Expert Advice on Diagnosing and Treating Aphasia

Updated on Jun 30, 2022 | Featured, Your Health

Aphasia is loss of the ability to understand or express spoken or written language. It commonly occurs after strokes or traumatic brain injuries. It can also occur in people with brain tumors or degenerative diseases that affect the language areas of the brain.

According to the National Aphasia Association, this disorder affects about two million people in the United States, and is more common than Parkinson’s disease, cerebral palsy, or muscular dystrophy, yet most people have never heard about it. That changed after the family of actor Bruce Willis announced he will step away from acting following a recent diagnosis of aphasia.

Laura Stein, MD, MPH

In this Q&A, Laura Stein, MD, MPH, Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai and attending physician at the Mount Sinai and Mount Sinai Queens Stroke Centers, discusses how aphasia is diagnosed, the potential burdens for families and caregivers, and some treatment options, notably treatments by speech-language pathologists.

What is aphasia?

Aphasia is a term doctors use to describe the loss of one’s ability to use their language function, or communicate with the world around them. It’s due to damage in the brain. It’s easy to lose sight of how all-encompassing language function is. It’s what we say with our words. It’s understanding others. It’s our ability to read, our ability to write, our ability to do everything in between. We have to remember that aphasia represents a symptom that patients experience or a sign doctors look for on their exams. It’s really just a term describing these problems with language and communication. It tells us nothing about why someone is having problems with their language and communication. I also want to acknowledge that aphasia can be profoundly difficult and frustrating for patients and their families. Our ability to communicate with the world around us is paramount to the human experience.

What are the signs and symptoms of aphasia?

The signs and symptoms of aphasia are actually quite varied, depending on the individual. Aphasia can be so mild that someone talking to an individual with an aphasia might not even know that they have it. In such a case, someone with a mild aphasia might have trouble coming up with words or the names of objects. At times, their speech may sound broken and fragmented, but they may still be able to communicate what they want to communicate and understand what people are saying, what they’re reading around them. Unfortunately, aphasia can be very debilitating at times, and some people have a difficult time making their needs known or understanding what’s going on around them. These can be very troubling and frustrating symptoms for patients and their families to live with.

How is aphasia diagnosed?

Aphasia is diagnosed with a detailed examination of one’s language function, and might be performed by a neurologist like myself, or a speech-language pathologist. It’s really important to assess every component of language function. We listen to what somebody says, whether spontaneously or with various prompts. We assess what they understand when they’re spoken to. We assess their ability to read, their ability to write, their ability to name everyday objects around them, their ability to repeat sentences that are spoken to them.

What causes aphasia?

The causes of aphasia can be quite varied. Anytime language function is abnormal, we worry about damage to specific locations of the brain where the language centers are located. In a majority of people, the language centers are on the left side of the brain, but in a small minority they may be on the right. Aphasia is more common in older individuals, and stroke is the most common cause  because of how many people have strokes in our society at older ages. However, there are many causes, like a degenerative disease that might cause dementia, a tumor, infection, or head trauma. But it’s really all about figuring out what part of the brain is not working normally, and why

What are the types of aphasia, and how do they differ?

There are multiple types of aphasia. The networks that underlie language function are complicated and interconnected. We’ll break it down in broad senses: There are expressive and receptive aphasias. With expressive aphasia, an individual has difficulty expressing themselves—speaking in sentences, coming up with words, writing; their speech may sound broken and fragmented. With receptive aphasia, an individual has more trouble understanding language, what people are saying, what they are reading. Someone may have a mixed aphasia, with expressive and receptive components. The most profound aphasia is a global aphasia, where all aspects of language function are impaired, and it is incredibly difficult to communicate with the world around you.

How is aphasia treated?

First and foremost, we have to understand what the cause of the aphasia is. Once we identify a cause, such as a stroke, we can think about treatments and if we can prevent the aphasia from getting worse. Beyond that, we think about how can we help the individual rehabilitate. We have outstanding speech-language pathologists who are specially trained in optimizing one’s language function and their ability to communicate with the world around them, despite their aphasia.

Learn more about speech-language pathology services at Mount Sinai
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Match Day 2022: Graduating Medical Students Receive Their Residency Matches

Mar 24, 2022 | Featured

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During a special celebration, 124 students at the Icahn School of Medicine at Mount Sinai learned what the next phase of their career path would be at Match Day 2022, when each of them opened a carefully sealed envelope that revealed the U.S. residency program they had “matched” to and would be attending this year following graduation.

