Overview

Aphasia is a condition that robs you of the ability to communicate. It can affect your ability to speak, write and understand language, both verbal and written.

Aphasia typically occurs suddenly after a stroke or a head injury. But it can also come on gradually from a slow-growing brain tumor or a disease that causes progressive, permanent damage (degenerative). The severity of aphasia depends on a number of conditions, including the cause and the extent of the brain damage.

Once the cause has been addressed, the main treatment for aphasia is speech and language therapy. The person with aphasia relearns and practices language skills and learns to use other ways to communicate. Family members often participate in the process, helping the person communicate.

Symptoms

Aphasia is a sign of some other condition, such as a stroke or a brain tumor.

A person with aphasia may:

• 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

Patterns of aphasia

People with aphasia may have different patterns of strengths and weaknesses.

• Expressive aphasia. This is also called Broca's or nonfluent aphasia. People with this pattern of aphasia may understand what other people say better than they can speak. People with this pattern of aphasia struggle to get words out, speak in very short sentences and omit words. A person might say, "Want food" or "Walk park today."

  A listener can usually understand the meaning, but people with this aphasia pattern are often aware of their difficulty communicating and may get frustrated. They may also have right-sided paralysis or weakness.

• Comprehensive aphasia. People with this pattern of aphasia (also called fluent or Wernicke's aphasia) may speak easily and fluently in long, complex sentences that don't make sense or include unrecognizable, incorrect or unnecessary words. They usually don't understand spoken language well and often don't realize that others can't understand them.
• Global aphasia. This aphasia pattern is characterized by poor comprehension and difficulty forming words and sentences. Global aphasia results from extensive damage to the brain's language networks. People with global aphasia have severe disabilities with expression and comprehension.

When to see a doctor

Because aphasia is often a sign of a serious problem, such as a stroke, seek emergency medical care if you suddenly develop:

• Difficulty speaking
• Trouble understanding speech
• Difficulty with word recall
• Problems with reading or writing

Causes

The most common cause of aphasia is brain damage resulting from a stroke — the blockage or rupture of a blood vessel in the brain. Loss of blood to the brain leads to brain cell death or damage in areas that control language.

Brain damage caused by a severe head injury, a tumor, an infection or a degenerative process also can cause aphasia. In these cases, the aphasia usually occurs with other types of cognitive problems, such as memory problems or confusion.

Primary progressive aphasia is the term used for language difficulty that develops gradually. This is due to the gradual degeneration of brain cells located in the language networks. Sometimes this type of aphasia will progress to a more generalized dementia.

Sometimes temporary episodes of aphasia can occur. These can be due to migraines, seizures or a transient ischemic attack (TIA). A TIA occurs when blood flow is temporarily blocked to an area of the brain. People who've had a TIA are at an increased risk of having a stroke in the near future.

Complications

Aphasia can create numerous quality-of-life problems because communication is so much a part of your life. Communication difficulty may affect your:

• Job
• Relationships
• Day-to-day function

Language barriers may lead to embarrassment, depression and relationship problems.

Diagnosis

Your doctor will likely give you a physical and a neurological exam, test your strength, feeling and reflexes, and listen to your heart and the vessels in your neck. He or she will likely request an imaging test, usually an MRI, to quickly identify what's causing the aphasia.

You'll also likely undergo tests and informal observations to assess your language skills, such as the ability to:

• Name common objects
• Engage in a conversation
• Understand and use words correctly
• Answer questions about something read or heard
• Repeat words and sentences
• Follow instructions
• Answer yes-no questions and respond to open-ended questions about common subjects
• Read and write

Treatment

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 aims to improve the person's ability to communicate by restoring as much language as possible, teaching how to make up 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.

Other treatments

Brain stimulation is currently being studied for aphasia treatment and may help improve the ability to name things. But no long-term research has been done yet. One treatment is called transcranial magnetic stimulation and another is transcranial direct current stimulation.

These treatments aim to stimulate damaged brain cells. Both are noninvasive. One uses magnetic fields and the other uses a low current through electrodes placed on the head.

Coping and support

People with aphasia

If you have aphasia, the following tips may help you communicate with others:

• Carry a card explaining that you have aphasia and what aphasia is.
• Carry identification and information on how to contact significant others.
• Carry a pencil and a small pad of paper with you at all times.
• Use drawings, diagrams or photos as shortcuts.
• Use gestures or point to objects.

Family and friends

Family members and friends can use the following tips when communicating with a person with aphasia:

• Simplify your sentences and slow your pace.
• Keep conversations one-on-one initially.
• Allow the person time to talk.
• Don't finish sentences or correct errors, though it's OK to ask questions if you're not sure about the intended meaning. For example, you could ask, "Are you saying you want juice?"
• Reduce distracting noise in the environment.
• Keep paper and pencils or pens available.
• Write a key word or a short sentence to help explain something.
• Help the person with aphasia create a book of words, pictures and photos to assist with conversations.
• Use drawings or gestures when you aren't understood.
• Involve the person with aphasia in conversations as much as possible.
• Check for comprehension or summarize what you've discussed.

Support groups

Local chapters of such organizations as the National Aphasia Association, the American Stroke Association, the American Heart Association and some medical centers may offer support groups for people with aphasia and others affected by the disorder. These groups provide people with a sense of community and a place to air frustrations and learn coping strategies. Ask your doctor or speech-language pathologist if he or she knows of any local support groups.

Preparing for an appointment

If your aphasia is due to a stroke or head injury, you'll probably first see an emergency room physician. You'll then see a doctor who specializes in disorders of the nervous system (neurologist), and you may eventually be referred to a speech-language pathologist for rehabilitation.

Because this condition generally arises as an emergency, you won't have time to prepare. If possible, bring the medications or supplements you take with you to the hospital so that your doctor is aware of them.

When you have follow-up appointments, you'll likely need a companion to drive you to your doctor's office. In addition, this person may be able to help you communicate with your doctor.

Some questions a loved one or friend may want to ask your doctor include:

• What's the most likely cause of these speech difficulties?
• Are tests needed?
• Is aphasia temporary or long lasting?
• What treatments are available for aphasia, and which do you recommend?
• Are there services available, such as speech-language therapy or home health assistance?
• Are there ways to help my loved one understand others or communicate more effectively?

What to expect from your doctor

Your doctor will likely have questions, too. A loved one or friend can help your doctor get the information needed. Your doctor may ask:

• When did the symptoms start?
• Do you understand what others are saying?
• Do others understand what you're saying?
• Has the aphasia been continuous, or does it come and go?
• Have you noticed changes in your speech — such as the way you move your jaw, tongue and lips to make speech sounds — or the sound of your voice?
• Have you noticed changes in your ability to understand what you read or your ability to spell and write sentences?