What is aphasia? Symptoms, causes and treatment

Until recently, most people had little awareness of aphasia. In 2016 and 2020, for example, surveys by the National Aphasia Association estimated that less than 10% of the population had heard of language syndrome.

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Experts say that has likely changed since news broke in March 2022 that movie star Bruce Willis has aphasia and will be away from acting. The ad caused Internet searches to spike for aphasia for a week, according to Google Trends.

“The occurrence of any medical problem for someone we know or admire encourages us to learn more about it. Many people will now become more familiar with aphasia and know that it is a language impairment,” says Nina Drunkers, longtime aphasia researcher and associate professor of psychology at UCLA. Berkeley, assistant professor of neuroscience at the University of California-Davis.

What is aphasia: causes and symptoms

Aphasia is the umbrella term for language disorders that prevent people from speaking or understanding. Syndromes are caused by brain damage from:

When someone develops aphasia, it can be difficult to:

  • Find the correct word for the sentence.
  • Produce sounds correctly.
  • Understand the meaning of the words.
  • Read or write.

Symptoms of aphasia depend on the location of the brain damage. For example: “Damage to the parietal lobe in the back of the brain may cause problems with reading and writing. Damage to the left temporal lobe may affect your ability to match concepts and words. Damage to the frontal lobe may make it difficult to produce speech,” Dronkers says. “.

Types of aphasia

There are many types of aphasia. They fall into several categories.

fluency aphasia

People with aphasia are able to produce connected speech, but it may lack meaning. Types of fluent aphasia include:

  • anomic aphasia; People with nonverbal aphasia may be able to speak and understand language, but have difficulty retrieving everyday words. They may misname things or mispronounce words.
  • Conductive aphasia. People with conduction aphasia have difficulty repeating phrases and sentences because of the loss of auditory short-term memory.
  • Wernicke’s aphasia. People with Wernicke’s aphasia have well-formed but meaningless speech. They may not understand what someone is saying and may not realize that they are speaking without being understood.
  • Sensory aphasia across the cortex. Subjects with transcortical sensory aphasia appear to have Wernicke’s aphasia, but their ability to repeat words and sentences is significantly preserved.

non-fluent aphasia

People with non-fluent aphasia have difficulty speaking. Types of non-fluent aphasia include:

  • Broca’s aphasia. People with Broca’s aphasia can maintain comprehension, but their speech is slow and labored. They find it difficult to form complete sentences or to understand sentences with complex grammar rules. They also struggle with reading and writing.
  • International aphasia. This is considered the most severe form of aphasia. People with aphasia are unable to produce or understand words and sentences. They are also unable to read or write. General aphasia usually occurs after a stroke.
  • Transcortical motor aphasia. A person with transcortical motor aphasia may understand language but have difficulty forming sentences correctly or automatically answering questions. Like sensory aphasia across the cortex, their ability to repeat complete sentences is remarkably intact.

Primary progressive aphasia

PPA is characterized by obvious difficulties in finding words beyond age-related cognitive decline. Patients may stop talking mid-sentence and often pause to find the right words.

This disorder is usually not hereditary. “But there are cases where members of families with known genetics of neurodegenerative diseases can develop primary progressive aphasia,” notes Dr. Zachary Miller, an associate professor of neuroscience at UCSF who treats patients at the UCSD Center for Memory and Aging. San Francisco. .

There are three different types of PPA:

  • non-fluent variable. People with a variant of the PPA may not be good at understanding words but have problems forming words, understanding complex sentences, and getting the correct grammar.
  • Logopenic variant. Logopenic variant PPA is characterized by difficulty finding words and repetition of sentences due to short-term auditory memory problems.
  • semantic variable. This aphasia includes a loss of conceptual knowledge. People with the PPA semantic variant have profound difficulties in understanding written or spoken language. Someone might say, ‘Give me a bowl,’ and the patient would ask, ‘What is a bowl? “They can speak fluently, but lose the connection of concepts,” Miller explains.

PPA often remains isolated as a language difficulty for a few years before it takes on other characteristics (such as memory problems) of the dementia that causes it.

Diagnosis of aphasia

For people who have experienced an emergency or emergency medical problem, such as a stroke or brain injury, aphasia may be diagnosed in a hospital or rehabilitation setting.

For people with slowly creeping aphasia, diagnosis begins with a visit to their primary care doctor. This expert can refer you to:

  • A neurologist looks for the underlying cause of the disease.
  • A neuropsychologist, looking for certain cognitive deficiencies.
  • A speech pathologist, looking for deficiencies in the ability to understand language and produce speech.

“It helps to bring a family member to the assessment. It should be someone who is around frequently and can say what they notice. Providing as much of this detail as possible will help paint a picture of what is happening,” notes Jeremy Davis, Chair of the Department of Neuropsychology at the University of Texas Health Science Center at San Antonio and at the Glenn Pages Institute for Alzheimer’s and Neurodegenerative Diseases.

Treatment and diagnosis

Treatment for aphasia begins with treating the underlying condition. In the meantime, dealing with the daily challenges of aphasia requires speech therapy.

“The goals of treatment are to try to teach other areas of the brain to help take over the lost functions, as well as to teach the patient strategies to compensate for their deficit,” Dronkers says.

For difficulty in uttering speech, words can be reinforced by:

  • exaggeration. “You can work on moving your mouth and lips for exaggerated pronunciation or work on certain words and phrases that are important for you to say,” Miller says.
  • Reconstruct word associations. “You can practice by writing the name of something and reading and reading it while looking at or holding the object,” Dronkers says.
  • Learn new ways of expression. “People who have difficulty expressing a sentence may do better if they sing it. It circumvents the mechanism of speech production and relies on a different output system,” says Dronkers. “Or they may use an app with images they can point to. On our UC Berkeley Aphasia Lab Recovery website, we list a number of apps that can be used.”

For difficulty finding words, you can give cues to the brain to find the missing word. For example, if you can’t remember the word “hat,” call it “the thing you wear on your head” or use other related words to describe what you’re trying to say. “At some point, you’re going to activate the groups of cells in the brain that contain information about the object, and play the missing word,” Dronkers says.

Family members, co-workers and caregivers can also support people with aphasia. For example, they can ask yes or no questions to a person who has difficulty pronouncing speech. “The family has to understand that it takes a while for someone to get the words out,” Davis says. “They need to be patient and allow more time for the person.”

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When it is caused by a stroke or traumatic brain injury, aphasia often progresses to a milder form. “As the person recovers, the aphasia becomes less severe during the first year,” Dronkers says.

The prognosis is not encouraging for people with primary progressive aphasia, which continues to get worse, although speech therapy can help avoid worsening.

Individual counseling and attending an aphasia support group can be helpful, as talking about aphasia difficulties can make them less frightening. And any effort to understand, maintain or improve communication—at any stage of aphasia—can enhance a person’s quality of life.

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