Aphasia

What Causes Aphasia?

Aphasia is caused by damage to the brain’s language centers, but the harm can come from a variety of causes:

• • Stroke. A stroke happens when a blocked or broken blood vessel cuts off blood flow to the brain. Oxygen-starved brain cells die or are damaged, and when the damage occurs in the language centers, aphasia can result.

• Head trauma or injury

• Brain tumors

• Infections of the brain

• Degenerative brain diseases such as Alzheimer’s disease

Is Aphasia Hereditary?

Most cases of aphasia are caused by circumstances that are not inherited. Primary progressive aphasia (PPA), however, has been linked to inherited factors. About 40-50% of PPA patients have a family history of the disorder.

In some rare cases, PPA is caused by an abnormal variation in a specific gene, called the GRN gene. Most cases of PPA, though, are not caused by this particular gene mutation. Scientists are not sure what genetic factors, aside from the GRN gene, cause PPA to run in families, but it’s most likely caused by a combination of genetics and environmental factors.

How is Aphasia Detected?

Aphasia is often a sign of a potentially life-threatening medical event, such as a stroke. If you notice someone exhibiting the warning signs of aphasia, seek medical help for them immediately.

Warning signs of aphasia include:

• Difficulty coming up with the right words, including names of familiar people, objects, places, etc.
• Difficulty expressing thoughts
• Difficulty understanding conversation
• Difficulty with reading or writing
• Mixing up words or putting them in the wrong order
• Speaking in very simple or short sentences
• Repeating words or phrases
• Leaving words out of sentences
• Replacing words with other words that don’t make sense
• Mixing up sounds within words
• Speaking in entirely nonsensical language
• Not recognizing that they’re having communication difficulties

How is Aphasia Diagnosed?

If a patient presents symptoms consistent with aphasia, a doctor will conduct a diagnostic process focused on confirming (or ruling out) aphasia and identifying the cause of the symptoms.

Diagnostic steps may include:

• Physical exam
• Neurological exam. This exam will test neurological functions such as reflexes, strength, coordination, balance, sensory perception, etc.
• Cardiovascular exam to check for evidence of a stroke
• Imaging tests (magnetic resonance imaging (MRI) or computed tomography (CT)) to look for evidence of damage to the brain
• Tests and evaluations of language skills and comprehension

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How is Aphasia Treated?

In cases of aphasia where brain damage is not extensive and symptoms are relatively mild, the condition may improve without treatment. In most cases, however, rehabilitative therapy is necessary. Rehabilitation usually improves symptoms, but patients rarely recover all of their language skills.

A speech-language pathologist usually directs rehabilitation. Therapies may focus on re-learning language skills, but alternative communication skills may be explored if those therapies are not successful. These approaches may include using visual communication methods or using technological tools (tablets, smartphones, etc.) for communicating.

How Does Aphasia Progress?

The communication difficulties of aphasia can lead to social isolation, which can, in turn, produce life-altering complications. Sufferers may have a hard time continuing with their jobs, and they may struggle with their daily routines and relationships. Depression and anxiety are common complications, as well.

Primary progressive aphasia differs from other types of aphasia because it’s caused by the ongoing degeneration of brain tissue. Symptoms worsen over time, and often other neurological symptoms develop, including problems with movement, thinking, and memory. Sufferers eventually need to be cared for, and life expectancy after PPA diagnosis is 3-12 years.

How is Aphasia Prevented?

There’s no direct way to prevent aphasia, but because most cases are caused by stroke, measures to prevent strokes can also reduce the risk of aphasia.

Stroke risk can be decreased by:

• Eating a healthy, balanced diet
• Getting regular exercise
• Getting plenty of sleep
• Controlling high blood sugar, high blood pressure, and cholesterol levels
• Quitting smoking
• Limiting alcohol consumption

Aphasia Caregiver Tips

Communicating with someone suffering from aphasia can be frustrating for both parties. To help your loved one (and yourself) to cope, keep these tips in mind:

• Limit distractions. Provide a quiet, calm environment, and limit the number of people engaging in conversation with the sufferer. Speak slowly and simply.
• Help your loved one to exercise their language skills. Don’t finish sentences for them, and involve them in conversations as much as possible.
• Use nonverbal communication methods when necessary. Try using drawings, photos, and other visual aids.
• Make sure your loved one understands you. Repeat yourself if necessary, and double-check to verify that you’re being understood.

