Aphasia: Causes and Treatment
If you or a loved one experiences any sudden problems talking or understanding speech, call 911 immediately. Language difficulties can be a symptom of a stroke, which requires immediate medical attention.
A breakdown in language communication is called aphasia. When aphasia happens abruptly, it is likely caused by a stroke. When it develops gradually over time, it could be caused by Alzheimer’s disease or other neurodegenerative conditions.
Cedars-Sinai neurologists Jessica Choi, MD, and Sarah Kremen, MD, director of Neurobehavior at the Jona Goldrich Center for Alzheimer’s and Memory Disorders, explain the types of aphasia and how speech-language therapy can benefit all patients.
“Interventions can make an impact in minutes. The results can be drastic, and many patients who come to the hospital within the necessary time frame to receive acute medications recover their language skills very well.”
What Is Aphasia?
Aphasia is a disorder caused by damage to the structures of the brain that control language. It is usually caused by a stroke or neurodegenerative disease, but it can also happen after a traumatic brain injury or as the result of a brain tumor.
Aphasia symptoms are different depending on where the brain is injured. The condition can be classified as either receptive, which indicates a patient has difficulty understanding language, or expressive, which indicates a patient has difficulty communicating with language.
Aphasia from stroke can be diagnosed during a stroke assessment or by a speech-language pathologist in conjunction with brain imaging. Aphasia also often is identified in a memory evaluation with a neurologist or neuropsychologist. All forms of aphasia can be treated with speech-language therapy, but only some people will recover, depending on the underlying cause.
Aphasia After Stroke
A stroke is caused either by bleeding in the brain or a blocked artery that restricts blood and oxygen to the brain.
When emergency medicine doctors suspect a stroke is the cause of a patient’s aphasia, they will assess how well the person can name items, repeat phrases, provide basic information and understand other commands. These tests help doctors determine where the brain is injured and diagnose between six types of stroke-related aphasia syndrome. These include Broca’s aphasia, which leaves patients unable to produce speech, and Wernicke’s aphasia, which causes people to speak in long and confusing sentences and have trouble understanding others.
Diagnosing and treating a stroke early is critical. Research shows that patients with ischemic stroke who receive acute treatments within four and a half hours recover better than patients who don’t.
“Interventions can make an impact in minutes,” Choi said. “The results can be drastic, and many patients who come to the hospital within the necessary time frame to receive acute medications recover their language skills very well.”
Patients with stroke often continue to recover in acute rehab, where they undergo speech therapy.
If you have aphasia symptoms, do not take aspirin, which can exacerbate a brain bleed, Choi said. Immediately call 911 so you can see a stroke expert as soon as possible.
Primary Progressive Aphasia
Primary progressive aphasia (PPA) is usually caused by neurodegeneration. It often occurs with frontotemporal lobar degeneration (FTLD), a type of dementia most common in younger patients. A PPA diagnosis can only be made when a person has experienced language problems for two years without other symptoms.
There are three types of PPA:
- Nonfluent PPA is usually caused by FTLD and makes it difficult for patients to find and say words. It leads to speaking in short sentences and eventually results in mutism.
- Semantic PPA is usually caused by FTLD and affects a person’s ability to understand language and speak in sentences that make sense.
- Lopogenic PPA is usually caused by Alzheimer’s and also results in word-finding problems.
People can’t recover from PPA, but if the underlying cause is Alzheimer’s, certain medications may delay its progression. Every patient with PPA should meet with a speech-language therapist, who can teach them to use assistive devices to communicate, Kremen said.
Support for Patients and Families
Aphasia is frustrating for patients and their loved ones, and an aphasia diagnosis requires major lifestyle adjustments.
“Language is such a necessary part of human interaction, and aphasia is hard for everybody,” Kremen said.
The Aphasia Community Group hosted by Cedars-Sinai and other support groups offered by the Association for Frontotemporal Degeneration can help patients relate and can help caregivers and loved ones learn how to facilitate easier communication.
“Everything in stroke recovery is therapy oriented and involves exercising to regain function,” Choi said. “Supportive family members and advocates can make a dramatic difference in a patient’s recovery from aphasia by providing encouragement and meeting them at their level.”
