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.