Aphasia

Symptoms of aphasia

Aphasia affects everyone differently. But most people will have difficulty expressing themselves or understanding things they hear or read.

If aphasia has been caused by a sudden brain injury, such as a stroke or severe head injury, symptoms usually develop straight after the injury.

In cases where there's gradual damage to the brain as a result of a condition that gets worse over time, such as dementia or a brain tumour, the symptoms may develop gradually.

Types of aphasia

Aphasia is often classified as "expressive" or "receptive". This depends on whether there are problems understanding or expressing language, or both.

But most people with aphasia have some trouble with their speaking. They will also have a mixture of problems with writing, reading and perhaps listening.

Symptoms can range widely from getting a few words mixed up to having difficulty with all forms of communication.

Some people are unaware that their speech makes no sense and get frustrated when others don't understand them.

Expressive aphasia

Someone with expressive aphasia experiences difficulty communicating their thoughts, ideas and messages to others.

This may affect speech, writing, gestures or drawing. It may cause problems with everyday tasks like using the telephone, writing an email, or speaking to family and friends.

People with expressive aphasia may have some of the following signs and symptoms:

• slow and halting speech – with difficulty constructing a sentence
• struggling to get certain words out – such as the names of objects, places or people
• only using basic nouns and verbs – for example, "want drink" or "go town today"
• spelling or grammatical errors
• using a wrong but related word – such as saying "chair" instead of "table"
• including nonsense words or their speech not making sense (speech-sound errors)

Receptive aphasia

A person with receptive aphasia experiences difficulty understanding things they hear or read. They may also have difficulty interpreting gestures, drawings, numbers and pictures.

This can affect everyday activities such as reading an email, managing finances, having conversations, listening to the radio, or following TV programmes.

People with receptive aphasia may have some of the following signs and symptoms:

• difficulty understanding what people say
• difficulty understanding written words
• misinterpreting the meaning of words, gestures, pictures or drawings
• giving responses that may not make sense if they've misunderstood questions or comments
• not being aware of their difficulties with understanding, or their own speech errors

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.

Primary progressive aphasia

This is a rare type of dementia, where language is heavily affected. As it's a progressive condition, the symptoms get worse over time.

Usually, the first problem people with primary progressive aphasia (PPA) notice is difficulty finding the right word or remembering somebody's name.

The problems gradually get worse, and can include:

• speech becoming hesitant and difficult, and making mistakes with the sounds of words or grammar
• speech becoming slow with short, simple sentences
• forgetting the meaning of complicated words, and later also simple ones, making it more difficult for them to understand other people
• speech becoming more vague and the person having difficulty being specific or clarifying what they're saying
• becoming less likely to join in with or start conversations

A person with PPA may also experience other symptoms later in their illness, including:

• changes in their personality and behaviour
• difficulties with memory and thinking – similar to Alzheimer's disease
• difficulties with movement – similar to Parkinson's disease

Causes of aphasia

Aphasia is caused by damage to parts of the brain responsible for understanding and producing language.

Common causes include:

• stroke – the most common cause of aphasia
• severe head injury
• brain tumour
• progressive neurological conditions – conditions that cause the brain and nervous system to become damaged over time, such as dementia

Aphasia can affect people of all ages, but it's most common in people over the age of 65. This is because strokes and progressive neurological conditions tend to affect older adults.

Diagnosing aphasia

Aphasia is usually diagnosed after tests carried out by a clinician. This can be either a speech and language therapist or a doctor. They can also help arrange treatment if necessary.

These tests often involve simple exercises, such as asking a person to name objects in the room, repeat words and sentences, and read and write.

The aim of these tests is to understand a person's ability to:

• understand basic speech and grammar
• express words, phrases and sentences
• socially communicate – for example, hold a conversation or understand a joke
• read and write letters, words and sentences

Imaging techniques such as a CT scan or MRI scan can be used to assess brain damage.

Treating aphasia

Speech and language therapy is the main type of treatment for people with aphasia, see more useful links below.

This aims to help restore some of your ability to communicate, as well as help you develop alternative ways of communicating, if necessary.

You may receive speech and language therapy on an individual basis or in a group, depending on your needs and the service provided.

An increasing number of computer-based applications are available to support people with aphasia.

But it's important to start using these with the help of a speech and language therapist.

How successful treatment is differs from person to person. Most people with aphasia make some degree of recovery, and some recover fully.

If the aphasia is caused by a one-off event, like a stroke, most patients recover to some degree with therapy. There's no evidence to suggest that recovery stops at a specific time after stroke.

But the chances of recovery is poorer for people with aphasia resulting from a progressive neurological condition.

Some people can still respond to therapy, but there are currently no good ways of reversing the ongoing injury to the brain.

When aphasia is caused by a progressive condition, treatment focuses on making the most of what people can still do and developing other ways of communicating to prepare for a time when speaking will be more difficult.

Complications of aphasia

The challenges of living with aphasia can impact how a person feels and interacts with others.

In some cases, it can lead to:

• isolation
• anxiety
• depression

If you're concerned about someone with aphasia, encourage them to discuss any problems with their GP or a member of their care team to access the relevant support.

If the person is unable to do this themselves, they may require someone to communicate on their behalf.

• Aphasia

More useful links

• How to use your health services
• Speech and language therapy – BHSCT
• Speech and language therapy – NHSCT
• Speech and language therapy – SEHSCT
• Speech and language therapy – SHSCT
• Speech and language therapy – WHSCT