Aphasia, what is it? Symptoms and Treatments

What is aphasia

Aphasia is the medical term for a person who has lost the ability to use or understand their language. It occurs when the brain is damaged, usually with a stroke.

The different forms of aphasia

There are generally two forms of aphasia:

  1. Fluent aphasia: The person has difficulty understanding a sentence although they can speak easily.
  2. Non-fluent aphasia: the person has difficulty expressing themselves, although the flow is normal.

Global aphasia

It is the most serious form of aphasia. It results from significant damage to the language areas of the brain. The patient cannot speak or understand spoken or written language.

Broca’s aphasia, or non-fluent aphasia

Also called “non-fluent aphasia”, Broca’s aphasia is characterized by difficulty speaking, naming words, even if the affected person can largely understand what is being said. They are often aware of their difficulty in communicating and may feel frustrated.

Wernicke’s aphasia, or fluent aphasia

Also called “fluent aphasia,” people with this type of aphasia can express themselves but have difficulty understanding what they are saying. They talk a lot, but their words don’t make sense.

Anomic aphasia

People with this type of aphasia have trouble naming specific objects. They are able to speak and use verbs, but they cannot remember the names of some things.

 The causes of aphasia

The most common cause of aphasia is a stroke that is ischemic (blockage of a blood vessel) or hemorrhagic (bleeding from a blood vessel). In this case, aphasia appears suddenly. Stroke causes damage to the areas that control language located in the left hemisphere. According to statistics, about 30% of stroke survivors have aphasia, of which the vast majority of cases are ischemic strokes.

The other cause of aphasia is caused by dementia which frequently manifests itself in progressive speech disorders and is called “primary progressive aphasia”. It is found in patients with Alzheimer’s disease or frontotemporal dementias. There are three variant forms of primary progressive aphasia:

  • progressive fluent aphasia, characterized by decreased comprehension of words.
  • progressive logopenic aphasia, characterized by decreased word production and difficulty finding words;
  • progressive non-fluent aphasia, characterized primarily by a decrease in language production.

Other types of brain damage can cause aphasia such as head trauma, brain tumor, or infection that affects the brain. In these cases, aphasia usually occurs along with other types of cognitive problems, such as memory problems or confusion.

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Sometimes temporary episodes of aphasia can occur. These can be caused by migraines, seizures, or a transient ischemic attack (TIA). An AID occurs when blood flow is temporarily blocked in an area of ​​the brain. People who have had TIA have an increased risk of having a stroke in the near future.

 Who is most affected?

The elderly are the most affected because the risk of stroke, tumors and neurodegenerative diseases increase with age. However, it can affect younger individuals and even children very well.

 Diagnosis of aphasia

The diagnosis of aphasia is fairly easy to make, since symptoms usually appear suddenly following a stroke. It is urgent to consult when the person has:

  • difficulty speaking to the point that others do not understand it
  • difficulty understanding a sentence to the point that the person does not understand what others are saying
  • difficulty remembering words;
  • reading or writing problems.

Once aphasia is identified, patients should have a brain scan, usually magnetic resonance imaging (MRI) , to find out which parts of the brain are damaged and how severe the damage is.

In the case of aphasia that appears suddenly, the cause is very often an ischemic stroke. The patient should be treated within hours and further evaluated.

Electroencephalography (EEG) may be necessary to detect if the cause is not epileptic.

If the aphasia appears insidiously and gradually, especially in the elderly, one would suspect the presence of a neurodegenerative disease such as Alzheimer’s disease or primary progressive aphasia.

The tests carried out by the doctor will make it possible to know which parts of the language are affected. These tests will assess the patient’s ability to:

  • Understand and use words correctly.
  • Repeating difficult words or phrases.
  • Understanding speech (eg answering yes or no questions).
  • Read and write.
  • Solve puzzles or word problems.
  • Describe scenes or name common objects.

 Evolution and possible complications

Aphasia affects the quality of life because it prevents good communication which can affect one’s professional activity and relationships. Language barriers can also lead to depression.

People with aphasia can often relearn to speak or at least communicate to some extent.

