How many people do you talk to in a day? Think about the texts and emails you send, too. Communication is a huge part of daily life. Most of us never think twice about it – unless we begin to recognize the development of aphasia symptoms.
But for people with aphasia, communicating can become quite difficult. They may struggle to find words, speak in sentences that don’t make sense or have trouble understanding what others are saying.
About 2 million people in the United States are living with aphasia. Yet many adults have never heard the term.
Concerned you may have aphasia symptoms, but are unsure? Make an appointment with a neurologist to get some answers.
What is aphasia?
Aphasia is a language disorder caused by damage to the brain’s language centers. It makes it hard to speak, understand others, read and write.
Paul LaPenna, DO, a neurologist in our Greenville market, explains what aphasia symptoms look like, what causes the condition and how it’s treated.
“The ability to understand and speak in a way that can be comprehended is mostly in the left hemisphere of the brain, so any disease that affects that area of the brain can cause an impairment,” Dr. LaPenna says. “Aphasia is a symptom of a disease, but it is not itself a disease.”
It’s worth noting that aphasia affects language, not intelligence. As a result, people with aphasia appear more cognitively impaired than they actually are, simply because they have trouble using language.
A note on aphasia vs. dysphasia: You may have come across the term “dysphasia” used to describe a similar condition. Dysphasia is no longer widely used in health care – “aphasia” is now the standard term for both full and partial language loss.
Recognizing aphasia symptoms
Aphasia symptoms generally fall into three areas: how a person speaks, how well they understand others and how they read and write.
Speaking
Expressive aphasia affects a person’s ability to put their thoughts into words. Signs include:
- Speaking in short or incomplete sentences
- Leaving out small words like “is,” “and” or “the”
- Using the wrong word for something
- Making up words that don’t exist
- Speaking in sentences that sound fluent but don’t make sense to others
People with expressive aphasia often know exactly what they want to say but can’t get the words out correctly.
Understanding
Receptive aphasia affects a person’s ability to understand what others are saying. Signs include:
- Trouble following conversations, even simple ones
- Difficulty understanding spoken or written language
- Not realizing that their own speech is unclear or hard to follow
Reading and writing
Aphasia can also affect reading and writing, even in people who were fully literate before. This can look like:
- Difficulty reading text
- Trouble writing or spelling
- Being unable to understand written words
Types of aphasia
Aphasia is most often divided into two broad categories: fluent and nonfluent. The type a person has depends on which part of the brain was damaged.
These are a few of the most common types of aphasia:
- Broca’s aphasia is the most recognizable nonfluent type. People with this type speak in short, halting phrases with great effort. They often leave out small words. They usually understand others fairly well but are aware of their own speaking difficulties, which can be frustrating.
- Wernicke’s aphasia is the most recognizable fluent type. People with this type can speak in long, flowing sentences – but those sentences often contain the wrong words or made-up words that don’t make sense. Unlike those with Broca’s aphasia, they may not realize that their speech is unclear.
- Global aphasia is one of the most severe types. It occurs when large portions of the brain’s language centers are damaged. People with global aphasia have significant trouble both producing and understanding language.
- Anomic aphasia is a milder form where a person’s main struggle is word-finding. They know what they want to say but can’t retrieve the right word.
- Primary progressive aphasia (PPA) is different from the types above because it gets worse over time. It’s caused by degenerative brain diseases that gradually damage language areas of the brain.
Aphasia vs. dysarthria vs. apraxia: Understanding the differences
Aphasia is sometimes confused with two other speech-related conditions: dysarthria and apraxia. Aphasia can actually occur alongside either or both of these disorders.
- Aphasia vs. dysarthria: Dysarthria is a motor speech disorder caused by muscle weakness or poor muscle control. Someone with dysarthria may have slurred or slow speech, but their ability to understand language is typically intact. The problem is physical, not linguistic.
