Related video: What is frontotemporal dementia?
About 180,000 Americans are diagnosed with aphasia each year, but it took a movie star to bring the condition into the spotlight. Last week, the family of Bruce Willis revealed he had the language disorder, which can affect a person’s ability to speak, listen, read and write.
Despite these profound impacts, aphasia doesn’t affect a person’s intelligence, says Manaswita Dutta, PhD, CCC-SLP, a speech-language pathologist and assistant professor in the Department of Communication Disorders and Sciences at RUSH University Medical Center.
We asked Dutta to describe how patients experience aphasia and explain the outlook for those who have it.
What is aphasia, and what causes it?
Aphasia is not a cognitive disorder but rather an acquired language disorder that results from damage to parts of the brain that help us process language, Dutta says. Usually, this means the left side of the brain, which handles our language abilities.
Stroke is the most common cause, but aphasia can also occur after head injuries or a brain tumor. Another type of aphasia can occur when brain tissue deteriorates with age.
The Willis family has not released the cause of the actor’s aphasia.
What are the different types of aphasia?
One type of aphasia is called receptive aphasia. It occurs in people who have damage to the temporal lobe of their brain. People with receptive aphasia can speak, but their sentences may not make sense. They may also have trouble understanding simple words and sentences.
Another kind of aphasia is expressive aphasia, which occurs from damage to the frontal lobe of the brain. People with expressive aphasia can often understand language but have severely reduced speech. “They might use gestures or use single words to communicate. They often use a lot of nouns and miss a lot of verbs, so their grammar is affected significantly,” she says.
These types of aphasias are different from primary progressive aphasia, or PPA, which happens gradually because of degeneration in the brain. However, PPA is not dementia. “In dementia, memory is typically affected first, which can then have an effect on communication and language,” she explains. “But in PPA, the first symptoms are language issues, such as not being able to find words during a conversation. Then as PPA progresses, people start having problems with memory, attention and other cognitive skills.”
Following are early warning signs of PPA:
- Missing words during conversations
- Replacing words (saying “plate” instead of “knife,” or “bus” instead of “car”)
- Making up nonsense words that sound like the correct word (saying “lat” instead of “cat”)
If you or a loved one has some of these symptoms, Dutta recommends seeing a primary care provider or neurologist.
What is it like to have aphasia?
Not being able to communicate effectively can leave many people with aphasia feeling frustrated, isolated and depressed, Dutta says.
Although aphasia is not a cognitive disorder, some people with aphasia also have cognitive problems that are not related to language. Dutta’s research focuses on people with aphasia who also have trouble with their executive functioning skills, like working memory, planning, judgment and critical thinking that we rely on every day. “That doesn’t mean that the aphasia is causing problems with executive functioning or other cognitive issues. These issues just occur along with aphasia,” she says.
Does aphasia always get worse?
No. “Not every person with aphasia will experience a decline in language,” Dutta says.
Whether the condition worsens depends on the type of aphasia. “While people with PPA will see their language abilities decline over time, people who have aphasia as the result of a stroke or injury will not see their language abilities get worse over time,” she adds.
How is aphasia diagnosed and treated?
The cause of aphasia is usually diagnosed using a brain imaging test, such as functional magnetic resonance imaging. Then, a primary care provider or neurologist will refer the patient to a speech-language pathologist, also known as a speech therapist, like Dutta.
At all three RUSH hospitals, speech therapists conduct thorough assessments of patients with aphasia to see which language skills are affected. Then, they work with each patient to develop an individualized treatment plan based on the type and severity of aphasia as well as their goals. “For one patient, this might mean giving a talk in a lecture hall. For another, it might mean texting their daughter,” Dutta says. “The whole focus is not only to improve language outcomes but also to improve the psychosocial impact of living with aphasia.”
Over the course of several weeks or months, speech therapists teach patients with aphasia how to improve their communication and understanding of language. “Our main goal is to restore language functions but sometimes, that may not be possible depending on the severity of the aphasia,” she says. “In that case, we can train patients to use other strategies to express themselves, such as gesturing, drawing or using a text-to-speech assistive device. This can improve the quality of life for people with aphasia.”
How is the family affected by a person’s aphasia?
“Aphasia is often considered a family disease because it is a life-changing diagnosis that not only impacts the individual with aphasia but also places a heavy burden on their family members and caregivers,” Dutta says.
At RUSH, family members are involved during the patient assessment and treatment planning process. “We want to know how the family is coping with this change,” she says. “That is why we involve them in the goal-setting process. They may want their loved one with aphasia to become a bit more independent so some of the load is taken off them.”
Speech therapists also provide communication partner training, so family members can have better conversations with their loved ones and help them express themselves.
Do people with aphasia need to stop working?
Like Bruce Willis, many people with aphasia find that working is difficult. But many others can improve their language functions through speech therapy and return to their jobs. Or they may switch to part-time work or a profession that requires less communication.
At RUSH, speech therapists are committed to helping patients with aphasia return to work if that is their goal.
“There’s absolutely no reason to think that if somebody has been diagnosed with aphasia, there’s no hope,” Dutta says. “There’s absolutely hope, and we can definitely make returning to employment a priority in our therapy.”
Learn more about the RUSH approach to speech therapy for aphasia.