Aphasia - your questions answered
We've received many questions about aphasia – what it is – and how it is related to dementia. In brief, aphasia is a language disorder that results from damage to two specific parts of the brain called the frontal lobe and the temporal lobe (see picture above). Looking at the brain inside the skull, there are four visible areas called ‘lobes’. Damage to the frontal lobe (the part of the brain behind the forehead) results in difficulties expressing oneself through speech. People may know what they want to say but they have a lot of difficulty getting the words out and their speech is often halting, slow, and effortful. This is referred to as non-fluent aphasia. You may also hear it called ‘Broca’s aphasia’, named after the neurologist who first described the difficulties. Damage to the temporal lobe (parts of the brain behind the temples) results in difficulties understanding what others say. As a result, a person may have trouble following conversations, directions (e.g. “turn left at the next corner”), or television programs. Further, the person’s speech may be fluent (if the frontal lobe is not damaged) but empty and puzzling, affecting conversation and social engagement. Depending on the severity of the damage, the language that is expressed may not make sense – almost like the person is speaking another language. Due to the comprehension difficulties, the person may not have any awareness or realisation that their speech is not making sense – creating a disconnect. Temporal lobe-related aphasia is referred to as fluent aphasia, or ‘Wernicke’s aphasia’, named after another neurologist who first described it. If damage to the brain is extensive and involves both the temporal and frontal lobes, the aphasia is termed ‘global’. Here both speech production and comprehension can be profoundly impacted. The most common cause of aphasia is a stroke where blood flow to these areas of the brain is interrupted, immediately affecting speech and language function. You may be familiar with the ‘FAST’ acronym for detecting a stroke: Face, Arm, Speech, and Time. Although less common, aphasia also can be progressive, reflecting ongoing deterioration within the brain. This condition is called ‘primary progressive aphasia’ or ‘PPA’ and this is the type of aphasia that is characteristic of a particular form of dementia. It presents initially as a gradual and seemingly isolated and unexplained loss of the ability to understand language, recall and form words, and/or put sentences together. It is important to understand that aphasia is not a problem of intellect. It is a language problem, reflected in a person’s ability to communicate. Speech pathologists are important members of healthcare teams to both diagnose and provide effective treatment for people with aphasia – facilitating optimal functional speech and language through evidence-based strategies, exploring ways in which technology can be used to assist with communication, and helping family members, co-workers, and care partners understand the changes in the brain that underlie the communication challenges. Although experimental at this stage, there is exciting research with initiatives such as transcranial direct current stimulation. In this approach, the brain is stimulated with a low current through strategically placed surface electrodes on the head. Preliminary results are showing increased ability to recall names of objects and people and use them in functional phrases and sentences. If you know a person with communication difficulties due to aphasia or PPA, allow enough time to communicate, use writing, body language, or technology like an iPad. If you or a loved one is concerned about aphasia, please seek support or advice from your doctor, a speech pathologist or contact us at island@dementia.utas.edu.au.
Thanks to Lyn Goldberg and Jade Cartwright for this article: - Lyn Goldberg, PhD, is an Associate Professor at the University of Tasmania’s Wicking Dementia Research and Education Centre, Jade Cartwright, PhD, is an Associate Professor in Speech Pathology at the University of Tasmania’s School of Health Sciences,
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