Many people with aphasia also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with aphasia:

• People with aphasia often suffer from depression or anxiety.
• The onset of aphasia often follows a stroke.
• Aphasia is often associated with Alzheimer’s disease, frontotemporal dementia, and other types of dementia.

Aphasia sometimes develops after a traumatic brain injury or a brain tumor.

Aphasia Brain Science

Scientists are working in many different areas to understand aphasia better and develop more effective treatments for the disorder.

• Medications. Using drug therapies to treat aphasia is a new approach. Researchers are working on drugs that may help to repair the damage that causes aphasia by increasing blood flow to the brain. Other medications may boost brain chemicals called neurotransmitters, and those chemicals may help diminish the symptoms of aphasia.
• Imaging. Some researchers use functional magnetic resonance imaging (fMRI) to examine how the brain processes language, both in normal brains and in brains suffering from aphasia. Increased knowledge of these processes could lead to new treatments.
• Brain stimulation. Therapeutic techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) use magnetic fields or electrical current to temporarily disrupt normal brain activity. Some researchers suspect that these technologies might be able to help aphasia sufferers to improve their language abilities.

Aphasia Research

Title: Aerobic Exercise and Aphasia Treatment

Stage: Recruiting

Principal investigator: Elizabeth Galleta, MD 

NYU Langone Medical Center

New York, NY

The purpose of the study is to determine if speech therapy can be enhanced by Aerobic Exercise (AE). Investigators will use a single subject design to determine if aphasia therapy results in more significant gains when combined with aerobic exercise.

Title: Analysis of Brain Activity to Uncover Brain-behavior Relationships Related to Therapy Outcomes in Aphasia

Stage: Recruiting

Principal investigator: Chaleece W Sandberg, PhD 

Hershey Medical Campus

Hershey, PA

Aphasia is a loss of language due to stroke or other brain injuries. Word-finding in conversation is a universal and persistent difficulty in aphasia. While several techniques exist to improve word-finding in aphasia, it is unclear how the brain changes in response to behavioral therapy. In this study, persons with aphasia will receive behavioral therapy to help them be more successful at finding words. Twenty therapy sessions will be provided in 10 weeks. Each therapy session will last about 2 hours and will include a variety of language tasks. Before beginning word-finding therapy, each participant will receive two fMRI scans, spaced 10 weeks apart. After finishing treatment, each participant will receive two additional fMRI scans, spaced 10 weeks apart. For a portion of the MRI scan, participants will complete language tasks. These fMRI scans aim to measure brain changes that may occur due to successful behavioral therapy. The hypotheses are as follows: First, that the behavioral therapy will improve word-finding as it has done in the past. Second, that the brain will change in a couple of different ways. It is expected that the network of regions that support word-finding will be more connected and work together more efficiently after therapy. It is also expected that the networks of areas that support other aspects of cognitive function, such as attention and executive function, will also be more connected and work together more efficiently.

Title: Treating Primary Progressive Aphasia (PPA) Using High-definition tDCS

Stage: Recruiting

Principal investigator: Roy H. Hamilton, MD 

University of Pennsylvania

Philadelphia, PA

This is a double-blind, sham-controlled, crossover study in which subjects with the non-fluent/agrammatic and logopenic variants of primary progressive aphasia (naPPA and lvPPA, respectively) will undergo language testing and structural and functional brain imaging before and after receiving 10 semi-consecutive daily sessions of real or sham high-definition transcranial direct current stimulation (HD-tDCS) paired with modified constraint-induced language therapy (mCILT). Language testing and brain imaging will be repeated immediately after completion of and 3 months following completion of treatment. The 3-month follow-up will be the primary endpoint. The investigators will examine changes in language performance induced by HD-tDCS + mCILT compared to sham HD-tDCS + mCILT. The investigators will also use network science to analyze brain imaging (fMRI) data to identify network properties associated with baseline PPA severity and tDCS-induced changes in performance. This study will combine knowledge gained from our behavioral, imaging, and network data to determine the relative degrees to which these properties predict whether persons with PPA will respond to intervention.