What Research Is Being Done For Aphasia
Researchers are testing new types of speech-language therapy in people with both recent and chronic aphasia to see if new methods can better help them recover word retrieval, grammar, prosody , and other aspects of speech.
Some of these new methods involve improving cognitive abilities that support the processing of language, such as short-term memory and attention. Others involve activities that stimulate the mental representations of sounds, words, and sentences, making them easier to access and retrieve.
Researchers are also exploring drug therapy as an experimental approach to treating aphasia. Some studies are testing whether drugs that affect the chemical neurotransmitters in the brain can be used in combination with speech-language therapy to improve recovery of various language functions.
Other research is focused on using advanced imaging methods, such as functional magnetic resonance imaging , to explore how language is processed in the normal and damaged brain and to understand recovery processes. This type of research may advance our knowledge of how the areas involved in speech and understanding language reorganize after a brain injury. The results could have implications for the diagnosis and treatment of aphasia and other neurological disorders.
NIDCD-funded clinical trials are also testing other treatments for aphasia. A list of active NIDCD-funded aphasia trials can be found at ClinicalTrials.gov.
How Can You Maintain Communication
If your loved one has been diagnosed with aphasia, the following strategies may help you communicate more effectively:
- Make sure you have the persons attention before speaking.
- Use body language, eye contact, and gestures both to communicate and to understand.
- Dont talk down to the person aphasia often occurs without affecting intelligence at all.
- Slow down and use simple sentence structures and words.
- Dont try to finish the persons sentences. Allow him or her to finish speaking or communicating.
- Dont emphasize or correct problems in word usage or pronunciation.
- Hire an in-home caregiver to help your loved one maintain independence as long as possible.
While aphasia can be frustrating for both the affected individual and his or her family, remember that regular contact and conversations with loved ones still play an important role in helping to alleviate problems and encourage recovery or coping strategies.
Aphasia Symptoms Associated With Dementia
People with the most common types of dementia, such as Alzheimer’s disease and vascular dementia, usually have a mild form of aphasia.
This often involves problems finding words and can affect names, even of people they know well.
It doesn’t mean they don’t recognise the person or don’t know who they are, they just can’t access the name or get mixed up.
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How Is Aphasia Diagnosed
Aphasia is usually first recognized by the physician who treats the person for his or her brain injury. Most individuals will undergo a magnetic resonance imaging or computed tomography scan to confirm the presence of a brain injury and to identify its precise location. The physician also typically tests the persons ability to understand and produce language, such as following commands, answering questions, naming objects, and carrying on a conversation.
If the physician suspects aphasia, the patient is usually referred to a speech-language pathologist, who performs a comprehensive examination of the persons communication abilities. The persons ability to speak, express ideas, converse socially, understand language, and read and write are all assessed in detail.
Simple Language Test May Predict Alzheimers Onset Years Before Symptoms Start
Thankfully, she never totally lost the ability to communicate with her family, but often shed seemingly have the word on the tip of her tongue and couldnt push it past her lips.
Aphasia appears gradually for people with Alzheimers disease, while stroke patients are often afflicted immediately. However, it doesnt exhibit the same way for every dementia patient. For some, communicating in writing is laborious, as they lose the ability to write words and sentences and, in many cases, are unable to read written words. When they do write, the wrong words land on the paper.
An inability to recognize people and objects is also a symptom of aphasia. Perhaps this is why my mother found it difficult to identify people in photographs. Face-to-face, she knew her children and grandchildren, but often couldnt pick them out in photos. Shed point at the individual and ask, Who is that? I mistakenly thought her eyesight kept her from differentiating one person from another.
During the late stages of Alzheimers disease, she didnt recognize herself in a mirror and asked, Who is that old woman? I assume she recognized me in the reflection since she didnt ask. Standing in front of the mirror, I would have her touch her nose and the top of her head. As the reflection matched her movements, shed smile or chuckle and say, Oh, thats me.
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How Aphasia Relates To Alzheimers Disease
If you or a loved one has trouble finding the right words and phrases to communicate, it could signal aphasia. In the mid to late stages of Alzheimers disease, my mother exhibited the condition. She had regular checkups at a memory clinic and was fortunate to enroll in a clinical trial.
On one of her diagnostic visits, the doctor pointed to his watch and asked my mother what it was and what its purpose was. Her response was close, but not quite right. She knew its purpose was to tell time, but referred to his watch as a clock. That is an example of aphasia.
Causes Of Aphasia And Dementia
We have already established that both dementia and aphasia are caused when there are damages in the brain.
