Aphasia: Putting the disorder into words

"It's on the tip of my tongue" is a phrase everyone has said time and time again. Sometimes it's hard to find that word you're looking for — whether it's someone's name, a common object or something else. But for people with a disorder called aphasia, it's as if their brain's word cabinet falls over and mixes all of their words around, resulting in varying levels and forms of language comprehension and expression impairment.

Causes of aphasia

A stroke and its subsequent brain damage is the most common cause of aphasia. A stroke results from the bursting or blockage of blood vessels supplying the brain. This creates a reduction of blood flow to the brain, which deprives the brain of essential nutrients and oxygen needed to support brain cell life.

Aphasia also can surface due to a brain tumor, infection or degenerative disease. There is always an underlying cause of aphasia and this determines the severity of language difficulties.

Temporary aphasia can appear during a migraine. It can occur from a seizure or transient ischemic attack (TIA), which is a mini-stroke. Anyone who experiences a TIA is at an elevated risk for a full-blown stroke in the future.

Symptoms of aphasia

A person who is affected by aphasia may:

• Use words or sentences that don't make sense
• Speak in brief or incomplete sentences
• Experience difficulty understanding conversations
• Have trouble writing coherent sentences

Seek medical help immediately if you or a loved one experiences these symptoms. A form of aphasia can be the first sign of stroke.

Types of aphasia

Aphasia presents itself in three different ways. Your health care team may classify aphasia as:

• Broca's (nonfluent) aphasia
  People with this form of aphasia speak in short sentences with missing words and have difficulty getting words out. Broca's aphasia is often very frustrating for sufferers as most of them are aware of their communication difficulties.
• Wernicke (fluent) aphasia
  Fluent aphasia refers to individuals who communicate in long sentences that are hard to understand or contain incomprehensible, unneeded or incorrect words. Most people with fluent aphasia don't realize they have a communication disorder.
• Global aphasia
  This is the most severe form of aphasia. It causes major comprehension and expression disabilities.

Testing for aphasia

A common initial test for your health care team to determine the cause of aphasia is a CT scan or MRI.

Aside from that, testing for aphasia usually involves exercises and observations to gauge your ability to:

• Have a conversation
• Follow directions
• Repeat words and sentences
• Explain a situation as depicted on paper
• Read and write

Treatment and coping with aphasia

Speech-language therapy is the most common form of treatment for aphasia, and this comes after the underlying cause of aphasia has been addressed. Early intervention and timely treatment are imperative for achieving maximum results.

A speech-language pathologist works with aphasic patients to regain as many previous language skills as possible or, with certain diseases and conditions, to maintain their current level of communication ability. Patients commonly work in a hierarchical fashion, meaning that they start with simple exercises and work their way up. This includes speaking, reading or writing single words, then progressing to full sentences to a paragraph.

In terms of coping, family and friends can adjust to simplify conversations and ensure comprehension. In turn, this keeps people with aphasia included and eases some apprehension they may have about communication. Those with aphasia may also choose to use images and gestures to help them communicate.

Additionally, there are stroke and aphasia support groups to aid in the healing and coping process.

Aphasia is a challenging communication disorder that creates many obstacles for patients and their families. Fortunately, raising awareness about the condition, its underlying causes and treatment options can help to reduce the effects aphasia has on many lives.

By Mayo Clinic Health System staff