The graduating Class of 2022 matched to 25 specialties and to many of the most competitive residency programs in the nation, including the Children’s Hospital in Philadelphia, Yale New Haven Hospital, Massachusetts General Hospital, Johns Hopkins and Washington University.  A total of 52 students will remain within the Mount Sinai Health System for at least part of their residency training.

The most popular specialties for matching students were Internal Medicine (23), Emergency Medicine (10), Anesthesiology (14), General Surgery (9), Obstetrics and Gynecology (9), and Psychiatry (8).

The School hosted a hybrid celebration on Friday, March 18, beginning with a fully-produced and highly energetic television show, culminating with a reveal of the matches and a carnival-themed after party. Each year, the matches are orchestrated through the National Resident Matching Program (NRMP), which uses mathematical algorithms to align the preferences of applicants with the preferences of residency programs available at teaching hospitals across the nation.

On Match Day, the Mount Sinai Health System also extended residency offers to 557 students from across the country, including graduates from sixteen of the nation’s top twenty medical schools, who will arrive in July.

Meet three of the graduates, who display the range of experiences and accomplishments of this year’s class.

Kimia Ziadkhanpour

Kimia Ziadkhanpour, the first in her family to become a doctor, matched to anesthesia at Brigham and Women’s Hospital in Boston.

Her interest in medicine began when she was six years old. In her native Tehran, she and her grandfather would hold hands as they traveled 30 miles on public buses to appointments with his cardiologist after he experienced a heart attack in his early 70s.

“At first his prognosis seemed good and his spirits were high; we would play in the yard every day,” she says. “But about a year and half later he died. My father tried to explain to me how he died, and none of it made sense to me. So I started searching for answers in books about science and anatomy.”

Indeed, as she grew older, Ms. Ziadkhanpour would wonder if her grandfather might have lived longer if he had had better care, or a doctor who was closer.

When she was seven, she moved to the United States, which opened doors to continue her interest in medicine later in life, first at the Massachusetts Institute of Technology, then later at the Icahn School of Medicine.

“One of the things I will take away from my experience at the Icahn School of Medicine at Mount Sinai is the idea that we treat every patient as if they are family, regardless of their background. And we give the same level of care to our patients, whether they come through the doors of our student run East Harlem Health Outreach Partnership and have no insurance or if they are from the wealthy, Upper East Side,” says Ms. Ziadkhanpour.

Thomas Fetherston

Thomas Fetherston matched to Tripler Army Medical Center in Hawaii through the military match in December. The only veteran in the class of 2022, Mr. Fetherston, a Second Lieutenant, served in the U.S. Army, where his experiences as a combat medic reinforced his interest in emergency medicine.

Having served a tour in Afghanistan, he traveled full circle when he and colleagues at Mount Sinai worked together to hold a clinic for evacuees of Afghanistan in New Jersey, in collaboration with the Church World Service, a faith-based organization that provides development, disaster relief, and refugee assistance around the world.

“The clinic was an incredibly meaningful culmination of my four years of medical school and Army service. In just one single day, we were able to evaluate 28 patients, four of whom needed immediate treatment and another 15 who need follow up treatment,” he says. The Health System and the medical school place a huge value on the community and the importance of providing service to address inequities in health care access, and this is just one small example.”

Thomas Fetherston outside of Souf village, near Kandahar in Afghanistan

Parth Trivedi

Parth Trivedi matched to Internal Medicine at The Mount Sinai Hospital.

In his fourth year as a medical student, Mr. Trivedi co-authored an important paper that was published in Gastroenterology in January, 2022, which described a troubling increase in early-onset colorectal cancer and precancerous polyps among adults under the age of 50. It was the first large-scale study to look at precancerous polyps in this age group, representing a significant contribution to the literature on early onset pre-cancerous lesions in this age group.

Mr. Trivedi, who helped design the study and provide statistical analysis, says he hopes the study will make a difference.

“We hope that the data we shared and our analysis will ultimately inform decision making by policymakers and primary care doctors on whom to screen and how early,” he says.