What sets the two conditions apart is the section of the brain that is hurt.
For aphasia, people will get the illness when the part of the brain that controls speech is damaged. This mostly happens because of traumatic brain injury or a stroke.
Infections and brain tumors are other probable causes of aphasia.
Dementia is quite different from this.
Even though a stroke or traumatic brain injury can also cause it, it is mostly a result of amyloid plaque build-up in the brain, which leads to the development of the most common dementia type known as Alzheimers disease.
This build-up cuts off neurons in the brain that are responsible for relaying messages from one part of the brain to the next.
It ends up affecting the entire brain and not the speech part, as is the case with aphasia.
This is why a person with dementia may not know the name of a familiar face or even remember how to hold a fork because they cannot access their memories.
The person with aphasia only has problems accessing the part of the brain that deals with speech.
These differences between aphasia and dementia are instrumental when it comes to diagnosis.
A doctor can study the symptoms to know whether a person is only having trouble with speech or they are having communication problems as well as other challenges with their day to day lives to understand what the person is suffering from.
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What Are The Types Of Aphasia
- receptive aphasia: when the individual has trouble understanding what is being said
- expressive aphasia: when the individual is having difficulty expressing what they want to say
It is also possible for a stroke patient to have mixed aphasia or global aphasia, which is the term for a severe case of both receptive and expressive aphasia.
Receptive Aphasia
Imagine being in a room with your friends and family, but every single one of them is speaking a strange, foreign language. Maybe you recognize a word here or there, but youre struggling to make any sense of whats being said. Thats what it feels like for people with receptive aphasia. An individual with receptive aphasia can still communicate, but they have a lot of difficulty understanding what is being communicated back to them.
Receptive aphasia is even more difficult to deal with when people speak in long or complex sentences, if multiple people are speaking at once, or if there is too much background noise. People with receptive aphasia might be able to read something short and simple, like a newspaper headline, but would struggle to read the actual article. In addition, those with receptive aphasia might still be able to communicate by writing, but then they might struggle to read back what they just wrote.
Expressive Aphasia
What Causes Alzheimer’s Disease To Progress So Quickly
The progression of Alzheimers disease varies widely between individuals, with most people living with the condition for between 3 and 11 years after the initial diagnosis. In some cases, people may survive for more than 20 years. When Alzheimers is detected early, there are possible treatments that can help to slow the progression of the disease and contribute to a longer life expectancy.
It is therefore crucial to plan for the future and follow the progression of the disease through each stage. Alzheimers disease first begins with physical changes in the brain. This can happen at a gradual pace before any noticeable symptoms appear. In fact, this pre-clinical Alzheimers disease stage can begin 10 to 15 years before any symptoms appear.
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Speech Difficulty Known As Aphasia Can Range From Simply Forgetting A Word To The Complete Loss Of Ability To Speak
Scientists at Northwestern Medicine have pinpointed the location of of the brain networks that can lead to primary progressive aphasia , which is a form of dementia where an individual loses speech and language abilities rather than memory. PPA occurs when nerve cells in language-related parts of the brain malfunction.
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Prognosis And Life Expectancy
While some people with PPA are able to continue working for quite some time, others find that they are unable to perform at their job, especially if their work requires a higher level of communication and collaboration with others.
As with other frontotemporal dementias, the long-term prognosis is limited. The typical life expectancy from onset of the disease is 3 to 12 years. Often, complications from PPA, such as swallowing difficulties, often lead to the eventual decline.
Dementia & Alzheimer’s Disease
It is easy to confuse some of the symptoms of aphasia and dementia, which often leads to questions on whether the two medical conditions are related.
Before we go deeper into answering the query, it is important to first define these conditions.
Aphasia is a language or speech disorder that is a result of complications in the brain.
In Greek, the word Aphasia translates to speechlessness.
Dementia, on the other hand, is a general term that describes a range of medical conditions that are caused by abnormal brain changes.
In Latin, the term dementia stands for madness which implies severe memory loss in a person who was previously normal beyond what is expected as a person grows older.
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What Is Primary Progressive Aphasia
Primary Progressive Aphasia is a neurological syndrome in which language capabilities become slowly and progressively impaired. Unlike other forms of aphasia that result from stroke or brain injury, PPA is caused by neurodegenerative diseases, such as Alzheimers Disease or Frontotemporal Lobar Degeneration. PPA results from deterioration of brain tissue important for speech and language. Although the first symptoms are problems with speech and language, other problems associated with the underlying disease, such as memory loss, often occur later.
