Aphasia: causes, symptoms, complications and treatment

Definition

Aphasia is a communication disorder that occurs due to brain

damage in one or more areas that control language. It can interfere
with your verbal communication, written communication, or both. It
can cause problems with your ability to:

 Read
 Write
 Speak
 Understand speech
 Listen

According to the National Aphasia Association, about 1 million

Americans have some form of aphasia.

Aphasia
History

The first recorded case of aphasia is from an Egyptian papyrus, the

Edwin Smith Papyrus, which details speech problems in a person
with a traumatic brain injury to the temporal lobe. During the
second half of the 19th century, aphasia was a major focus for
scientists and philosophers who were working in the beginning
stages of the field of psychology.

Aphasia was non-medically described in early texts, such as the

Bible and writings of Homer, but there was no further mention of
what aphasia was or how it occurred at that time. In medical
research, speechlessness was described as an incorrect prognosis,
and there was no assumption that underlying language
complications existed. The earliest recorded medical cases of
aphasia were made back in the Middle Ages, were it was thought to
be an imbalance of bodily fluids in the brain that caused the inability
to speak one’s mind. The first medical documents dating back to the
late 19th century contain early descriptions of aphasia. Broca and
his colleagues were some of the first to write about aphasia, but
Wernicke was the first credited to have written extensively about
aphasia being a disorder that contained comprehension difficulties.
Despite claims of who reported on aphasia first, it was F.J. Gall that
gave the first full description of aphasia after studying wounds to
the brain, as well as his observation of speech difficulties resulting
from vascular lesions.

Epidemiology

Among 188,015 inhabitants, 269 patients had first-ever ischemic

stroke (FEIS), of whom 80 (30%; 95% CI, 24 to 36) had aphasia.
The overall incidence rate of aphasia attributable to FEIS amounted
to 43 per 100,000 inhabitants (95% CI, 33 to 52). Aphasic stroke
patients were older than nonaphasic patients. The risk of aphasia
attributable to FEIS increased by 4% (95% CI, 1% to 7%), and
after controlling for atrial fibrillation, by 3% (95% CI, 1% to 7%)
with each year of patients’ age. Gender had no effect on incidence,
severity, or fluency of aphasia. Cardioembolism was more frequent
in aphasic stroke patients than in nonaphasic ones (odds ratio [OR],
1.85; 95% CI, 1.07 to 3.20). Aphasic patients sought medical help
earlier than nonaphasic stroke patients. Still, after controlling for
stroke onset-assessment interval, aphasic stroke patients were
more likely to receive thrombolysis than nonaphasics (OR, 3.5; 95%
CI, 1.12 to 10.96).

Types

There are types of aphasia. Each type can cause impairment that
varies from mild to severe. Common types of aphasia include the
following:

Expressive aphasia (non-fluent): With expressive aphasia, the

person knows what he or she wants to say, yet has difficulty
communicating it to others. It doesn’t matter whether the person is
trying to say or write what he or she is trying to communicate.

Receptive aphasia (fluent): With receptive aphasia, the person

can hear a voice or read the print, but may not understand the
meaning of the message. Oftentimes, someone with receptive
aphasia takes language literally. Their own speech may be disturbed
because they do not understand their own language.

Anomic aphasia: With anomic aphasia, the person has word-

finding difficulties. This is called anomia. Because of the difficulties,
the person struggles to find the right words for speaking and
writing.

Global aphasia: This is the most severe type of aphasia. It is often

seen right after someone has a stroke. With global aphasia, the
person has difficulty speaking and understanding words. In addition,
the person is unable to read or write.

Primary progressive aphasia: Primary progressive aphasia is a

rare disorder where people slowly lose their ability to talk, read,
write, and comprehend what they hear in conversation over a
period of time. With a stroke, aphasia may improve with proper
therapy. There is no treatment to reverse primary progressive
aphasia. People with primary progressive aphasia are able to
communicate in ways other than speech. For instance, they might
use gestures. And many benefit from a combination of speech
therapy and medications.

Causes

Aphasia is usually caused by a stroke or brain injury with damage to

one or more parts of the brain that deal with language. According to
the National Aphasia Association, about 25% to 40% of people who
survive a stroke get aphasia.

Aphasia may also be caused by a brain tumor, brain infection, or

dementia such as Alzheimer’s disease. In some cases, aphasia is a
symptom of epilepsy or other neurological disorder.

Symptoms

Aphasia is a sign 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
 Not understand other people’s conversation
 Write sentences that don’t make sense

The severity and scope of the problems depend on the extent of

damage and the area of the brain affected.

Complications

 Aphasia impacts many aspects of life, from personal

relationships to economic wellbeing, as communication is
fundamental to day-to-day living. It can leave the patient
feeling frustrated and distressed, and their loved ones can
become impatient. Together with other effects of the stroke,
aphasia can lead to depression.
 A person with aphasia is encouraged to go to support groups,
and to get someone to help them practice their communication
skills. If they are at risk of depression, they should see their
doctor about treatment.
 Before meeting with a doctor, a friend can help them to
practice what they want to say or write down any questions
they may have.

Diagnosis and test

If your doctor suspects you have aphasia, they may order imaging
tests to find the source of the problem. A CT or MRI scan can help
them identify the location and severity of your brain damage.

You doctor may also screen you for aphasia during treatment for a
brain injury or stroke. For example, they may test your ability to:

 follow commands
 name objects
 participate in a conversation
  answer questions
 write words

If you have aphasia, a speech-language pathologist can help

identify your specific communication disabilities. During your
examination, they’ll test your ability to:

 speak clearly
 express ideas coherently
 interact with others
 read
 write
 understand verbal and written language
 use alternative forms of communication
 swallow

Treatment and medications

If the brain damage is mild, a person may 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
currently 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 relatively slow process.

Although most people make significant progress, few people regain
full pre-injury communication levels.

For aphasia, speech and language therapy tries to improve the

person’s ability to communicate by restoring as much language as
possible, teaching how to compensate 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 initiating conversations,
speaking in turn, clarifying misunderstandings 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 currently 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) and piracetam, have shown promise
in small studies. But more research is needed before these
treatments can be recommended.

Prevention

Many of the conditions that cause aphasia aren’t preventable, such

as brain tumors or degenerative diseases. However, the most
common cause of aphasia is stroke. If you reduce your risk of
stroke, you can lower your risk of aphasia.

Take the following steps to lower your risk of stroke:

 Stop smoking if you smoke.

 Drink alcohol only in moderation.
 Exercise daily.
 Eat a diet that’s low in sodium and fat.
 Take steps to control your blood pressure and cholesterol.
 Take steps to control diabetes or circulation problems if you
have them.
 Get treatment for atrial fibrillation if you have it.
 Get immediate medical care if you develop the symptoms of a
stroke.