Nursing Excellence: A Valued Preceptor Role Models Emotional as Well as Clinical Patient Care

Mar 17, 2022 | Featured, Nursing, Stories of Excellence

Megan Pace, RN, MSN, a nurse in the Intensive Care Unit at Mount Sinai Beth Israel

Megan Pace, RN, MSN, has been a nurse in the Intensive Care Unit at Mount Sinai Beth Israel since 2010. According to Maria LaTrace, RN, BSN, MSN, Senior Nursing Director, Patient Care Service at the hospital, Megan has always been a source of reliable and dependable guidance to her peers and is considered the “go to” for precepting and onboarding new nurses to the unit.

Within the past year, Megan has been a preceptor on almost every shift. Maria says that Megan displays tireless enthusiasm, patience, and diligence with the new staff members. “She is able to find the energy to make every single one of them feel that she or he is her priority.”

“It’s important to understand that nursing is more than just giving medications and charting at a computer, you have to remember there is a person and their loved ones on the receiving end of your care.”

Despite the incredible strain and cumulative burden of the past two years in ICU nursing, Megan is the “voice of reason” on her unit, Maria says. “She brings a measured sense of calm to every situation, which is invaluable for her orientees to witness, in that they see how to use rational, logical, and evidence-based reasoning in all decisions.”

That is certainly the case for one of Megan’s orientees, Jasmine Brinson, RN, BSN.

“Megan has been a great contributor to my smooth transition from medical surgical nursing to critical care. Venturing into a new specialty can be challenging and overwhelming, but Megan was always patient with me and encouraged me to ask as many questions as possible,” Jasmine says. “During my first week off orientation, I was so overwhelmed and felt unsure of myself. Megan was working on the opposite side of the unit, and she literally dropped everything and came to assist me, at the same time reassuring me that I was doing just fine.”

Having been a teacher before she moved into nursing, Megan feels she is perfectly suited to the role of preceptor.

“I have had some great role models throughout my career, and I have always strived to emulate their behaviors and make sure I am modeling those same behaviors for my orientees,” she says. “I think being a good role model is a key characteristic of being a good preceptor. It’s important to understand that nursing is more than just giving medications and charting at a computer, you have to remember there is a person and their loved ones on the receiving end of your care. When precepting, I try to stress the importance of the social and emotional aspect of nursing to my orientees. It is important they make it just as much of a priority as giving that medication or charting blood pressure.”

She adds, “These past two years have been rough for health care workers, but knowing that patients and their families appreciate my care makes it all worthwhile.”

Read more Stories of Nursing Excellence

SARS-CoV-2: Three Leading Microbiologists Discuss the Path Forward

Mar 8, 2022 | COVID-19, Featured, Research

From left: Florian Krammer, PhD, Adolfo García-Sastre, PhD, and Peter Palese, PhD

Microbiologists at the Icahn School of Medicine at Mount Sinai, who created the first and most reliable test to determine whether an individual has antibodies to SARS-CoV-2, have been monitoring the virus since it began circulating in Wuhan, China, in late 2019.

Now, Peter Palese, PhD, Horace W. Goldsmith Professor and Chair of the Department of Microbiology, and Florian Krammer, PhD, Mount Sinai Professor in Vaccinology— weigh in on the future of SARS-CoV-2 and its place in our lives. They, and their colleague, Adolfo García-Sastre, PhD, the Irene and Dr. Arthur M. Professor of Medicine, recently created a low-cost COVID-19 vaccine that can be manufactured wherever influenza vaccines are made—particularly in low-and-middle-income countries. The scientists are also working on a universal flu vaccine, which would confer immunity without having to be administered annually.

As we move away from this pandemic will SARS-CoV-2 continue to play a large part in our lives?  

Dr. Palese: Clearly the future is difficult to predict, but one likely scenario would be similar to the way we manage influenza viruses, which necessitates continuing vaccinations as we go into the future—perhaps once a year or once every two years. In this case, the virus continually changes but the effects can be ameliorated by vaccines, and those vaccines have to be changed. But they reduce fatality and hospitalization and the need for people to stay home.

Dr. Krammer: In this scenario the virus is not going to disappear. It’s just going to stick around and become the fifth coronavirus that circulates in humans. The other four coronaviruses make up about 30 percent of all common colds, and they’re seasonal; they come in the winter like influenza.

Dr. García-Sastre: Some of these common coronaviruses that cause the common cold have been with us for a long time and are very different from SARS-CoV-2. They are happily living with us, rarely cause any major disease, and do not cause a threat.

