Aphasia

Overview

Aphasia is a disorder that affects how you communicate. It can impact your speech, as well as the way you write and understand both spoken and written language.

Aphasia usually happens suddenly after a stroke or a head injury. But it can also come on gradually from a slow-growing brain tumor or a disease that causes progressive, permanent damage (degenerative). The severity of aphasia depends on a number of things, including the cause and the extent of the brain damage.

The main treatment for aphasia involves treating the condition that causes it, as well as speech and language therapy. The person with aphasia relearns and practices language skills and learns to use other ways to communicate. Family members often participate in the process, helping the person communicate.

Symptoms

Aphasia is a symptom of some other condition, such as a stroke or a brain tumor.

A person with aphasia may:

• Speak in short or incomplete sentences
• Speak in sentences that don't make sense
• Substitute one word for another or one sound for another
• Speak unrecognizable words
• Have difficulty finding words
• Not understand other people's conversation
• Not understand what they read
• Write sentences that don't make sense

Patterns of aphasia

People with aphasia may have different strengths and weaknesses in their speech patterns. Sometimes these patterns are labeled as different types of aphasia, including:

• Broca's aphasia
• Wernicke aphasia
• Transcortical aphasia
• Conduction aphasia
• Mixed aphasia
• Global aphasia

These patterns describe how well the person can understand what others say. They also describe how easy it is for the person to speak or to correctly repeat what someone else says.

Aphasia may develop slowly over time. When that happens, the aphasia may be labeled with one of these names:

• Logopenic aphasia
• Semantic aphasia
• Agrammatism

Many people with aphasia have patterns of speech difficulty that don't match these types. It may help to consider that each person with aphasia has unique symptoms, strengths and weaknesses rather than trying to label a particular type of aphasia.

When to see a doctor

Because aphasia is often a sign of a serious problem, such as a stroke, seek emergency medical care if you or a loved one suddenly develop:

• Difficulty speaking
• Trouble understanding speech
• Difficulty with word recall
• Problems with reading or writing

Causes

The most common cause of aphasia is brain damage resulting from a stroke — the blockage or rupture of a blood vessel in the brain. Loss of blood to the brain leads to brain cell death or damage in areas that control language.

Brain damage caused by a severe head injury, a tumor, an infection or a degenerative process also can cause aphasia. In these cases, the aphasia usually occurs with other types of cognitive problems, such as memory problems or confusion.

Primary progressive aphasia is the term used for language difficulty that develops gradually. This is due to the gradual degeneration of brain cells located in the language networks. Sometimes this type of aphasia will progress to a more generalized dementia.

Sometimes temporary episodes of aphasia can occur. These can be due to migraines, seizures or a transient ischemic attack (TIA). A TIA occurs when blood flow is temporarily blocked to an area of the brain. People who've had a TIA are at an increased risk of having a stroke in the near future.

Complications

Aphasia can create numerous quality-of-life problems because communication is so much a part of your life. Communication difficulty may affect your:

• Job
• Relationships
• Day-to-day function

Difficulty expressing wants and needs can result in embarrassment, frustration, isolation and depression. Other problems may occur together, such as more difficulty moving around and problems with memory and thinking.

Diagnosis

Your health care provider will likely give you physical and neurological exams, test your strength, feeling and reflexes, and listen to your heart and the vessels in your neck. An imaging test, usually an MRI or CT scan, can be used to quickly identify what's causing the aphasia.

A speech-language pathologist can complete a comprehensive language assessment to confirm the presence of aphasia and determine the appropriate course of language treatment. The assessment helps find out whether the person can:

• Name common objects
• Engage in a conversation
• Understand and use words correctly
• Answer questions about something read or heard
• Repeat words and sentences
• Follow instructions
• Answer yes-no questions and respond to open-ended questions about common subjects
• Read and write

Treatment

If the brain damage is mild, it's possible to recover language skills without treatment. However, most people undergo speech and language therapy to rehabilitate their language skills and supplement their communication experiences. Researchers are investigating the use of medications, alone or in combination with speech therapy, to help people with aphasia.

