Aphasia is an impaired ability to use or comprehend previously understood words and language. This condition affects around a million people in the United States alone, including members of Congress, actors, singers, and four-star generals. It occurs due to damage to the language centers of the brain and can range in severity from extreme difficulty recalling certain words to a complete inability to comprehend either written or spoken language. While it can affect any age group, the majority of people affected by this condition are middle-aged or older.
The severity and presentation of this condition are influenced by several factors, including the cause of the brain injury, the location of the injury, the extent of the damage, and the initial age and overall health of the patient. For some individuals, like Emilia Clarke, their ability to use words quickly recovers. Others have more lasting impairments but, with perseverance, may regain much of their former abilities. For those suffering from degenerative disorders, including retired action star Bruce Willis, the condition is likely to worsen over time.
Causes of Aphasia
Aphasia is caused by damage to the structure of the brain’s language center. Strokes, which are more common as we age, are caused by either a burst or blocked vessel in the brain. Either scenario blocks the blood flow to a part of the brain, starving brain cells of vital nutrients. When enough cells in the language center die off, aphasia results.
Strokes are not the only cause of damage to the brain, however. Brain tumors can starve or crowd out healthy brain cells, and degenerative diseases like dementia and Alzheimer’s can eat away at those areas of the brain. Physical injury, including blunt force trauma, penetration of the brain, or gunshot wounds to the brain’s language center, can also trigger communication difficulties.
Types of Aphasia
There are several types of aphasia, defined mainly by the type of language-based impediment the individual exhibits. The kind that occurs is frequently determined by where and how much of the language center is injured.
The most common types of aphasia include:
Anomic aphasia
This is one of the milder forms of this condition. Those with anomic aphasia have difficulty finding the right words when communicating, particularly nouns and verbs. Both speech and writing are otherwise grammatically correct, however, and they have little to no difficulty understanding either written or spoken language.
Broca’s
Broca’s aphasia is caused specifically by damage to the Broca’s area of the brain. The part of the brain known as Broca’s area is in the frontal lobe of the brain, most often in the left hemisphere. Other names for this condition include non-fluent aphasia and expressive aphasia. It becomes very difficult for people with this form of disorder to produce sentences. They often know what they want to say, but the language to express it becomes difficult to convey. Sentences are often short, with improper word order, grammar, and syntax. People experiencing Broca’s aphasia can usually understand language better than express it.
Wernicke’s
Wernicke’s aphasia, like Broca’s aphasia, is named for the affected area of the brain. Like Broca’s area, Wernicke’s is also usually found in the left hemisphere but in the temporal lobe rather than the frontal lobe. Speech and the ability to write appear to come easily for those with Wernicke’s at first glance. It is fluent and sounds almost like a normal language. Unfortunately, the words themselves don’t tend to make any sense, with random words and phrases strung together into long, rambling sentences. Those with Wernicke’s aphasia often have trouble with comprehension and are often unaware that they are making communication errors.
Global aphasia
Damage to multiple language centers in the brain, including Broca’s and Wernicke’s areas, can result in global aphasia. This presentation of the condition affects both the understanding and use of written and spoken language.
Conduction aphasia
This type of aphasia is marked by an inability to repeat words or phrases. Other areas of language are often unaffected, though a percentage of those experiencing conduction aphasia may also have some trouble finding the right words. Compared to the other forms listed, conduction is a relatively rare condition.
Mixed transcortical aphasia
Mixed transcortical aphasia, also known as isolation aphasia, is characterized by repetition. Speech is not fluent but slow and halting. These individuals often struggle to initiate speech, but they can frequently repeat what is communicated to them. Comprehension of language, both written and spoken, is also heavily impacted.
Primary progressive aphasia
This particular form of aphasia differs from the others in that it is caused by a degenerative disease such as Alzheimer’s or another form of dementia. It can present in many different ways but is always characterized by symptoms that progressively worsen over time.
Transcortical motor aphasia
This type of aphasia closely mimics Broca’s aphasia. TMA is due to a stroke or brain injury that impacts Broca’s area in the brain but doesn’t directly injure that area.
Transcortical sensory aphasia
Transcortical sensory aphasia is caused by damage to the brain that affects Wernicke’s area but isn’t actually located in Wernicke’s area. It mimics Wernicke’s aphasia, with comprehension challenges and fluent speech patterns that are composed of random words and phrases. Like those with Wernicke’s, patients with this type of aphasia may not realize that their communications aren’t making sense.
Communication Adjustments
There are several steps that can be taken to improve communication with people who have developed aphasia, both on the part of the patient and on the part of the person communicating with the patient. Individuals conversing with a person with aphasia should slow down their speech rate, use simple, short sentences, and repeat key words or phrases frequently. Give the person you are communicating with plenty of extra time to express themselves without correcting their speech or talking down to them. Encourage all forms of communication—spoken, written, gestures, drawing, and pointing.
For those with aphasia, slowing down and focusing on one idea at a time can facilitate smoother communication. Take the time you need to gather and express your thoughts. For those who have better-written skills than spoken, typing or writing may help with communication. Communicating via text and email may also be easier for these individuals. Don’t be afraid to employ props like photos, maps, or notecards to get your point across.
Living with Aphasia
If you or a loved one are suffering from aphasia, there are additional resources to ease the burden of communication. Your doctor or psychiatric care team can refer you to specialists in the medical field. A neuropsychologist may be requested to diagnose, monitor, and treat changes in cognitive skills, including memory and behavior, after brain injury has occurred. Both occupational therapists and speech-language pathologists are skilled at retraining patients with the needed communication skills and may also be able to recommend adaptive equipment to make communication easier.
There are also several great resources specifically for people with this condition. The National Aphasia Association has a vast database of information about aphasia, including communication and therapy guides, a list of helpful books, and an introduction to assistive technology. They also have an online database of aphasia centers, so caregivers and patients can find a center with more localized resources and an online community. The American Stroke Association also has an abundance of information about aphasia and other conditions that are common after a stroke.
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