The chances of recovery depend on the severity of the aphasia which itself depends on:

  • the damaged part of the brain,
  • the extent and cause of the damage. The initial severity of aphasia is an important factor in determining the prognosis of patients with aphasia due to stroke. This severity depends on the time between treatment and the onset of damage. The shorter the period, the better the recovery will be.
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In stroke or trauma, aphasia is transient, with recovery that may be partially (for example, the patient continues to block on certain words) or fully complete.

Recovery can be complete when rehabilitation is carried out as soon as symptoms appear.

Symptoms of aphasia and treatment of aphasia

Symptoms of aphasia

Symptoms depend on the severity of the disorder and the location of the lesion.

Aphasia against the background of a stroke most often develops after the blockage of the internal carotid artery. Symptoms of aphasia depend on the location of the stroke lesion.

  • Repeating the same words, regardless of the context or situation.
  • Use of personal “jargon”
  • Wrong pronunciation
  • Difficulty producing sounds
  • Replacing one word with another or one sound with another
  • Sometimes producing very long sentences that don’t make sense
  • Speak in short or incomplete sentences
  • Use of incomprehensible words
  • Difficulty or inability to understand other’s conversation
  • Write sentences that don’t make sense

 How to prevent aphasia?

It is possible to minimize the risk of having a stroke by adopting a healthy lifestyle to reduce the risk of cardiovascular risk factors, for example by treating your high blood pressure. On the other hand, we have less control over other causes (eg head trauma) that can cause aphasia.

Treatments for aphasia

If the brain damage is mild, a person can recover without treatment.

Speech therapy

However, most people benefit from treatment based on speech therapy . It must be started as soon as possible, as soon as the symptoms appear, and followed intensively (4 or 5 sessions per week) in order to be able to hope to regain language and comprehension capacities close to normal.

The degree of recovery from aphasia following a stroke is variable and all the more effective when treatment begins immediately after the onset of brain damage.

Activities such as theater or singing are also good complementary means to work on communication and expression.

Language recovery is usually a slow process. Although most people are making significant progress, the effectiveness of rehabilitation approaches remains limited.

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Group therapy

Participants can practice starting conversations, taking turns speaking, and relearning to converse in understandable ways.

Computer Assisted Therapy

The use of computer-assisted therapy can be particularly useful for relearning verbs and word sounds (phonemes).

Medications

Certain drugs are currently under investigation for the treatment of aphasia. These include drugs that can improve blood flow to the brain, improve the brain’s ability to recover, or help replace missing neurotransmitters in the brain. Several drugs, such as memantine and piracetam , have shown promise in small studies. Further studies are needed to confirm these results before these treatments can be recommended.

Neuromodulation

Numerous studies conducted over more than a decade have shown that non-invasive brain stimulation techniques, namely transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), can facilitate speech recovery in patients. with aphasia, originating from stroke or neurodegenerative disease.

TMS creates a magnetic field that allows current generation in neurons located in the cortex. This is also the case with tDCS which delivers a very slight current in the brain. The two methods differ in that TMS provides local stimulation, while so-called conventional tDCS reaches neurons more diffusely.

The eight clinical studies carried out since 2016 relate in almost all cases to patients suffering from non-fluent aphasia following a stroke. Overall, it appears that patients see their language improve, in particular their ability to name objects more easily. These beneficial effects last two to four months after neurostimulation.

 How to deal with a person with aphasia?

Here are some tips for communicating with someone with aphasia:

  • Simplify your sentences and slow down your pace.
  • Give the person time to speak.
  • Do not complete sentences or correct mistakes.
  • Reduce distraction noises in the environment.

References

Barwood, CH et al. (2013). Long term language recovery subsequent to low frequency rTMS in chronic non-fluent aphasia. Neuro Rehabil.  32, 915–928. doi: 10.3233 / NRE-130915.

Belin, P. et al. (1996). Recovery from nonfluent aphasia after melodic intonation therapy: a PET study. Neurology  47, 1504–1511.

Cotelli, M. et al. (2012). Prefrontal cortex rTMS enhances naming action in progressive non-fluent aphasia. Eur. J. Neurol.  19, 1404–1412.

Dammekens, E. et al. (2014). Neural correlates of high frequency repetitive transcranial magnetic stimulation improvement in post-stroke non-fluent aphasia: a case study. Neurocase  20, 1–9.