Onset of dementia is delayed by four to nine years in people who speak more than one language.

Although he studied medicine in Argentina, his native country, Marcelo Bertier came to Malaga 32 years ago, drawn to the quality of life in the city. Now, the university’s professor of neurology and scientist at IBIMA is known globally as a pioneer in the combined treatment of aphasia (a language disorder that makes communication through speech or writing difficult after a brain injury) which uses medications, language rehabilitation, and non-intensive brain stimulation.

What is the topic of the brain that made you dedicate so much of your life to it?

– We humans have our brains. They regulate everything and I have been an expert in this field since 1980, when I started working with people who had lost their language through some kind of brain damage. My interest has always been to study the biological underpinnings of language. It’s what makes us human, what sets us apart from other primates and is a fascinating and mysterious topic, even though society hardly pays any attention to it.

Treatments “In cases of chronic aphasia, the role of management can be greatly improved” stats “In Andalusia alone, more than 7,000 people annually suffer a stroke”

How do we take better care of our brains?

Stroke is one of the most common causes of aphasia, so we have to control vascular risk factors (high blood pressure, diabetes, cholesterol, smoking, obesity, sedentary lifestyle, etc.), but there are also other things that can A healthy person can control it. Act. For example, a bilingual person has more cognitive reserve, more capacity in his brain than a monolingual person. In fact, symptoms of dementia are delayed by four to nine years in people who speak more than one language, so using another language, reading and understanding what you’re reading is key. The part of the brain that regulates our language must remain active, so it is desirable to talk with one or more.

– After many years of study, what is the most revealing thing?

– Historically, it was believed that there was only a remote possibility of language recovery after total or partial loss as a result of brain damage; Now, we know that’s not the case. This was the main challenge: finding ways for people with aphasia to reconnect in some way and restore their quality of life.

The announcement of Bruce Willis’ retirement after being diagnosed with aphasia brought the disorder into the media spotlight. What is the probability that a healthy person will suffer from it?

Aphasia has multiple causes: the most common in adults are stroke and cardiovascular accidents in general. also neurodegenerative diseases such as Alzheimer’s disease or primary progressive aphasia, which may be Bruce Willis’ injury; But also, it can be tumors or head trauma. The older you get, the greater the risk of suffering from one of these conditions, and therefore the possibility of developing aphasia. It is a symptom of some neurological conditions and its clinical characteristics and long-term mode of development vary. With a malignancy it will be worse than someone who has had a stroke. In general, diseases affecting the left hemisphere of the brain, which is responsible for language, are prone to developing aphasia. The vast majority of right-handed people have lateral language on the left side of the brain. Left-handed people tend to behave similarly to right-handed people, but may have more atypical locations in both hemispheres, and exceptionally in the right hemisphere. This also happens with those who do not know anything.

Does this mean that the risk of aphasia is related to whether the person is left-handed or right-handed?

Not necessarily, because we see right-handed people recover well and left-handed or humiliated people who do not. Aphasia is a heterogeneous disorder in which many personality characteristics are involved. If an illiterate person was affected by it, he would not be like a highly capable person. Their ability to recover is very different. An illiterate person has a very limited vocabulary, surprisingly, it consists of only 300-500 words, while a university graduate can use about 30,000 words. This means that their language is wider, richer and more distributed in the brain. The margin of retrieval is greater in a person with more vocabulary, because he has more resources, and more possibilities to find alternatives for those words he cannot pronounce.

Can aphasia occur from day to day?

-It depends. Bruce Willis had time to prepare press releases to announce his retirement, which makes us believe that his illness developed slowly, like neurodegenerative ones. On the other hand, if someone has a stroke, they go from being able to talk to not being able to, just like that. It is a sudden change and this indicates the possible cause.

– And when that happens, how do people manage the deficit in wanting to express themselves orally but not being able to?

It depends on the severity of the aphasia. About 30 percent of secondary aphasia cases are serious, although this does not necessarily mean that they will not improve. However, aphasia is a devastating disorder. In a study conducted in Toronto, Canada, in 2010, they asked 65,000 seniors in nursing homes what most affected their quality of life. Aphasia was the first before cancer and quadriplegia. When someone loses the ability to speak, they will lose their job, their finances will be affected, their relationships with family and friends will be different, and they are more likely to experience depression, anxiety, and frustration. They will lose independence, because sometimes they cannot move. Aphasia is a cornerstone, but there are a number of side effects that reduce quality of life. That is why our task is not only to deal with language problems, but all the side effects associated with them.

What is the dark side of this disorder?

The worst case is when there are a lot of side effects. There are many dangerous and even fatal diseases that do not create the same obstacles for a long time. For example, a patient with amyotrophic lateral sclerosis, which is also a devastating disease, can live reasonably well for the early years. However, a person with aphasia loses a lot from day one. The only difference from the rest is that they may recover at least partially.

Are there clear signs that something is wrong?

-yes. The first is a person’s ability to communicate as they normally would, difficulty remembering certain words or slow communication. They also begin to say words that don’t make sense, may not understand what they are reading, or be able to read aloud or write. All of these indicate a change in language and are a warning sign, especially if they occur suddenly. The most common symptom in neurodegenerative diseases is the inability to pronounce words, for example if they want to say “cup” but cannot. They know what they want to say, but can’t get to the word to speak it.

Do the authorities provide the appropriate treatment?

Stroke units play a key role in early diagnosis in order to reverse the effects so that the aphasia does not occur or is less severe if it does. When it comes to chronic care, I think it can be improved. Since society does not know what aphasia is, the state does not pay much attention to it. The resources are good, but they could be improved. Telecare is one of the most widely used methods during a pandemic and is more economical than in-person treatments. I hope to continue. In fact, we have a project that aims to show that online therapy can work and is cheaper to apply. It reduces costs and does not leave patients isolated, because one of the reasons for aphasia abandoning their treatments is the transportation problem.

What role does your unit play?

– It was created in 2004 and since then the multidisciplinary team has grown in terms of researchers. Psychologists, speech therapists, linguists, computer (neuroimaging) engineers, and neurologists are there to treat all aspects of the disorder. We have pioneered the treatment of aphasia with medication and use it in conjunction with intensive rehabilitation techniques and non-surgical brain stimulation. When used together, the results are more powerful.

– But for now, your unit is still only doing research.

It is a research unit with ongoing projects in which people who meet a number of criteria are welcome to participate. But not everyone has aphasia, because we are not a treatment center. We would be stunned if we tried to do both: in Andalusia alone, 7,000 people a year suffer a stroke. However, as a public organisation, we provide advice and analysis free of charge.

– What’s Next?

We now know a lot about the left hemisphere and how the brain repairs itself, but one of the biggest challenges is identifying the predictive factors. We would like to know whether or not someone will be able to fully recover, so that we can tailor our treatment strategy to that knowledge at hand and find what works best for them.


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