Bruce Willis was recently diagnosed with aphasia, forcing him to retire to focus on his health. The heartbreaking news about the beloved Die Hard action hero has one silver lining, in that its raised awareness of the condition, which affects more than 200,000 Americans per year and causes difficulty with comprehending language and speaking and communicating clearly. Find out what aphasia is, how it’s diagnosed and how it’s treated—as well as how to help a loved one who may be suffering from it in silence.
What is aphasia?
“Aphasia is a language disorder that results from damage to the left hemisphere of the brain. It can cause difficulty using words and sentences, understanding language, reading and writing,“Jennifer Brello, MEd; CCC-SLP, clinical associate professor at the Ohio State University and director of the OSU Aphasia Initiative, told Parade. Like almost every other medical condition, aphasia can manifest differently in different patients. Board-certified neurologistDr. Jessica Ailani, MD, director of Medstar Headache Center, professor of Clinical Neurology at Medstar Georgetown University Hospital and member of the National Healthcare Foundation’s Healthcare Leadership Council, told Parade, “In most cases with aphasia, a person will have difficulty with their speech. There may be trouble expressing words or forming sentences. Sometimes there may be trouble understanding others. Many times aphasia is sudden if it relates to a head injury or stroke or if it is due to a migraine. If there is a gradual appearance of difficulty with language, this may indicate a slower process of breakdown of the language network which may indicate a neurodegenerative process.”
What are the 3 types of aphasia?
According to Dr. Ailani, there are three different types of aphasia. They include:
Global aphasia: Having trouble understanding others and difficulty saying words and sentencesExpressive aphasia: The ability to understand what others are saying but having difficulty speaking or saying words. Patients with expressive aphasia may be able to speak in short or very short sentences.Comprehensive aphasia: Having difficulty understanding what others are saying, even if you can communicate easily yourself. “Oftentimes a person with comprehensive aphasia will carry on a one-sided conversation with you,” Dr. Ailani says, “but the conversation may not be something you understand.”
Bello adds that there is a fourth classification for the condition as well: “Language difficulties resulting from degenerative brain disease is called primary progressive aphasia, which is a type of dementia.”
What is the main cause of aphasia?
Aphasia can be caused by a number of underlying issues, the most common being stroke. “The dominant frontotemporal regions of the brain help with speech production and perception (for right-handed people, usually the left side is the ‘dominant side’ whereas for left-handed people it can be the right side of the brain),” neurologist, epileptologist and clinical assistant professor of neurology at NYU Grossman School of Medicine Dr. Santoshi Billakota, MD, explains. “This trauma can be due to a stroke in that region, tumor, any lesion or even dementia. If it is not permanent and comes and goes, it could suggest focal seizures.” The type of aphasia can be determined by which area of the brain is damaged, Dr. Billakota notes, with damage to all structures, can lead to global aphasia.
Can a person recover from aphasia?
Unfortunately, no. “Since the typical causes of aphasia are from an injury to the brain structure, it usually can not be cured,” Dr. Ailani said, noting, however, “For people who have episodes of aphasia during diseases such as migraine, their speech will return to normal between attacks.” Neurologist with CNS Physicians at Craig Hospital Dr. Michael Makley, MD, says that primary progressive aphasia is the least likely type from which to recover. “This is a progressive disorder, much like Alzheimer’s disease, where people get worse over time,” he explained. “You can intervene with some therapies, but eventually, due to the progressive nature of this type of aphasia disorder, it generally just keeps getting worse and there’s no medicines or treatments that can really change that trajectory.”
How is aphasia diagnosed?
Aphasia diagnosis processes may vary depending on the cause and the patient’s medical history. “Aphasia resulting from acquired brain injury will be diagnosed by a speech-language pathologist or physician,” Bello says, noting, “Anyone who is experiencing changes in their ability to use language without an acute brain injury should talk with their primary care provider.” According to Dr. Ailani, other methods include neurological exams involving speech and language testing, as well as an MRI of the brain to evaluate for any potential underlying structural changes.
How do you fix aphasia?
Speech therapy can help aphasia patients communicate. Other options can include outpatient treatments, group therapy, psychotherapy and rehabilitation. Treating the underlying cause of the patient’s aphasia, like surgical removal of tumors or radiation to shrink them, management of dementia and anti-epileptic treatment can be options as well, Dr. Billakota notes. Every patient’s needs may be different. Talk to your or your loved one’s medical provider to see what programs and services are available near you or the patient for treatment.
How can I help someone with aphasia?
Dr. Billakota says that if aphasia is sudden, it may be due to a stroke and to call 911 immediately. For other cases, Dr. Ailani says helping a loved one get medical attention is crucial. “It is important to speak to your health care provider about seeing a neurologist if you suspect you or a loved one has symptoms of aphasia,” she said. “To prepare for your appointment, make notes of the symptoms that have been experienced, such as what types of words have been difficult to say; how often does this happen and for how long; whether you have trouble speaking, writing or both; is it easier to understand people or is this difficult too; does anyone else in the family have similar symptoms; any changes in mood or behavior around the same time; any new medications or changes in your medical history?” It’s also key to be empathetic to the person with aphasia because of the social and psychological impacts of the disorder—and to just be there, because they may feel very alone. “Aphasia can have a significant impact on quality of life. It can limit the ability to socialize with family, friends, work, and participate in life activities,” Bello says. “Additionally, persons living with aphasia are more likely to experience social isolation which can lead to depression and reduced life satisfaction.” Dr. Makley concurred, emphasizing the importance of remembering that the person you love is still who they are, even if they can’t express themselves the way that they used to with you. “There can be a lot of depression with patients with language disorders, particularly with expressive language disorders because they become very frustrated and they’re treated differently,” he said. “So I think the one thing to take home is that you treat people with language disorders as the human beings that they are.” He added that language is one of our fundamental human characteristics and expressing language is one of the things that many people would argue is makes us human. “Language is part of our culture and art, and expressing language or singing or music—that’s all a part of what makes us really special,” he said. “Although a person might have problems with language, they are still a person—they’re still in there. And I think they need to be treated with respect and understanding of that, but the language disorder is just a language disorder. They’re still in there.” Next, find out the most important early warning signs of dementia.
Sources
Dr. Jessica Ailani, MDDr. Santoshi Billakota, MDJennifer Brello, MEd., CCC-SLPDr. Michael Makley, MD
