Aphasia is a disorder that affects a person’s ability to communicate. It is often the result of an underlying neurological condition in which portions of the brain that control language are damaged. People with aphasia may have trouble with “language production” (including speaking and writing), comprehension (understanding others’ speech or reading), or both.

More than 2 million people in the United States suffer from aphasia; it typically occurs suddenly, often following a stroke or traumatic brain injury. It can also develop slowly over time from a disease process such as a brain tumor or neurodegenerative disease. In some cases, it can be a temporary condition brought about by a seizure, migraine, or transient ischemic attack (a temporary blockage of blood flow to the brain). While aphasia describes a deficit in someone’s ability to process language, the underlying cause or condition may affect other cognitive skills as well.

Aphasia forms and symptoms

There are many different forms of aphasia. Symptoms can vary depending on the form of aphasia a person has. The different forms can be understood in terms of three broad categories:

• Expressive aphasia: This is also referred to as Broca’s aphasia or nonfluent aphasia. A hallmark of this form is difficulty with speaking. People with expressive aphasia may have difficulty making sounds to produce words. They may only be able to produce single words or simple phrases. They typically know what they want to say but struggle with articulating themselves. Their ability to understand others’ speech, however, is relatively preserved.
• Receptive aphasia: This is also referred to as Wernicke’s aphasia or fluent aphasia. The primary feature of this form is difficulty with comprehension. People with receptive aphasia may have difficulty understanding complex sentences, or they may have difficulty understanding individual words. They can typically speak in long and complete sentences; however, the sentences they produce may have little meaning. They tend to use incorrect, unnecessary or meaningless words.
• Global aphasia: People with this form of aphasia have profound difficulties with all aspects of language, including speech, comprehension, reading and writing. They also struggle with repeating what they hear. As a result, they have extreme difficulty communicating. These individuals rely more heavily on nonverbal aspects of communication, such as facial expression and tone of voice.

Typically, when aphasia is the result of a stroke or brain injury, symptoms do not get worse. In contrast, when aphasia is the result of a dementia process (or neurodegenerative disease), language symptoms are progressive. That means the disease begins with subtle problems that get worse over time. This condition is known as primary progressive aphasia (PPA). There are three variants of PPA:

• Nonfluent/agrammatic variant PPA: People with this variant have no trouble understanding the meaning of words, but they have difficulty getting words out and putting sentences together. They may have difficulty pronouncing simple words or using correct grammar.

• Semantic variant PPA: People with this variant lose their knowledge of what words mean. They may substitute specific words for vague terms. Over time, they may struggle with recognizing objects and people.

• Logopenic variant PPA: People with this variant may have frequent pauses to find the words they are looking for. Their speech becomes slower over time. They also have difficulty repeating phrases or words they hear.

Treatment

People who suffer aphasia because of a stroke or brain injury can see dramatic recovery in their language and communication abilities in the first few months after the initial injury. Once the areas of the brain responsible for language functions are damaged resulting in aphasia, symptoms do not usually get worse. Speech therapy can help these people restore some of their lost language abilities, help them use and strengthen their preserved language abilities, and introduce them to other modes of communicating (e.g., assistive electronic devices).

Even when aphasia is a result of a dementia process, speech therapy can help people make up for their communication difficulties. Although language skills will not improve with treatment, the focus of speech therapy is to maximize functional communication for as long as possible, helping patients maintain meaningful relationships with their loved ones.

When to seek emergency medical care

By far, the most common cause of aphasia is stroke. It is important to seek immediate medical attention if you or someone around you suddenly develops trouble with speaking or understanding speech, sudden paralysis or weakness on one side of the body, drooping on one side of the face, confusion, dizziness or problems with balance, or loss of vision.