What you need to know about aphasia

When the family of Bruce Willis shared in March 2022 that the actor was ending his career due to aphasia, a language disorder, fans expressed their sadness and respect. Here was a blockbuster film hero showing real-life courage in revealing his illness. The news also sparked worldwide interest in aphasia, a disorder that had been unfamiliar to most people.

What is aphasia?

Aphasia results from brain damage. This might be from a stroke (disruption of blood to the brain), tumor, head injury, brain infection, or progressive neurological disease (such as Alzheimer's).

The part of the brain that is damaged determines the type of aphasia that develops. There are many kinds, and they fall into three main categories. A person can have one or a combination of the following:

Anomic aphasia (anomia) comes from damage anywhere in the left hemisphere of the brain. It causes word-finding problems, particularly difficulty coming up with nouns. This is different from the trouble many seniors have remembering names of people or places. "We don't consider that abnormal unless the word you can't find is the name of your child or spouse. Anomia is trouble coming up with ordinary words like tree, sidewalk, table, desk, pencil, cup, or asparagus," explains Dr. Andrew Budson, a neurologist and chief of Cognitive and Behavioral Neurology at VA Boston Healthcare System.

Broca's aphasia comes from damage in Broca's area, part of the frontal lobe of the brain. This area is in charge of arranging words in sentences and translating meaning into sounds. People with Broca's aphasia have a hard time producing speech. "People know what they want to say, but it's difficult to get the words out," Dr. Budson says. "They generally understand what you are saying to them."

Wernicke's aphasia comes from damage in Wernicke's area, located in the temporal lobe of the brain. This area connects information about word meanings with the speech output centers in Broca's area. People with Wernicke's aphasia have difficulty making sense of what other people are saying. "They can speak fluently, but the words that come out are nonsense," Dr. Budson says.

Aphasia can be mild or severe. In many cases, intelligence remains intact despite aphasia. For example, people with Broca's aphasia may understand entirely who they are, where they are, who the people around them are, what day it is, and how to balance a checkbook — but be unable to speak their thoughts.

Diagnosis

If you or a loved one is having difficulty with word finding, speaking, or understanding speech, talk to your primary care doctor. You may be referred to a specialist — such as a neurologist or a neuropsychologist — for further evaluation.

"Knowing the type of aphasia is important for families to adapt and to make sure someone gets the right rehabilitation or treatment," Dr. Budson says.

Treatment

Speech therapy helps people with aphasia learn to communicate. It's mostly for people with mild to moderate Broca's aphasia or anomia, since it's difficult for people with Wernicke's aphasia to understand instructions.

Here are some common strategies for communication:

Asking yes-or-no questions. Since people with Broca's aphasia or anomia can understand you, ask them questions to which they can nod or shake their head. That often works when they can't say the words "yes" or "no."

Using pictures. People can use booklets or an app filled with images. For example, there might be pictures of different foods. If you ask them what they want for dinner, they can point to the options they want.

Using melodies. Sometimes people with Broca's aphasia can sing words they can't say. Singing tricks the brain into unlocking words stored in undamaged areas. That means they can try singing their answer to a familiar tune, like "Happy Birthday to You."

"For example, if you ask a person what they want for dinner," says Dr. Budson, "they would sing, 'I'd like chicken with rice, I'd like chicken with rice,' and so on. It's a way that some people have been able to overcome aphasia," Dr. Budson says.

Using word "cousins." When a word escapes people with anomia, they're taught to think of related words. "If a person wants a 'cup,' you ask them to think of things like a cup—maybe a glass, jar, or mug. That activates the brain network with all words related to cup, and eventually 'cup' will pop into the person's mind," Dr. Budson says. "By the way, that's useful when anyone has difficulty finding the right word or name. Give it a try."

Can you recover from aphasia?

If the cause of the aphasia improves, so may the aphasia. But many people will continue to live with some level of aphasia, especially if the cause is a progressive brain disease, such as Alzheimer's.

"The important thing is that you and your family or caregivers learn to work with your limitations," Dr. Budson says. "Aphasia can be very isolating. Having some way to communicate helps people with aphasia to be engaged in life and feel connected to others. Everyone needs that."

Image: © wanderluster/Getty Images