Aphasia – Causes, Symptoms, Complications, and Treatment

Definition

Aphasia is a communication disorder that occurs due to brain damage in one or more areas that control language. It can interfere with your verbal communication, written communication, or both. It can cause problems with your ability to:

• Read
• Write
• Speak
• Understand speech
• Listen

According to the National Aphasia Association, about 1 million Americans have some form of aphasia.

History                                      

The first recorded case of aphasia is from an Egyptian papyrus, the Edwin Smith Papyrus, which details speech problems in a person with a traumatic brain injury to the temporal lobe. During the second half of the 19th century, aphasia was a major focus for scientists and philosophers who were working in the beginning stages of the field of psychology.

It was non-medically described in early texts, such as the Bible and writings of Homer, but there was no further mention of what aphasia was or how it occurred at that time. In medical research, speechlessness was described as an incorrect prognosis, and there was no assumption that underlying language complications existed. The earliest recorded medical cases of aphasia were made back in the Middle Ages, were it was thought to be an imbalance of bodily fluids in the brain that caused the inability to speak one’s mind. The first medical documents dating back to the late 19th century contain early descriptions of aphasia. Broca and his colleagues were some of the first to write about aphasia, but Wernicke was the first credited to have written extensively about aphasia being a disorder that contained comprehension difficulties. Despite claims of who reported on aphasia first, it was F.J. Gall that gave the first full description of aphasia after studying wounds to the brain, as well as his observation of speech difficulties resulting from vascular lesions.

Epidemiology

Among 188,015 inhabitants, 269 patients had first-ever ischemic stroke (FEIS), of whom 80 (30%; 95% CI, 24 to 36) had aphasia. The overall incidence rate of aphasia attributable to FEIS amounted to 43 per 100,000 inhabitants (95% CI, 33 to 52). Aphasic stroke patients were older than nonaphasic patients. The risk of aphasia attributable to FEIS increased by 4% (95% CI, 1% to 7%), and after controlling for atrial fibrillation, by 3% (95% CI, 1% to 7%) with each year of patients’ age. Gender had no effect on incidence, severity, or fluency of aphasia. Cardioembolism was more frequent in aphasic stroke patients than in nonaphasic ones (odds ratio [OR], 1.85; 95% CI, 1.07 to 3.20). Aphasic patients sought medical help earlier than nonaphasic stroke patients. Still, after controlling for stroke onset-assessment interval, aphasic stroke patients were more likely to receive thrombolysis than nonaphasics (OR, 3.5; 95% CI, 1.12 to 10.96).

Types

There are types of aphasia. Each type can cause impairment that varies from mild to severe. Common types of include:

Expressive aphasia (non-fluent): With expressive aphasia, the person knows what he or she wants to say, yet has difficulty communicating it to others. It doesn’t matter whether the person is trying to say or write what he or she is trying to communicate.

Receptive aphasia (fluent): With receptive aphasia, the person can hear a voice or read the print, but may not understand the meaning of the message. Oftentimes, someone with receptive aphasia takes language literally. Their own speech may be disturbed because they do not understand their own language.

Anomic aphasia: With anomic aphasia, the person has word-finding difficulties. This is called anomia. Because of the difficulties, the person struggles to find the right words for speaking and writing.

Global aphasia: This is the most severe type of aphasia. It is often seen right after someone has a stroke. With global aphasia, the person has difficulty speaking and understanding words. In addition, the person is unable to read or write.

Primary progressive aphasia: Primary progressive aphasia is a rare disorder where people slowly lose their ability to talk, read, write, and comprehend what they hear in conversation over a period of time. With a stroke, aphasia may improve with proper therapy. There is no treatment to reverse it. People with this disease are able to communicate in ways other than speech. For instance, they might use gestures. And many benefit from a combination of speech therapy and medications.

Causes of aphasia

It is usually caused by a stroke or brain injury with damage to one or more parts of the brain that deal with language. According to the National Aphasia Association, about 25% to 40% of people who survive a stroke get aphasia.

It may also be caused by a brain tumor, brain infection, or dementia such as Alzheimer’s disease. In some cases, it is a symptom of epilepsy or other neurological disorder.

Symptoms

It is a sign of some other condition, such as a stroke or a brain tumor. Few symptoms include

• Speak in short or incomplete sentences
• Speak in sentences that don’t make sense
• Substitute one word for another or one sound for another
• Speak unrecognizable words
• Not understand other people’s conversation
• Write sentences that don’t make sense

The severity and scope of the problems depend on the extent of damage and the area of the brain affected.

Complications of aphasia

• Aphasia impacts many aspects of life, from personal relationships to economic well being, as communication is fundamental to day-to-day living. It can leave the patient feeling frustrated and distressed, and their loved ones can become impatient. Together with other effects of the stroke, it can lead to depression.
• A patient is encouraged to go to support groups, and to get someone to help them practice their communication skills. If they are at risk of depression, they should see their doctor about treatment.
• Before meeting with a doctor, a friend can help them to practice what they want to say or write down any questions they may have.

Diagnosis of aphasia

If your doctor suspects it, they may order imaging tests to find the source of the problem. A CT or MRI scan can help them identify the location and severity of your brain damage.

You doctor may also screen you during treatment for a brain injury or stroke. For example, they may test your ability to:

• follow commands
• name objects
• participate in a conversation
• answer questions
• write words

A speech-language pathologist can help to identify your specific communication disabilities. During your examination, they’ll test your ability to:

• speak clearly
• express ideas coherently
• interact with others
• read
• write
• understand verbal and written language
• use alternative forms of communication
• swallow

Treatment and medications

If the brain damage is mild, a person may recover language skills without treatment. However, most people undergo speech and language therapy to rehabilitate their language skills and supplement their communication experiences. Researchers are currently investigating the use of medications, alone or in combination with speech therapy, to help people with aphasia.

Speech and language rehabilitation

Recovery of language skills is usually a relatively slow process. Although most people make significant progress, few people regain full pre-injury communication levels.

For aphasia, speech and language therapy tries to improve the person’s ability to communicate by restoring as much language as possible, teaching how to compensate for lost language skills and finding other methods of communicating.

Therapy:

• Starts early. Some studies have found that therapy is most effective when it begins soon after the brain injury.
• Often works in groups. In a group setting, people with aphasia can try out their communication skills in a safe environment. Participants can practice initiating conversations, speaking in turn, clarifying misunderstandings and fixing conversations that have completely broken down.
• May include use of computers. Using computer-assisted therapy can be especially helpful for relearning verbs and word sounds (phonemes).

Medications

Certain drugs are currently being studied for the treatment of aphasia. These include drugs that may improve blood flow to the brain, enhance the brain’s recovery ability or help replace depleted chemicals in the brain (neurotransmitters). Several medications, such as memantine (Namenda) and piracetam, have shown promise in small studies. But more research is needed before these treatments can be recommended.

Prevention of aphasia

Many of the conditions that cause this disease is not preventable, such as brain tumors or degenerative diseases. However, the most common cause is stroke. If you reduce your risk of stroke, you can lower your risks.

Take the following steps to lower your risk of stroke:

• Stop smoking if you smoke.
• Drink alcohol only in moderation.
• Exercise daily.
• Eat a diet that’s low in sodium and fat.
• Take steps to control your blood pressure and cholesterol.
• Take steps to control diabetes or circulation problems if you have them.
• Get treatment for atrial fibrillation if you have it.
• Get immediate medical care if you develop the symptoms of a stroke.