Dr. Krammer: Now, influenza typically causes more damage than these common coronaviruses which are typically causing mild infection, except in people who have problems with their immune system who are sometimes brought to the intensive care unit. I think SARS-CoV-2 will land somewhere between influenza and human coronaviruses—between those two extremes.

Is it possible that this virus will simply disappear?

Dr. Palese: You can never exclude the possibility that this virus will peter out the way the coronavirus (SARS-CoV-1) did twenty years ago, when it emerged to cause some really high fatalities but disappeared. On the one hand it was a nightmare, but then it was over.

Dr. Krammer: I don’t think the virus will just disappear, but it might. We didn’t think there would be so many variants this quickly, especially not something like Omicron, so there might be surprises. I hope for society’s sake that this fades into the background and we’re not afraid every fall that another wave is coming. The scenario I would like to see in six months is that Peter and I – as virologists – are concerned about it but that the problem is insignificant enough so that the public does not have to be. We’ll see if that happens.

How do we continue to ensure protection from COVID-19?

Dr. Krammer: We have to look at the baseline immunity that exists in the population. If a lot of people have immunity and there is less virus circulating chances are that you either don’t get infected or, if you get infected, your immunity will be protect you against severe outcomes. Then the disease and infections become less relevant. And that is what we hope for. Now, you can get there through vaccinations—that’s the painless way, or you can get there by having had the infections, and that’s the painful way. But both contribute to having higher baseline immunity in the population. Unfortunately, even in this scenario, immunocompromised patients are still at risk of severe outcomes although there risk of getting infected is lower.

Dr. García-Sastre: Vaccinations are still the solution to the problem. We should make sure that as many people as possible are vaccinated and boosted.

Dr. Krammer: I think we need to keep working on vaccines against SARS-CoV-2. Right now we have this situation where the vaccine protects very well against severe disease if you’re not immune compromised. But those vaccines are not protecting very well from infection anymore. They did against the original virus, but not with the variants. That’s why, for example, we need a variant-specific vaccine for Omicron. There are ways to make vaccines differently so you get more sterilizing immunity, which would suppress infections more, in general, and that would make the world safer for those who don’t mount good immune responses.

Dr. Palese: In creating our COVID-19 vaccine at Mount Sinai, we are using the Newcastle-disease virus in a vector-driven approach. If the FDA [U.S. Food and Drug Administration] is agreeable and allows the comprehensive use of genetically modified viruses, such as ours, then we can prevent the emergence of these new variants by vaccinating right away with the correct vaccine against the new variant, and we should be in good shape.

Do you think the public needs a fourth vaccine right now?

Dr. Krammer: For populations that don’t mount optimal responses or their responses disappear quickly, there might be an advantage in getting another dose. But for the general population, I don’t think this is useful right now. If there is a fourth dose, it should be variant-specific, an adapted vaccine that reflects what’s circulating right now.

For immunocompromised individuals, there are already a couple of important therapeutic treatments—including PAXLOVID from Pfizer Inc., operating under the FDA’s emergency use authorization—that can help them to greatly reduce their risk of a severe outcome.

Is it feasible to create a universal coronavirus vaccine—similar to the universal influenza vaccine you are developing?

Dr. Krammer: By universal you mean a variant-proof SARS-CoV-2 vaccine, I assume? One that would protect against all variants? We’ve made a lot of progress with the universal influenza vaccine in the last few years. But vaccine development has just started for coronaviruses and there are a lot of approaches out there. Coronaviruses are very diverse. A truly universal coronavirus vaccine would include protection against SARS-CoV-1 and other viruses in that subgenus and then you have a bigger genus of betacoronaviruses and, in addition, you have alpha-, delta-, and gammacoronaviruses (meant are the coronavirus genera, not the SARS-CoV-2 variants). So developing a universal coronavirus vaccine that would protect against all of them is a very big ask. It might be possible at some point, but it is small steps now and would take a lot of time. Of course, something that protects against variants that are around now or could be developed within the next five years, that’s actually possible.

Read more from Mount Sinai experts on COVID-19

As COVID-19 Cases Fall, Here Are Four Things to Keep in Mind About Masking and Safety

Mar 2, 2022 | COVID-19, Featured, Your Health

The CDC has assigned a “community level” of COVID-19 risk for each county in the United States, based on factors like total COVID-19 cases and hospital admissions. Right now the level is “low” in most of the New York City area.

