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Everything You Need to Know About Aphasia

How to recognize the language-robbing condition and help those who have it

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Aphasia is a condition that affects people’s ability to communicate. There are several different types of aphasia, which is usually caused by damage to an area on the left side of the brain that controls language and comprehension. Depending on the underlying cause, some people can recover from aphasia, but other types of aphasia are progressive and degenerative. Most people with aphasia are middle age or older, although children can have the condition, too. About 2 million people in the United States currently have aphasia, according to the National Aphasia Association, and around 180,000 Americans develop the condition each year.

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Hugo Botha, a Mayo Clinic neurologist who specializes in cognitive and language problems, says aphasia is not a disease but “a collection of symptoms, and a term to reflect they have a language problem, and then you have to go hunting to figure out why they have aphasia.”

Symptoms

Those who suffer from aphasia usually have trouble saying words, completing sentences or understanding speech. Their words may sound garbled or slurred. Sometimes the speech is what doctors call telegraphic, with very simple sentence structure. Instead of “I’m going over here,” someone with aphasia might say, “I go here.”

A sudden onset of aphasia is one of the most common signs of stroke. If you notice that you or someone around you is suddenly having speech problems, call 911 right away, because getting treatment is critical and can lessen long-term aphasia and other problems caused by the brain damage from stroke.

Depending on the type, people who have aphasia are often able to think clearly but may not find the words they want to say — like trying to remember words in another language that you studied long ago. But aphasia is more serious than having trouble recalling the name of the last book you read or your neighbor’s daughter. “We all have those tip-of-the-tongue moments all the time,” says Borna Bonakdarpour, a neurology professor at the Northwestern University Feinberg School of Medicine, but aphasia is different. “It happens consistently. It affects their job. They may have difficulty reading email or texts or talking to people. It affects their daily activities.”

Common causes

Stroke is the most common cause of aphasia in the United States, Botha says. A transient ischemic attack (TIA), which happens when blood flow to the brain is temporarily blocked, can also cause short-term aphasia that goes away within a few hours or days. A TIA should be taken seriously, with a trip to the emergency room, because it’s often a sign of a more serious stroke to come. A severe head injury from, say, an accident can cause aphasia, as can a tumor. Aphasia can also develop slowly, usually caused by a progressive brain disease such as Alzheimer’s or another neurological disorder.

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Types of aphasia

Aphasia is broadly divided into two types: fluent and non-fluent, which have subtypes. A few of the most common ones include:

  • Expressive aphasia, also called Broca’s aphasia, is a non-fluent aphasia. Those with this type of aphasia often have a right-side weakness or paralysis. They may understand speech and know what they want to say but have difficulty saying the words. Because they typically understand the speech of others and their own difficulties fairly well, they can become frustrated and discouraged.
  • Primary progressive aphasia is an umbrella term for several types of aphasia that usually develop slowly and gradually impair the person’s ability to read, write and speak. It typically has an underlying neurological cause such as frontal temporal dementia. Due to the slow progression, it can be hard to diagnose.
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Diagnosis and treatment

Experts say it’s crucial to diagnose aphasia early.

When the cause isn’t obvious, doctors may test a person’s ability to speak and understand language by ordering a magnetic resonance imaging (MRI) test or a computed tomography (CT) scan to identify the location of the injury in the brain. Then a speech pathologist will do an evaluation of the person’s ability to read, write, answer questions, name objects and converse.

Treatment almost always includes speech therapy, but the best treatment for aphasia depends on the underlying cause of the condition.

When someone comes to the emergency room with aphasia caused by a stroke, they are often given clot-busting medications that can lessen the long-term effects of the stroke. About a third of strokes result in aphasia, according to the National Aphasia Association. People who have had a stroke can typically improve their speech over time with the help of speech therapy.

Alzheimer’s patients receive treatment for that disease. Primary progressive aphasia has no cure, though patients who work with speech therapists can sometimes slow the progression of the loss of speech.

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Helping those with aphasia

Because many people with aphasia are thinking clearly but can’t communicate well, those around them sometimes think they have lost their intelligence when they haven’t. “People who have aphasia can seem more cognitively impaired than they really are,” Botha says.

Speech therapists can work with family members to help them understand how best to communicate with loved ones with aphasia. It helps to keep sentences and questions simple, Botha says. Try to be in the same room when speaking with someone who has aphasia, so they can read your body language. Avoid correcting the person’s speech. Radio, television, noisy restaurants and other distractions can make it harder for those with aphasia to communicate and pay attention.

Bonakdarpour says it’s important that those with aphasia stay active. While often the left side of the brain is damaged, the right side may be healthy. Painting, drawing and even singing are activities that those with aphasia can enjoy and even excel in. Rather than ignoring or speaking over someone with aphasia, it’s better to speak slowly and clearly and wait for their reaction. Help them feel valued and included. “Isolation is the worst thing that can happen,” he says. “Isolation makes brain disease worse. The less you use the brain, the worse it gets.”

Elizabeth Agnvall is the health and healthy living editor at aarp.org. She has worked as editor of Staying Sharp, AARP’s brain health platform and as a health editor at the AARP Bulletin. She also wrote for the Washington Post health section.

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