Speech and language rehabilitation

Recovery of language skills is usually a slow process. Although most people make significant progress, few people regain full pre-injury communication levels.

Speech and language therapy aims to improve the ability to communicate. The therapy helps by restoring as much language as possible, teaching how to make up for lost language skills and finding other methods of communicating.

Therapy:

• Starts early. Some studies have found that therapy is most effective when it begins soon after the brain injury.
• Often works in groups. In a group setting, people with aphasia can try out their communication skills in a safe environment. Participants can practice starting conversations, speaking in turn, clearing up confusion and fixing conversations that have completely broken down.
• May include use of computers. Using computer-assisted therapy can be especially helpful for relearning verbs and word sounds (phonemes).

Medications

Certain drugs are being studied for the treatment of aphasia. These include drugs that may improve blood flow to the brain, enhance the brain's recovery ability or help replace depleted chemicals in the brain (neurotransmitters). Several medications, such as memantine (Namenda), donepezil (Aricept, Adlarity), galantamine (Razadyne ER) and piracetam, have shown promise in small studies. But more research is needed before these treatments can be recommended.

Other treatments

Brain stimulation is being studied for aphasia treatment and may help improve the ability to name things. But no long-term research has been done yet. One treatment is called transcranial magnetic stimulation and another is transcranial direct current stimulation.

These treatments aim to stimulate damaged brain cells. Both are noninvasive. One uses magnetic fields and the other uses a low current through electrodes placed on the head.

Coping and support

People with aphasia

If you have aphasia, the following tips may help you communicate with others:

• Carry a card explaining that you have aphasia and what aphasia is.
• Carry identification and information on how to contact significant others.
• Carry a pencil and a small pad of paper with you at all times.
• Use drawings, diagrams or photos as shortcuts.
• Use gestures or point to objects.

Family and friends

Family members and friends can use the following tips when communicating with a person with aphasia:

• Simplify your sentences and slow your pace.
• Keep conversations one-on-one initially.
• Allow the person time to respond.
• Don't finish sentences or correct errors, though it's OK to ask questions if you're not sure about the intended meaning. For example, you could ask, "Are you saying you want juice?"
• Reduce distracting noise in the environment.
• Keep paper and pencils or pens available.
• Write a key word or a short sentence to help explain something.
• Help the person with aphasia create a book of words, pictures and photos to assist with conversations.
• Use drawings or gestures when you aren't understood.
• Involve the person with aphasia in conversations as much as possible.
• Check for comprehension or summarize what you've discussed.

Support groups

Local chapters of organizations such as the National Aphasia Association, the American Stroke Association, the American Heart Association and some medical centers may offer support groups for people with aphasia and others affected by the disorder. These groups provide people with a sense of community and a place to air frustrations and learn coping strategies. Ask your health care provider or speech-language pathologist about local support groups.

Preparing for your appointment

If your aphasia is due to a stroke or head injury, you'll probably first be seen in an emergency room.. You'll then see a doctor who specializes in disorders of the nervous system (neurologist), and you may eventually be referred to a speech-language pathologist for rehabilitation.

Because this condition generally arises as an emergency, you won't have time to prepare. If possible, bring the medications or supplements you take with you to the hospital so that your health care team is aware of them.

When you have follow-up appointments, you'll likely need someone to take you there. In addition, this person may be able to help you communicate with your health care provider.

Some questions a loved one or friend may want to ask your provider include:

• What's the most likely cause of these speech difficulties?
• Are tests needed?
• Is aphasia temporary or long lasting?
• What treatments are available for aphasia, and which do you recommend?
• Are there services available, such as speech-language therapy or home health assistance?
• Are there ways to help my loved one understand others or communicate more effectively?

What to expect from your doctor

Your health care provider will likely have questions, too. A loved one or friend can help your provider get the information needed. Your provider may ask:

• When did the symptoms start?
• Do you understand what others are saying?
• Do others understand what you're saying?
• Has the aphasia been continuous, or does it come and go?
• Have you noticed changes in your speech — such as the way you move your jaw, tongue and lips to make speech sounds — or the sound of your voice?
• Have you noticed changes in your ability to understand what you read or your ability to spell and write sentences?