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The Alzheimers thing with T as Finnerty might be a foreshadowing that he won't get all of his marbles back. There certainly doesn't seem to have been much recognition of what Christopher was telling him about the movie biz in the skip's eyes or face. Other than mumbling "I'm dead, right?" on coming out of the coma and passing his first basic "mental acuity" test, nothing about his long-term brain function yet.
Sil's asthma can't stand up to the strain of being boss, despite what his old lady sees for him. If T is brain damaged, you're gonna see all sorts of crap hit the fan.
Vito's going down, and soon. T's mental state in question, Silvio in the hospital, there's a vacuum and it brings Vito, Paulie and Bobby to a flash point. Vito's the logical loser in the struggle, plus the gay skeleton in his closet.
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