Understanding Aphasia

All About Aphasia

Aphasia, a disorder caused by damage to portions of the brain that are responsible for language, has been in the news in recent months due to two high-profile retirements. Actor Bruce Willis and talk show host Wendy Williams both had to step away from their careers after developing symptoms of aphasia. In both cases, the aphasia was eventually attributed to frontotemporal dementia. Other well-known entertainers, such as Sharon Stone and Aubrey Plaza, suffered strokes that also led to aphasia. Both women were fortunate enough to fully recover their speech abilities.

Aphasia is the result of damage to one or more parts of the brain that are involved in speech:

• The frontal and temporal lobes, on the front and side of the brain, are responsible for speech formation and understanding. The frontal lobe's motor cortex allows you to speak words, while the temporal lobe helps you access the right words and speech sounds.
• Broca’s area, located in the front of the brain’s left hemisphere, translates thoughts into spoken words and passes that information to the motor cortex, which controls the mouth, tongue, lips, and throat to form speech.
• Wernicke’s area, in the part of the brain where we process sound, is mainly involved in understanding and processing speech and written language.
• The arcuate fasciculus is a band of nerves connecting Wernicke’s area and Broca’s area. It helps you form words, speak clearly, and understand concepts in language form.

All these parts of the brain work together, allowing us to speak and understand what others are saying. Damage to any of these areas can result in various types of aphasia.

Types of Aphasia

There are two broad categories of aphasia: fluent and nonfluent. A person with fluent aphasia can produce properly structured sentences. However, these sentences lack meaning and often sound nonsensical. A person with nonfluent aphasia speaks haltingly and with great effort but understands what is being said to them. Within these two general categories of aphasia are a wide range of subtypes, with some of the most common listed below:

• Wernicke's aphasia is a type of fluent aphasia in which people speak in long, correctly structured but meaningless sentences characterized by word substitutions, made up words, and difficulty understanding language. People with this type of aphasia are often unaware of their mistakes and have difficulty understanding what other people are saying.
• Broca’s aphasia is difficulty speaking fluently. Individuals understand what is being said and try to communicate but they talk in slow, short, choppy sentences and struggle with grammar. They often omit small words, such as "is," "and" or "the."
• Global aphasia is the most severe form. Individuals with global aphasia have extreme difficulty speaking and understanding even simple words and sentences. Some repeat the same words or phrases over and over while others are unable to speak at all.
• Anomic aphasia is a mild form in which speech is fluent and grammatically correct, but the person has difficulty retrieving specific words, especially nouns and verbs.
• Transcortical aphasia is caused by damage to the anterior superior frontal lobe of the language-dominant hemisphere of the brain. A person is capable of repeating entire words and phrases but does not understand their meaning.
• Primary progressive aphasia is caused by a shrinking of certain lobes in the brain. This is a type of frontotemporal dementia that gets progressively worse over time. Unfortunately, there are no treatments currently for this type of aphasia.

Causes of Aphasia

There are many different conditions and injuries which may cause aphasia, including:

• Stroke due to the blockage or rupture of a blood vessel in the brain is the most common cause of aphasia
• Traumatic brain injury (TBI) from an accident, fall, or assault, can damage areas of the brain responsible for language
• Brain Tumors, especially those located near or within language areas of the brain, can interfere with language processing
• Progressive Neurological Disorders such as Alzheimer's, Parkinson's, primary progressive aphasia (PPA), frontotemporal dementia, or Lewy body dementia can cause gradual deterioration of language abilities
• Infections such as encephalitis or meningitis
• Inflammatory conditions such as multiple sclerosis can lead to aphasia
• Prolonged or severe seizures can sometimes result in temporary language difficulties, known as postictal aphasia
• Lack of oxygen to the brain, (anoxia), which can have a variety of causes such as near drowning, suffocation, carbon monoxide poisoning or overdosing on opioids or illegal drugs such as fentanyl, can cause aphasia depending on the part of the brain that is damaged

Treating Aphasia

There is no simple “cure” for aphasia, but it can be managed with speech therapy. Recovery time may vary from hours or days to months or years, depending on the extent and cause of brain damage. Some people may fully recover, while others show little improvement. Still more improve gradually, over time. But for some (especially those with primary progressive aphasia), the condition will continue to worsen.

Speech and language therapy is the main treatment for aphasia. Therapy is individualized to address the type of aphasia a person is struggling with, their prognosis, and their needs and goals. Treatment has a dual purpose: enhancing the patient’s remaining language skills and helping them regain the abilities they have lost. Therapy focuses on relearning and practicing language skills and teaching people alternative or supplementary communication methods.

If you think you or a loved one may have signs of aphasia, talk to your doctor immediately. They can conduct tests to determine the type of aphasia and appropriate treatment. For help finding a doctor, click here.

This article appeared in the June 2024 edition of the HealthPerks newsletter.