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Aphasia
By Mayo Clinic staffMayo Clinic Health Manager
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Definition
Aphasia is a disorder that robs you of the ability to communicate. It typically occurs suddenly, after a stroke or a head injury. But it can also come on gradually, from a slowly growing brain tumor.
Aphasia can affect your ability to express and understand language, both verbal and written. The amount of disability depends on the location and the severity of the brain damage that is the cause. According to the National Aphasia Association, the disorder affects about one in every 250 people, most commonly older individuals.
The primary treatment for aphasia is speech therapy that focuses on relearning and practicing language skills and using alternative or supplementary communication methods. Family members often participate in the therapy process and function as communication partners of the person with aphasia.
Symptoms
A person with aphasia may:
- Speak in short or incomplete sentences
- Speak in sentences that don't make sense
- Speak unrecognizable words
- Not comprehend other people's conversation
- Interpret figurative language literally
- Write sentences that don't make sense
The severity and scope of the problems depend on the extent of damage and the area of the brain affected. Some people may comprehend what others say relatively well but struggle to find words to speak. Other people may speak more clearly than they can write.
Your doctor may refer to one of three broad categories of aphasia — nonfluent, fluent and global — that describe what region of the brain was damaged and how communication is usually affected. The two primary language networks for most people are located in the brain's left hemisphere.
- Nonfluent aphasia. Damage to the language network near the left frontal area of the brain usually results in Broca aphasia. It's also called nonfluent aphasia. People with this disorder struggle to get words out, speak in very short sentences and leave out words. A person might say, "Want food" or "Walk park today." Although the sentences aren't complete, a listener can usually decipher the meaning. A person with Broca aphasia may comprehend what other people say to some degree. They're often aware of their own difficulty in communicating and may get frustrated with these limitations.
- Fluent aphasia. Wernicke aphasia is the result of damage to the language network in the middle left side of the brain. It's often called fluent aphasia. People with this form of aphasia may speak fluently in long, complex sentences that don't make sense or include unrecognizable, incorrect or unnecessary words. They usually don't comprehend spoken language well and often aren't aware of their own difficulty communicating.
- Global aphasia. Global aphasia results from extensive damage to the brain's language networks. People with global aphasia have severe disabilities with expression and comprehension.
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. This disruption of the blood supply leads to brain cell death or damage in areas of the brain controlling language. Aphasia may also be caused by a severe head injury, a brain tumor or an infection.
A relatively rare form of dementia called primary progressive aphasia causes the gradual degeneration of cells primarily located in the brain's language networks. Although dementia symptoms may eventually appear, aphasia is generally the first and most pronounced symptom. The aphasia symptoms progressively worsen over time.
When to seek medical advice
Because most cases of aphasia result from stroke, the symptoms of aphasia are most often identified during the medical assessment that follows a stroke.
People should seek immediate medical advice if they suddenly have difficulty speaking, comprehending speech, recalling words, reading or writing. They'll most likely be referred to a speech-language pathologist for an assessment of language problems, and they may need to see a neurologist to determine possible causes of the symptoms.
Tests and diagnosis
A speech-language pathologist will conduct tests and informal observations to assess 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
- Follow instructions
- Explain steps of a process
- Answer yes-no questions and respond to open-ended questions about common subjects
- Tell a story or explain the plot of a story
- Explain a joke or a figurative phrase, such as "I need to unwind"
- Read and write letters, words and sentences
Complications
People who have had a stroke or other brain injury often face a number of rehabilitative challenges. In particular, an individual may have difficulty with the motor skills needed to speak or write. Weakness on the right side of the body, including the face, arm and leg, often accompanies aphasia. These complications may exacerbate the communication challenges of aphasia.
Aphasia can create psychological and interpersonal complications for the affected individual, as well as for family and friends. People with aphasia are usually aware of their limitations for communicating. The language barriers may lead to embarrassment, depression and relationship problems.
Treatments and drugs
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. Recovery of language skills is usually a relatively slow process, and few people regain pre-injury communication levels.
In aphasia, speech and language therapy:
- Starts early. Therapy is most effective when it begins soon after the brain injury.
- Builds on success. The speech-language pathologist uses exercises to improve and practice communication skills. These may begin with simpler tasks such as naming objects and evolve into more complex exercises of explaining the purpose of an object.
- Shifts focus. The speech-language pathologist might teach the person ways to compensate for the language impairment and to communicate more effectively with gestures or drawings. Some people with aphasia may use a book or board with pictures and words to help them recall commonly used words or help them when they're stuck.
- 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 outings. Participating in real-life situations — such as going to a restaurant or a grocery store — puts rehabilitation efforts into practice.
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 down your pace.
- Allow the person time to talk.
- Don't finish sentences or correct errors.
- Keep conversations focused on one topic at a time.
- Reduce distracting noise in the environment.
- Keep paper and pencils or pens readily 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, American Stroke Association, the American Heart Association and some medical centers offer support groups for people with aphasia and others affected by the disorder. These groups provide people with a sense of community, a place to air frustrations and coping strategies.
