“It’s on the tip of my tongue!”
You throw your hands up in frustration. You know the word you want to say, you know what it means and what it looks like, yet somehow you just can’t pluck it from your brain and actually say it.
Or, you find it a struggle to speak, suddenly start dropping words like ‘a’ or ‘the’, and your sentences shrink so much that instead of saying, “I’ll have a cup of coffee,” you gather every last ounce of strength to laboriously gasp, “I coffee!”
These are just two examples of aphasia, a language disorder that makes it hard to communicate clearly, whether through speech or writing.
What is aphasia
Aphasia is a language disorder that leaves the affected person unable to properly understand, speak, read, or write.
Since 1836, when the theory of ‘language centers’ existing in the left side of the brain was first put forth, studies have consistently confirmed that it is indeed the brain’s left hemisphere that allows us to process, express, and comprehend communication.
Aphasia occurs when these language centers on the left side of the brain are damaged in any way.
Research shows that the risk of aphasia increases with age, and 1 in 3 people aged 85 years and above are likely to develop aphasia.
Types of aphasia
There are 3 types of aphasia.
- Receptive aphasia, also known as fluent aphasia
- Expressive aphasia, or non-fluent aphasia
- Global, also known as total, aphasia
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Receptive aphasia
Receptive aphasia, also called Wernicke’s aphasia after German neurologist Carl Wernicke, means having trouble understanding messages received from other people.
It happens when the Wernicke’s area, a section of the brain a little ways above and slightly behind the left ear, is damaged.
The reason receptive aphasia is called fluent aphasia is that although affected persons are not able to fully comprehend received messages, they can usually still talk ‘well’, even effortlessly, at a normal speed and rhythm.
However, while they may chatter easily and be grammatically correct, it is quite possible that what the person is saying makes no sense. They may frequently use wrong words, or use made-up words that have no actual meaning.
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Expressive aphasia
Expressive aphasia refers to having trouble getting your message across to other people. It is called Broca’s aphasia in a nod to French surgeon and neurologist Pierre Paul Broca.
The Broca’s area in the brain is located in the left temple, midway between the eye and ear.
Image caption: The Broca’s area and Wernicke’s area as located in the brain
People with expressive aphasia can understand received messages well, but they tend to chop up their own speech and drop words. They may also physically struggle to shape, sound out, and speak words. They can read fairly well, but have trouble with writing.
This is why expressive, or Broca’s, aphasia is also called non-fluent aphasia.
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Global aphasia
This is the severest, most debilitating form of aphasia. Affected people lose a substantial amount of their language abilities and have trouble in both expressing as well as receiving communication.
Also called total aphasia, global aphasia indicates that large sections of the left brain, including and surrounding the Wernicke’s and Broca’s areas, have been damaged.
What causes aphasia
Aphasia is caused in 2 ways.
- Sudden onset aphasia happens abruptly and without prior warning. This is the most frequently occurring form of aphasia, and is most commonly caused by stroke.
Other reasons for sudden onset aphasia may be trauma to the head and brain because of injury, surgery, a tumor, hemorrhage, or an infection in the brain tissue.
- Gradual aphasia, also known as primary progressive aphasia (PPA), is a slow loss of language comprehension skills. It usually happens when a neurodegenerative disease like Alzheimer’s begins to damage brain cells.
Unlike sudden onset aphasia which can be traced directly to stroke or trauma, gradual aphasia is more challenging to identify, and may be misdiagnosed or undiagnosed in the early stages.
Primary progressive aphasia may be misdiagnosed as stress, normal aging, mood swings, or some form of cognitive decline.
Dysarthria vs aphasia vs aphagia
Aphasia is when you can’t remember the correct word for something, even though you know exactly what the object is, and can mentally visualize it. Or, you can no longer put together a coherent sentence. It is caused by damage to certain parts of the brain and is classified as a neurological language disorder.
Dysarthria is a physical inability to talk. Dysarthria happens when you have trouble speaking because the muscles in the face, lips, tongue, throat, and respiratory system don’t work properly. Dysarthria is a neurological motor control disorder, not a language disorder.
Aphagia is when you can’t swallow, or refuse to swallow, because of damage to muscles and nerves that control the act of swallowing. Aphagia may be caused by stroke, brain injury, and cancer treatments like radiation or chemotherapy.
Aphagia is not a language disorder.
What are the symptoms of aphasia
Some aphasia symptoms may be specific to either receptive or expressive aphasia. Collectively, aphasia symptoms may include:
- Anomia, or forgetting naming words: Very often, this is the first and foremost symptom of expressive, or non-fluent aphasia. You are not able to say the name of an object, even if you can mentally visualize it as a picture, or as letters spelling it out.
For example, you can picture a fork. You can see it neatly spelled out in your mind, in large block letters. But out loud, you say, “food-eat thing.”
- Telegraphing, or omitting: This is another common symptom of Broca’s aphasia. You leave out, or omit, several words from your speech and/or writing. The result is choppy, fragmented sentences which may not be easily understood by others.
The symptom is called ‘telegraphic’ because it resembles the writing style used when sending telegrams. People tried to keep telegram messages as short as possible because extra words cost more money.
- Trouble with telephones, TVs, and radios: People with receptive aphasia may become stressed when watching television because they may not be able to easily understand rapid speech and shifts in dialogue between characters.
With telephones and radios, not having visual cues makes it hard for them to follow the audio.
- Neologisms: A symptom of fluent, or receptive, aphasia, neologisms are made-up or nonsense words that the speaker may deliver with great eloquence and confidence. Neologisms can sound like ‘crazy talk’: here’s an example: “the quesifashion of her condences myotroped was pretty funny.”
- Paralexia: Reduced reading ability in otherwise literate people. A person with paralexia may misread and/or mispronounce words, transpose or switch words, replace words (e.g. read ‘dog’ when the written text says ‘cat’), and not understand instructional diagrams.
Treating aphasia
Aphasia treatments typically involve therapy to restore speech and writing skills.
In severe cases of global aphasia, affected individuals may learn new means of communication, such as sign language.
Recovering from aphasia is possible. The extent of recovery, or whether a person regains full or partial control over their language abilities, depends on the severity of the disorder and how quickly therapy was started.
Staying a step ahead
It is difficult to predict a stroke with complete certainty, but good doctors who keep a vigilant eye on their patients may know who is at higher risk, and will be prepared accordingly.
In the event that you begin showing signs of aphasia, your primary care physician will conduct preliminary assessments, refer you to specialist doctors, ensure proper care coordination, and conduct follow-up care.
Aphasia can be a challenging health condition, but with early intervention, personalized therapy, and strong support systems, it is possible to make a significant recovery.