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Aphasia: Types, Causes, Symptoms, Diagnosis And Treatment

| Reviewed By Alex Maliekal

Bruce Willis, a 67-year-old actor most remembered for his role as John McClane in the Die Hard movies, has decided to retire from acting, following a diagnosis of aphasia, a condition that impairs a person's ability to talk and write.

On Wednesday, the actor's family, including his wife Emma Heming-Willis and ex-wife Demi Moore, posted an update on his health status on Instagram.

"Bruce has been experiencing some health issues and has recently been diagnosed with aphasia, which is impacting his cognitive abilities. As a result of this and with much consideration Bruce is stepping away from the career that has meant so much to him."

What Is Aphasia?

Aphasia is a language disorder, which affects a person's ability to communicate through speaking, writing and understanding language, both verbal and written [1]. According to the National Aphasia Association, aphasia is one of the most common disabilities caused by a stroke, which causes injury to the brain, particularly in older adults.

According to the National Institute on Deafness and Other Communication Disorders (NIDCD), aphasia usually occurs suddenly after a stroke or head injury, but it may also develop gradually due to a brain tumour or a progressive neurological disease.

Causes Of Aphasia

Aphasia is caused due to the damage to one or more language areas of the brain often caused by a stroke. Stroke occurs when there is a blockage or rupture of a blood vessel, resulting in the reduction of blood supply to the part of your brain and prevents the brain tissues from receiving oxygen and nutrients. This eventually leads to the death of brain cells due to inadequate oxygen and nutrients. About 21 to 38 per cent of people who survive a stroke get aphasia [2].


Types Of Aphasia

According to theNational Aphasia Association, these are the types of aphasia [3].

Global aphasia - This is the most severe form of aphasia caused by injuries to many language processing areas of the brain. These brain areas help in understanding spoken language, accessing vocabulary and using words and sentences. Patients with global aphasia produce few recognisable words and understand little or no spoken language. They also can neither read nor write.

Mixed transcortical aphasia - Also known as isolation aphasia is a rare speech problem which is characterised by limited spontaneous speech and reduced comprehension with intact repetition. The number of words spoken in a sentence that can be repeated is often decreased to three or four. Writing, naming words, comprehension reading or reading out loud is disturbed [4].

Broca's aphasia - It is also known as non-fluent or expressive aphasia which occurs as a result of damage to the left frontal area (speech and language areas) of your brain. People with Broca's aphasia find difficulty in speaking fluently. They speak in short, incomplete sentences and find difficulty to find the right words to speak. They may also understand what others are speaking and may be able to read but can't write.

Transcortical motor aphasia - Another rare non-fluent speech disorder that occurs in less than 10 per cent of stroke patients. It is characterised by normal repetition and comprehension with reduced slow spontaneous speech [5].

Wernicke's aphasia - It is also known as fluent or receptive aphasia. In Wernicke's aphasia, the damage is caused to the middle left side of the brain, an area that is responsible for processing the meaning of words and spoken language. People with this type of aphasia can't grasp the meaning of spoken words and sentences and they can't read or write. They also tend to speak long, complex sentences that have no meaning and include incorrect words.

Transcortical sensory aphasia - It is an uncommon type of aphasia that is characterised by impaired comprehension but preserved repetition. Patients with this type of aphasia can repeat long and complex sentences that they can't understand.

Anomic aphasia - It is a mild form of aphasia. The person often speaks fluently and produces grammatically correct sentences but it includes vague words. They can understand what others are speaking and can read well.

Primary progressive aphasia (PPA)- This type of aphasia is caused by neurodegenerative diseases, such as Alzheimer's disease or frontotemporal lobar degeneration. A person with this type of aphasia has speech and language problems.

Conduction aphasia - The patient with this type of aphasia may have trouble in repetition of words or sentences with intact comprehension and relatively fluent spontaneous speech [6].


Symptoms Of Aphasia

• Having difficulty in speaking
• Speaking short, incomplete sentences
• Speaking sentences that don't make sense.
• Speaking incorrect words.
• Struggling to find the appropriate word.
• Unable to understand other people's conversation.


Complications Of Aphasia

Aphasia can deteriorate the quality of your life and can cause problems where communication is required, affecting work and relationships. And this can cause emotional distress, depression and social isolation due to improper language function [7].

When To See A Doctor

Seek medical care immediately if you suddenly have difficulty in speaking or recalling words, trouble in understanding speech and inability to read or write.


Diagnosis Of Aphasia

Speech pathologists can help diagnose aphasia resulting from stroke. They perform a complete examination of the person's communication skills, which includes speaking, expressing ideas, understanding language, reading and writing. This helps in identifying the strengths and weakness of communication.


Treatment Of Aphasia

Depending on the types of aphasia, the treatment is performed. However, speech and language therapy is effective in treating patients with aphasia. A study showed that 33 hospitalised patients with subacute stroke who had 16 sessions of speech and language therapy for 30 -60 minutes a day, twice a week for eight weeks continuously showed an improvement in reading and listening comprehension, oral motor evaluation, automatic speech and repetition and naming words and also there was fluency in speech [8].

Common FAQs

Q. Can aphasia come on suddenly?

A. Aphasia often occurs suddenly after a stroke or a head injury, but it can also occur slowly from a brain tumour or a progressive neurological disease.

Q. What happens to people with aphasia?

A. A person with aphasia can have trouble in speaking, reading, writing and understanding language.

Q. Who is at risk for aphasia?

A. While aphasia is most common in older adults, however, it can occur in people of all ages, races and gender.

Q. Does aphasia affect a person's intelligence?

A. No, a person with aphasia will have difficulty in communicating, but intelligence won't get affected.

Q. Can a person recover from aphasia?

A. Yes, you can completely recover after stroke, but if the symptoms of aphasia last longer than two to three months after a stroke, there are decreased chances of recovery.


Prevention Of Aphasia

Although aphasia can't be prevented, you could lower the risk of stroke by maintaining a healthy lifestyle. These include the following:

• Eating nutritious foods.
• Maintaining a healthy weight.
• Exercising everyday.
• Keeping blood pressure, diabetes and cholesterol levels under control.
• Getting good sleep.
• Limiting the intake of alcohol and smoking.

Alex MaliekalGeneral Medicine
Alex Maliekal
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