When Bruce Willis’s family announced his departure from acting, the term “aphasia” entered the broader public conversation. Yet most Americans likely weren’t familiar with the actor’s diagnosis: Less than 10 percent correctly identified aphasia as a communication disorder in a 2016 survey conducted by the National Aphasia Association.

What is aphasia?

Aphasia is a disorder that can result from brain damage due to injury or disease. It most commonly occurs following a stroke or head injury, but it can also develop due to a brain tumor or progressive neurological disease. Aphasia can affect speech, the ability to read and write, and can impair one’s understanding of spoken and written language.

Anyone can acquire aphasia, although most people with the disorder are middle-aged or older. The National Aphasia Association estimates more than 2 million Americans have aphasia.

What are the symptoms of aphasia?

Aphasia symptoms reflect damage to the portions of the brain that are responsible for language. A person with aphasia may:

• Have trouble saying sentences. Single words or short phrases may be easier.
• Say the wrong word or made-up words.
• Not understand what other people say.
• Struggle with spelling, writing sentences, and/or reading.    

The disorder can range from mild to severe and can affect one or more aspects of language use. While aphasia makes it hard for a person to process language, it does not affect intelligence. Nevertheless, it is a challenging diagnosis since communication is a big part of life.

“It is difficult and frustrating for individuals suffering with aphasia,” says Summit Health neurologist Anita Mehta, DO. “It can be emotionally taxing to take care of someone with aphasia.”

Types of aphasia

There are several types of aphasia grouped into two categories – fluent and non-fluent.

• Fluent, or Wernicke’s, aphasia is characterized by speech that is difficult to understand or does not make sense. A person with fluent aphasia cannot form a coherent thought, and their sentences include unrecognizable, incorrect, or unnecessary words. This form of aphasia also impairs a person’s ability to understand the spoken language.
• Non-fluent, or Broca’s, aphasia is when someone understands speech and knows what they want to say, but they struggle to do so. The result is speech limited to short phrases and can take a lot of effort. Someone with non-fluent aphasia may also have right-sided weakness or paralysis.

Another type of aphasia, global aphasia, is the most severe. People with global aphasia can be very limited in producing and comprehending language.

Some people can experience temporary, or episodic, aphasia. Dr. Mehta says these episodes can be caused by migraines, seizures, or transient ischemic attacks (TIAs). TIAs occur when blood flow to an area of the brain is blocked. These attacks can increase one’s risk of having a stroke.

Aphasia, dementia, and Alzheimer’s disease

While aphasia is most commonly caused by stroke or brain injury, it can be caused by neurodegenerative disorders. These diseases occur when nerve cells in the central nervous system gradually stop working.

Primary progressive aphasia (PPA) is a type of aphasia that occurs with certain variants of frontotemporal dementia (FTD) and Alzheimer’s disease. Initial symptoms include speech and language problems; other symptoms associated with the underlying disorder, such as memory loss and behavior changes, can occur over time.

How is aphasia diagnosed and treated?

An aphasia diagnosis involves a clinical and neurological exam, says Dr. Mehta. Your provider may order additional tests such as an MRI to determine the cause of aphasia.

Treatment and prognosis for aphasia depend on factors such as the type and severity of brain injury and the patient’s age. In some mild cases, a patient may see improvement in their language skills within months. Still, many patients pursue speech therapy to restore as much language as possible and learn other ways to communicate.

Although medications and speech therapy can help in some cases, there are no specific treatments or cures for progressive diseases. “If aphasia is due to a neurodegenerative condition such as Alzheimer’s disease or frontotemporal dementia, the condition will worsen over time,” says Dr. Mehta. Researchers continue to study these disorders to advance treatment options.

Supporting someone with a communication disorder

Aphasia can have a significant effect on the quality of life. Dr. Mehta suggests the following ways friends and family members can support someone with this disorder:

• Speak slowly and concisely.
• Use short phrases and sentences to communicate.
• Reduce background noise.
• Use alternative methods to communicate, such as written communication.
• Add gestures or drawings to help reinforce communication.
• Don’t interrupt.
• Ask if your help is needed before giving it.

“Be patient,” she advises, adding that self-care is for caregivers, too. “It’s important to have time to rest and take care of yourself, as well.”

When to seek emergency care

Since aphasia often signals a serious problem, seek medical help right away if you suddenly have trouble with speaking or language comprehension.