The number of COVID-19 cases in New York is returning to the levels before the Omicron surge that began in December, and the Centers for Disease Control and Prevention has announced new guidance on masking.

We are heading in the right direction, and “there is reason for guarded optimism,” says Bernard Camins, MD, Medical Director for Infection Prevention at the Mount Sinai Health System, who has been tracking COVID-19 since the first cases were identified in New York in March 2020.

As the pandemic in New York approaches the two-year mark, here are four things to keep in mind:

  • Masks are still required in hospitals and health care facilities and on public transportation. N95 and KN95-type masks give you the most protection, followed by surgical masks, with cloth masks offering the least. We recommend you wear the best type of mask you are comfortable wearing that covers your mouth and nose.
  • The CDC has now assigned a “community level” of COVID-19 risk for each county in the United States, based on factors like total COVID-19 cases and hospital admissions. Right now the level is “low” in most of the New York City area. That means masks are not required in most places, but you can choose to mask at any time. If you have symptoms and a positive test you should isolate and stay home for at least six days and wear a mask when around others until you have recovered. If you have been exposed to someone with COVID-19, you should wear a mask around others until you are certain you have not been infected.  You can check your county’s “community level” on the CDC website.
  • Getting vaccinated and a booster shot is still recommended and is the best way to protect you and your family against the disease. Boosters are recommended even if you have already had COVID-19.
  • There are still many people who are at higher risk of infection: older adults, people with weakened immune systems (such as those who have been receiving active cancer treatment for tumors or cancers of the blood), and kids under five, as vaccines have not yet been authorized for young children.

One final note: Mount Sinai is committed to providing you with the COVID-19 information you need to keep yourself and your family safe and healthy. You can always find the latest updates from public health authorities and on our website.

Get more information from Mount Sinai about COVID-19
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Why a Master’s Degree? Mount Sinai’s Outstanding Graduate Students Share Their Experiences and Aspirations

Updated on Jun 30, 2022 | Featured, School

Here, we share the educational journeys of seven current and former students at Mount Sinai’s Graduate School of Biomedical Sciences. Learn what they are studying and how they will use their degree as they explore new paths and careers.

Medical Student Takes Detour to Understand the Potential of Artificial Intelligence

“I envision myself becoming an ambassador between the clinical side and the engineers and technicians who are on the development side, or even developing tools myself. Either way, my goal is to be on the forefront of harnessing AI for the benefit of dementia patients.”

Read his story

Aleta Murphy, MSBS: How a Brother With Autism Started a Mount Sinai Graduate Student on a Scientific Journey 

“Mount Sinai appealed to me because of the strong focus on biology as it relates to human diseases and medicine.”

Read her story

Briana Bell, MPH, Came to Mount Sinai for a Master of Public Health and Discovered a World of Research Opportunities

“I was also drawn [to Mount Sinai] by the extensive research experience of the program’s directors…their expertise and mentorship have been very beneficial for me.”

Read her story

Jeannys Nnemnbeng, MD, RRT, MSCR: On the Road to Becoming a Physician-Scientist With a Master of Science in Clinical Research

“I was looking for a program with a very specific focus on clinical research, and I knew Mount Sinai was top-notch, which meant I would have a very strong foundation for achieving my goal of becoming a physician-scientist in internal medicine.”

Read her story

 

 

 

Rosemary Espinal, BSN, RN: An ICU Nurse Enrolls in the Master of Science in Health Care Delivery Leadership Program To Bring New Perspectives to Patient Quality and Safety

“I want to use what I have learned to provide excellent care from a new perspective, address the disparities my mother faced as a non-English-speaking immigrant, and guide the next generation of nurses to high standards of quality and safety for our patients.”

Read her story

 

 

 

A Robust Immunotherapy Program and a Highly Collaborative Environment for Research Draws Matthew Brown to the Master of Science in Clinical Research Program

“The potential to have a significant impact in improving patient outcomes and expanding the range of therapeutic options available to patients is what excites me.”

Read his story

 

 

 

Tina Aswani Omprakash: A Journey From Inflammatory Bowel Disease Patient, to Patient Advocate, to Master of Public Health Student

“I gained a knowledge base that expanded my understanding of the disease and gave me insights to approach public health not just from my own personal experience but from a broader health care perspective.”   

Read her story

 

 

 

Read more about Mount Sinai’s Graduate School of Biomedical Sciences

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