Aphasia

Because aphasia primarily affects the brain’s language processing functions, signs typically include sudden or gradually increasing difficulty with written or verbal communication. Aphasia symptoms may include difficulty speaking, writing, reading, or comprehending speech. In some milder cases, people with aphasia retain most of their ability to communicate beyond struggling to recall specific words. In others, specific modes of communication may be impaired while others remain intact—for example, retaining one’s reading comprehension while losing the ability to write or produce speech.

Both the severity and type of language impairment can vary depending on the location and extent of brain damage. There are four broad categories into which aphasia symptoms usually fall.

• Anomic or amnesia — This is the least severe form of aphasia. It results in the inability to recall the correct names of familiar people, places, or objects.
• Expressive (Broca’s) aphasia – This form of aphasia occurs when a person is unable to translate otherwise clear and coherent thoughts into speech or writing.
• Receptive (Wernicke’s) aphasia – Receptive aphasia impacts an individual’s ability to understand spoken and written language, with words and letters that were once identifiable no longer making sense.
• Global aphasia – This is the most severe form of aphasia, resulting from extensive damage across the regions of the brain responsible for processing language. People with global aphasia lose nearly all ability to express or comprehend language in both written and spoken forms.

Individuals may be diagnosed with more specific types of aphasia falling within these broader categories based on the extent of impairment of written and verbal communication.

An aphasia diagnosis will start with a neurological and cognitive exam, but doctors may also conduct a thorough physical examination to identify signs of specific types of brain damage. (For example, following a stroke that damages the language centers in the left side of the brain, a person may exhibit weakness or restricted movement in their right arm and leg.) In many cases your doctor may also order a brain imaging test, such as an MRI, to help determine the location and extent of brain damage. These tests can identify the specific parts of the brain that have been damaged as well as offer clues to possible causes. This is especially important in cases where the onset of aphasia is not tied to a clear injury or stroke.

To assess your language skills and determine the severity of aphasia symptoms, your doctor may ask you to:

• Identify and name common objects
• Repeat certain words or phrases
• Respond to yes/no questions
• Write down responses to questions
• Read something and answer questions to test comprehension
• Follow basic instructions

Language therapy is the primary treatment for aphasia. Doctors may supplement this with computer-aided therapy or a rehabilitation program with a speech pathologist. These programs are tailored to an individual’s specific symptoms and will include exercises in writing, reading, identifying words or objects, and repeating words and phrases. If treatment is started soon after a stroke or injury, the chances of recovery are significantly higher, though it is impossible to know the extent to which someone is likely to regain language function. Researchers believe the window within which full recovery is possible may extend three to six months after the onset of symptoms.

While few people with aphasia fully recover their prior language skills, most do see some degree of recovery over time, especially when receiving long-term speech therapy. It’s also important to remember that aphasia does not impact a person’s ability to think and form ideas—just their ability to comprehend and/or communicate these thoughts through language. For this reason, many people with aphasia find new ways of expressing themselves through body language and gestures or even art therapy.

Researchers are currently testing whether certain medications may improve a person’s language skills following the onset of aphasia symptoms. These include medications that help improve blood flow to the brain as well as medications that help regulate chemical neurotransmitters in the brain.

The National Institute of Neurological Disorders and Stroke is currently running multiple aphasia treatment studies to better understand how the brain heals and adapts following damage to regions associated with language formation. Treatments currently being tested in clinical trials include electrotherapy and noninvasive brain stimulation as well as computer-aided therapy.