What is aphasia?
Aphasia is a learned loss of language skills. This differs from just the inability to speak, for example, which may come from paralysis of the lips or tongue, but it really goes beyond that. It will be talking and writing, or understanding, or listening and reading.
What can cause aphasia?
Damage to any part of the brain that facilitates language can lead to aphasia. Depending on the affected part of the brain, aphasia can take different forms.
The most common cause of incarceration is stroke, but other things can do this as well including traumatic brain injury, neurodegenerative diseases, tumors, or certain infections.
By neurodegeneration, does this include Alzheimer’s disease?
Alzheimer’s disease and frontotemporal dementia. I specialize in an uncommon disorder called primary progressive aphasia in which a neurodegenerative disease, usually Alzheimer’s or frontotemporal dementia, selectively attacks the part of the brain responsible for language. So instead of the slow erosion of memory that people usually associate with Alzheimer’s disease, you see a slow, gradual loss of language function.
Can you explain a little more – what are the different subtypes of aphasia that you see in patients?
In general, there are three: aphasia, which means difficulty understanding. expressive aphasia, meaning difficulty conveying your thoughts; And global aphasia, ie both.
The truth is that there are a lot of different variations of aphasia.
Do you notice aphasia specifically in the elderly or does it depend on the individual cause?
Since stroke is the most common cause of aphasia, and stroke is more common in the elderly, the condition tends to be more common with age. This is also true due to other disorders of brain aging, such as Alzheimer’s disease, for example. So there is a link between getting older, but this is really because of its association with diseases that can cause aphasia.
What are the specific symptoms of aphasia, noting that there are several types?
All of us lose words or names sometimes. This is just normal. In the case of aphasia, this can become more noticeable and striking. Some people just can’t come up with this word. Other people will find that they know what they want to say, but they can’t make it up with their mouths or tongues. Others are less aware of aphasia but fail to understand what they are being told.
And it’s not just a lack of ability to keep track of the conversation like, “Oh, I just wasn’t paying attention.” It could really be, “I don’t recognize that word that I would have known so well before.”
So maybe that’s a household name, or it could be something as simple as, God forbid, coffee. And you just say, “I need the thing.” I think it’s important to know that when it does occur, it will also happen in other styles like writing and reading so it really is aphasia.
You may develop disorders that only affect speech. You can have disorders that only affect writing, but it’s not aphasia by definition.
Do you also see aphasia in patients who use sign language?
Yeah. If you have aphasia with sign language, you will have effectively the same problems, but it will show sign instead of speech.
How is aphasia diagnosed in the first place?
It can be a challenge. Sometimes it is obvious. And to tell you the truth, in common situations like a stroke, it can be very straightforward and dramatic at the time. Clearly someone is really struggling to speak up. This can be very worrying. This is a direct reason to go to the hospital as soon as possible.
In primary progressive aphasia, which I focus on, the appearance of aphasia is more deceptive. It sneaks up on patients and can take years to reach a diagnosis. People don’t know how to describe it. Not necessarily because they have aphasia, but because our common language is so bad at describing slow language loss.
Most people who come to the clinic because of a so-called “memory problem”. And it takes some effort to figure out that it’s just problems remembering words or what things mean. Honing this often requires awareness, attention, and some experience on behalf of the medical provider.
What are the treatment options for aphasia?
Well, of course you want to address the underlying cause – whatever that may be. If it’s a stroke, you want to prevent that person from having more strokes. This is where you will start.
The mainstay of recovery is speech therapy for any type of aphasia. The way speech therapy is designed, constructed and delivered depends on the nature of the aphasia. It wouldn’t make sense, for example, to treat receptive aphasia the same way it would expressive aphasia. They are completely different. And this, again, painted with a wide brush. Specialists will delve into the nature of aphasia and fine-tune its treatment appropriately.
There are added things like communication strategies for loved ones to talk to the person with aphasia. There are many different ways to communicate successfully. Thus you can usually find a more effective strategy. There are resources for coping, whether it’s a support group, taking care of the mood, and making sure the quality of life remains as high as possible and the person is as safe as possible.
I think it is important to note that while aphasia can be a very frustrating disorder, there is still a lot that people can do. Often, aphasia excludes other cognitive functions. Therefore, some people with aphasia can drive their cars just fine. They can still get out to the activities they enjoy, as long as they find a way to communicate effectively with the things they have to do.
How common is aphasia?
The prevalence in the United States has been reported to be about one in 250 or so. I think the reason why most people don’t focus on it is generally that people don’t focus on the symptoms as much as on the cause. You won’t see or hear much about aphasia, but you will hear about a stroke. You will hear about tumors.
For the kind of aphasia that I do, which is caused by Alzheimer’s, for example, or other types of neurodegeneration, most people focus on this neurodegenerative disease rather than how it expresses itself in language. Many are surprised to learn that neurodegenerative diseases can affect language only for several years.
What is the recovery outlook for aphasia?
Like anything else, it depends on the severity of the injury. It depends on access to the right treatments and treatments.
It also depends on the cause. If it is an incurable disease. We may not fix it. But we can try to improve it, make it easier to live with it, and improve the quality of life.
But at the onset of a stroke, especially a mild stroke, the aphasia often improves. The same goes for TBI, if the injury is not devastating.
So we recommend treatments. My colleagues at Craig Hospital stress the benefits of longer treatment periods when it comes to TBI. I think this likely extends to other causes of aphasia as well.
We used to say after your initial injury, you have about a year or so. And after that, I became kind of stable, but that’s not really true. You can continue to work on the treatment and continue to see benefits from it.
I think my message to anyone with aphasia would be one of encouragement: keep going. On top of just looking for remedies, know that there’s a lot you can still do, that you can find fun and get out and do these things.
There is a world out there. There is a life to live.