- Aphasia vs. apraxia: Apraxia of speech is a motor planning disorder. The brain has trouble sending the right signals to coordinate the movements needed for speech, even when the muscles themselves work fine. A person with apraxia knows what they want to say, but the signals between brain and mouth get scrambled. With aphasia, the issue is with language itself – not with the physical act of speaking.
What causes aphasia?
The most common cause of aphasia is a stroke. In fact, about one-third of stroke survivors develop aphasia.
But a stroke isn’t the only cause. “A stroke is where I see it the most – but it can really be anything that impairs that area, such as a brain tumor, dementia or traumatic brain injury,” Dr. LaPenna says.
Other causes include brain infections, brain surgery and, in some cases, severe migraines or seizures that temporarily disrupt the brain’s language areas.
Frontotemporal dementia and aphasia
Actor Bruce Willis announced his retirement from acting in 2022 due to aphasia. In early 2023, his family revealed that frontotemporal dementia (FTD) was the underlying cause.
FTD is a type of dementia that affects the parts of the brain that control language, behavior and personality. In some cases – called primary progressive aphasia – aphasia is the first noticeable symptom, appearing before any memory or behavioral changes.
The science around FTD is still evolving. “A fair amount of people who have frontotemporal dementia have family members who have similar syndromes, so there may be a genetic component,” Dr. LaPenna says. “However, we don’t fully understand all the risk factors that go into developing that type of dementia.”
While FTD can be managed, it is a progressive condition with no current cure.
Can you reduce your risk?
There is no guaranteed way to prevent aphasia, since it depends on the underlying condition that causes it. But there are steps you can take to lower your risk of stroke and dementia – the two most common causes.
“I know patients probably get tired of their doctors saying you need to eat better and exercise more, but in reality, those things are very good for our brain and do help prevent dementia,” Dr. LaPenna explains. “In fact, most diseases could be prevented by doing those things, so that’s generally why we recommend them.”
Aphasia treatment: What to expect
The good news is that aphasia is treatable, and in many cases, people recover partially or fully.
“Many people who have aphasia after suffering a stroke get significantly better. Sometimes they even begin to communicate normally,” Dr. LaPenna says.
Recovery is typically most dramatic in the first few months after a brain injury. Language and communication skills can continue to improve for years after the initial injury, though progress tends to slow over time.
Aphasia language therapy
Speech therapy is the main treatment for aphasia.
“Regardless of the cause, aphasia is mostly treated by seeing a speech pathologist and doing speech therapy. Just like if you hurt your knee and went to a physical therapist to regain strength and mobility, it’s the same thing – you work with that speech therapist to regain those capacities or compensate for those lost capacities,” Dr. LaPenna says.
A speech-language pathologist works with patients to rebuild language skills through exercises tied to meaningful, everyday activities. Assistive tools like text-to-speech apps can also play a supporting role.
Supporting someone with aphasia
Living with aphasia can be isolating. Dr. LaPenna reminds us that empathy matters just as much as any medical intervention.
“As all of us age, we all lose human capacities that we once had when we were younger — memory, language and other abilities. Because of that, we should have empathy for those who suffer from these disorders. People who lose capacities often feel a burden to others, but they’re still fully human in every sense of the word. Therefore, they’re valuable and of infinite worth, and they should be treated with the same amount of dignity and respect as anyone else who still has these capacities.”
The American Speech-Language-Hearing Association (ASHA) recommends these communication tips for people interacting with someone who has aphasia:
- Get their attention before you start talking
- Turn off background noise like the TV or radio
- Speak at a normal volume – don’t raise your voice unless asked
- Keep your sentences simple, but don’t talk down to them
- Give them time to respond and don’t finish their sentences
- Use gestures, drawings and facial expressions to support your words
How we can help
If you or someone you love suddenly has trouble speaking, finding words or understanding others, don’t wait to get help. Aphasia can be one of the first signs of a stroke – a medical emergency that requires immediate care.
Your primary care provider is often the first step toward getting a referral to a neurologist who can take a closer look and discuss a treatment plan.
Learn about the neurology services we provide at Bon Secours.