PPA commonly begins as a subtle disorder of language, progressing to a nearly total inability to speak, in its most severe stage. The type or pattern of the language deficit may differ from patient to patient. The initial language disturbance may be fluent aphasia or non-fluent aphasia . A less common variety begins with impaired word-finding and progressive deterioration of naming and comprehension, with relatively preserved articulation.
As with aphasia that results from stroke or brain trauma, the manifestations of PPA depend on what parts of the left hemisphere are relatively more damaged at any given point in the illness. The person may or may not have difficulty understanding speech. Eventually, almost all patients become mute and unable to understand spoken or written language, even if their behavior seems otherwise normal.
Individual Language Measures And Subtypes
Impaired word-finding was the presenting complaint and a prominent finding at the initial clinical assessment of all of the PPA participants . Word-finding hesitation lowered word output fluency in some participants, but not in those who reacted to word-finding failures with lengthy circumlocutions. In fact, 2 individuals had WPM scores higher than control values. In the other language measures, performance ranged from severely impaired to nearly intact . The one exception was single word comprehension, which was universally preserved, with a group mean performance of 96% ± 5%. Symptoms of apraxia of speech were present in 6/19 individuals but at a level of prominence that was overshadowed by the aphasia.
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A Clinical Framework For Assessing Language Functions In Primary Progressive Aphasia
When confronted by an aphasic patient, it is important firstly to establish the context of the language disturbance. This usually requires the help of an informant who knows the patient well and can supply reliable background information. A diagnosis of PPA requires that speech or language dysfunction was the initial and most salient clinical complaint . However, the patientâs previous verbal skills are relevant to interpreting current deficits. It is also necessary to determine the extent of any uncorrected peripheral hearing or visual impairments as these can impact significantly on everyday communication and performance on language tests. In defining the history of the language problem, it is essential to establish the circumstances of onset and very first symptoms , overall duration and tempo. The length of the history bears strongly on the interpretation of deficits, since PPA syndromes tend to converge over time . In PPA, a history of gradual, but unrelenting decline over a number of months or several years is typical, but some apparent fluctuation is not uncommon, particularly under conditions that stress the language system, such as public speaking or conversations by telephone or in a non-native tongue. There may have been a sentinel event such as a family celebration or minor head injury that first drew attention to the patientâs difficulties informants may interpret this as an acute onset but a searching history usually reveals a more insidious prodrome.
Stages : Very Severe Decline
Stage seven is the final stage of Alzheimers. Because the disease is a terminal illness, people in stage seven are nearing death. In stage seven of the disease, people lose the ability to communicate or respond to their environment. While they may still be able to utter words and phrases, they have no insight into their condition and need assistance with all activities of daily living. In the final stages of Alzheimers, people may lose their ability to swallow.
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The Patient With Late Stage Or Global Aphasia
All PPA syndromes tend ultimately to give rise to global language failure with mutism or sparse, stereotyped utterances as well as more widespread cognitive decline. Accordingly, diagnosis later in the course may be more informed by associated neurological features such as Parkinsonism. On the other hand, âmixedâ aphasia does not of itself signify advanced disease: some patients exhibit deficits that transcend canonical syndromic boundaries early on . In our experience, this includes cases with progranulin mutations and Alzheimerâs, Pickâs and other pathological associations are reported .
The Worried Well Or Functional Patient
Word-finding difficulty is a very common complaint in patients attending memory clinics . Many will be experiencing the effects of normal ageing and intercurrent stressors they typically describe inefficiency in recalling names or clearly expressing their thoughts when preoccupied or fatigued and have no evidence of language deficits on objective testing. A taxonomy of neurologically unexplained, âfunctionalâ or ânon-organicâ speech disorders has been described . In our experience, these cases are rare and tend to present as excessively deliberate, but immaculately executed speech or with isolated disturbances of prosody . Dysprosody is a regular accompaniment of nfvPPA and âpureâ primary progressive dysprosodia is a rare satellite syndrome in the PPA spectrum . Indeed, âforeign accent syndromeâ has been described as a presentation of PPA . Our patients with nfvPPA have exhibited degraded native accents or loss of a previously competent second language accent, rather than developing a facsimile foreign accent. âOrganicâ dysprosody tends to be brought out by circumstances calling for heightened control of vocal intonation .
When interpreting a language disorder as âneurologically unexplainedâ, it is important to appreciate that bona fide PPA syndromes can have quite counter-intuitive manifestations. An expert second opinion may be useful and the passage of time often clarifies the situation.
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