechanisms, with ToM-related processes contributing to inferential discourse disturbances in some individuals.