Aphasia: Causes, Symptoms, & Treatment Options

Speaking, reading, writing, and understanding language are critical to our ability to engage with the world and enjoy life. When those abilities are compromised by a condition known as aphasia, it can be truly life-altering.

Despite affecting about 2 million people in the United States, aphasia was not widely known or understood by the general public for many years. But, with actors Bruce Willis and Emilia Clarke both recently revealing their diagnosis in the press, awareness is growing.

Caused by damage to parts of the brain that control speech and understanding of language, aphasia is most commonly brought on by a stroke but may also be the result of a head injury, tumor, dementia, infection, or a degenerative disease of the brain. Which specific communication skills are impacted is determined by which areas of the brain are affected.

A person with aphasia may:

• speak in short or incomplete sentences or ones that don't make sense.
• substitute one word for another or one sound for another.
• speak unrecognizable words.
• have difficulty finding words.
• have trouble understanding speech and following conversations. 
• not understand what they read.
• write sentences that don't make sense.

There are many types or patterns of aphasia, distinguished by the strengths or weaknesses a patient exhibits. For example, people with expressive aphasia are challenged to speak in complete sentences and often struggle to find words. Those with receptive aphasia have difficulty making sense of incoming language, as in a conversation. The most challenging type of aphasia is global aphasia in which the abilities to speak, understand, write, and read are all impacted. It is possible to have more than one type of aphasia and, whether alone or in combination, each can be experienced to different degrees.

Usually, aphasia is recognized by the patient, or someone close the person, like a family member, friend, or co-worker. Depending on the severity and nature of the onset, aphasia may be first evaluated by a primary care physician or an emergency medicine physician. Neurologists are often added to the care team to assist with further investigations and treatments of the underlying disorder producing the aphasia. Often, imaging, such as CT scans and MRIs, are used to assess the damage to the brain and resulting deficits.

Speech and language pathologists often fine-tune the understanding of the deficits and provide the critical therapy to optimize chance for recovery and help the patient's caregivers make accommodations to assist the patient's communication.

Treating aphasia involves caring for the underlying condition that brought it on as well as the condition itself. The goal of treatment is to improve an individual’s ability to communicate through speech-language and nonverbal communication therapies. Patients work to relearn and practice language skills and develop other means of communication. Very often, family members play an active role in treatment, work to strengthen their mutual communications skills.

While a full recovery is possible, most people remain affected by aphasia to varying degrees. This can be extremely challenging for the individual and those who love them. Often people with aphasia are perceived to have reduced intelligence, which is not the case. Loved ones are encouraged to be supportive and work to find new ways to allow affected individuals to be a contributing part of any communication. This may include:

• Engaging them in a natural conversational manner at an adult level.
• Using short, simple sentences to express ideas.
• Repeating key words or even writing them down to clarify meaning.
• Not correcting an individual’s speech.
• Not rushing an individual to complete a thought.
• Encouraging other types of communication besides speech, including gestures, drawing, or using a computer

While there is no guaranteed method to prevent aphasia, risk can be reduced by optimizing overall health. Vascular causes can be addressed through healthy diet and regular exercise, by quitting smoking, and treating high blood pressure, high cholesterol, and diabetes. Risk can be further reduced by participating in regular cancer screenings (based on age and risk), and through efforts to reduce the risk of trauma, such as wearing seatbelts and adhering to gun safety.

NOTE: Aphasia is often a sign of a serious problem.  If you or a loved one exhibit signs of aphasia (see above), you need to seek medical evaluation.  If the aphasia is of sudden onset, as in a stroke, go directly to the emergency department for prompt evaluation.

Herbert Gregg, MD, is a neurologist at Southwestern Vermont Medical Center.