What Exactly is Aphasia? A Neurologist Explains What We Should Know
By Dana Earley
The shocking news that Hollywood actor Bruce Willis – a South Jersey native -- is retiring due to a medical condition he has battled in private for several years has left people wondering what exactly is aphasia. Defined as an inability to comprehend or formulate language from damage to specific regions of the brain, aphasia affects about two million people in the U.S. Middle-aged and older adults are most commonly impacted, but aphasia can affect those of any age who experience a stroke or traumatic brain injury.
A conversation with Jefferson Health neurologist and Jefferson NJ Medical Director for Stroke Services David Roshal, DO, shed some light on the disease, including causes, types of aphasia, treatments and preventive measures.
Causes and Symptoms
Aside from the most common cause of aphasia – stroke -- brain tumors, brain infections, degenerative processes (e.g., Alzheimer’s dementia, primary progressive aphasia) and brain injury can also trigger aphasia, Dr. Roshal explains.
Sometimes transient episodes of aphasia – meaning those that appear and pass quickly - can occur. These can be due to seizures, migraines or a transient ischemic attack, commonly known as TIA (or a “mini-stroke”).
Aphasia can appear suddenly from a variety of causes but can also develop slowly and progress over time, as is often the case with degenerative dementias and brain tumors.
“Each patient’s case can present differently – either quickly or much more subtly over time. But statistically, stroke victims are most commonly affected,” says Dr. Roshal.
Symptoms of aphasia may include:
- Inability to comprehend language
- Inability to pronounce words
- Inability to name objects
- Inability to repeat a phrase
- Inability to read and write
- Speaking gibberish
Types of Aphasia
One of the more common types of aphasia, says Dr. Roshal, is receptive aphasia, also known as Wernicke’s or fluent aphasia.
“Patients with receptive aphasia may speak in long sentences that have no meaning, add unnecessary words and even create new words. Due to damage to the brain’s dominant temporal lobe, their speech is like a ‘word salad’” Dr. Roshal says, adding that they also have difficulty understanding others.”
Another common type of the condition is expressive aphasia, also called Broca’s or non-fluent aphasia. “These patients have some understanding, but have trouble with fluency due to damage to the dominant frontal lobe,” says Dr. Roshal. “Their speech is produced with great effort.”
Global aphasia is a combination of receptive and expressive aphasia. This type of aphasia results from extensive damage to the brain’s language networks, and patients usually have severe difficulties with expression and comprehension.
Treatments and Prevention
Speech therapy can help recover language function by help patients learn how to convey feelings and messages in new ways. Through the process of “neuroplasticity,” speech therapy can also help promote functional recovery by priming non-damaged areas of the brain to take over language function.
When asked if there is a way to delay or slow down aphasia in dementia patients, Dr. Roshal says there is nothing definitive now. The relatively new drug Aduhelm™ -- touted as slowing the progression of Alzheimer’s disease by removing amyloid plaques in the brain-- has the medical community divided over its safety and efficacy. A clinical trial known as the APOLLOE4 study is evaluating an investigational medication designed to slow the progression of Alzheimer’s disease in patients with a specific gene mutation that causes Alzheimer’s dementia.
To prevent the number one cause of aphasia – stroke – the medical community recommends exercising regularly, eating a healthy diet low in cholesterol, keeping alcohol consumption low and avoiding tobacco use.
“My recommendation to everyone is to also keep your brain active with puzzles, and games like Wordle or Sudoku, that ‘prime’ the language centers of the brain. Being mentally active is a win-win,” says Dr. Roshal. “You can also reduce your risk of dementia by simply giving yourself six to eight hours of sleep each night.”