The aphasia may be defined as disorders of language secondary to lesions of the brain.. In most cases there is disorder of the output of speech. In the experience of the author aphasia in spoken speech is invariably accompanied by similar abnormalities in writing. Aphasia in spoken language is of two major types: (1). Non-fluent aphasia, in which few words are produced slowly and with great effort, and sounds are incorrectly articulated. Production of grammatical words is relatively more affected so that sentences tend to, be ungrammatical, e.g., “Weather sunny.”
Fluent aphasia, in the more extreme forms of which the patient produces runs of well -articulated speech, which has the rhythm and melody of normal language and a basically normal grammatical structure, but which tends to convey little information , e.g., “I was at the other one and then I was at this one,” a fluent aphasic’s circumlocutory manner of explaining that he was in another hospital previously. The speech of these patients usually contains many incorrect words, called Literal (or phonemic) paraphysis are substitutions of well-articulated but incorrect .sounds, e.g., “spoot” for “spoon,” and verbal paraphasias are incorrect usages of words, e.g., “knife” for “fork,” or “department” for “hospital.”
In differential diagnosis, one must be wary of describing mutism as aphasia, since severe aphasia are usually not mute. Causes of mutism are (1) uncooperativeness, (2) psychiatric disorders, e.g., severe depression or schizophrenia,
- widespread disorders of brain, such as trauma, subarachnoid hemorrhage, or metabolic disorders,
- lesions of mesencephalic and pontine tegmentum, an<| (5) bilateral lesions of the cranial nerves serving the speech organs, their nuclei, or their supranuclear pathways.
Dysarthria should not be confused with aphasia. Dysarthric speech is incorrectly articulated, but if transcribed shows correct grammar and word usage. A helpful clue is that if a patient with disorder in speech rights correctly (or produces correct language on a typewriter), he is almost certainly not aphasic.
A common error is to misdiagnose a fluent aphasia as schizophrenic word-salad. Several clues help to make the differential diagnosis. Fluent aphasia is much more common than schizophrenic word-salad. The schizophrenic speech disorder usually develops in chronic “back ward” schizophrenics. By contrast fluent aphasia may come on abruptly as the result of a stroke in a previously well person. Finally fluent aphasia from vascular disease usually occurs in older people, whereas schizophrenia almost always is manifest before the age of 30.
What Is Aphasia:aphasia Syndromes and Their Localizations.
Broca’s aphasia is the result of a lesion of Broca’s area, i.e., the portion of the frontal lobe just anterior to the face, lip, tongue, and mouth area of the motor cortex. This produces a nonfluent aphasia, and writing is also involved. Comprehension of language is intact. There is nearly always a right hemiplegia. Wernicke’s aphasia results from a lesion of Wernicke’s area, the posterior portion of the superior temporal gyrus. The aphasia is typically fluent. Written language is equally impaired. Comprehension of spoken and written language is severely impaired. Repetition of spoken language is poor. There is usually no hemiplegia, and other elementary neurologic signs are usually lacking.
Conduction aphasia results from a lesion of the parietal operculum, i.e., the region lying above the sylvian fissure. There is fluent aphasia involving speech and writing, with severely impaired repetition but intact comprehension. Elementary neurologic signs are usually absent, with the occasional exception of cortical sensory loss on the opposite side. Anomic aphasia is characterized by fluent aphasia in speech and impairment of written language, but with intact comprehension and repetition. The components of the Gerstmann syndrome (discussed subsequently) are often present. In this syndrome the lesion, if focal, is at the region of the parietotemporal junction, but a similar syndrome is produced in nonfocal widespread disease of the brain, such as is caused by metabolic disease or by large tumors with raised intracranial pressure.
These four syndromes are the most common, and although overlapping forms are common, relatively pure forms are not rare. Certain other sjmdromes are much less common.In isolation of the speech area there is a large lesion involving the cortex and underlying white matter in a C-shaped configuration that spares Broca’s area, Wernicke’s area, and their interconnections, but destroys the cortex and underlying white matter that surround the speech region. These patients either may show little spontaneous speech or may have fluent abnormal speech.
The most striking characteristic of this disorder is that despite an almost total lack of comprehension, the patient can repeat well without dysarthria. This lesion is usually the result of anoxia or of carotid insufficiency. Alexia without agraphia is a syndrome in which the patient speaks and writes normally but cannot comprehend written language. The lesion, almost always the result of infarction in the distribution of the left posterior cerebral artery, consists of destruction of the left visual cortex and the splenium, i.e., the posterior portion, of the corpus callosum. In alexia with agraphia the patient can neither write nor comprehend written language, but other language functions are normal.
Other components of the Gerstmann syndrome (see below) may be present. The lesion involves a portion of the left angular gyrus. A right visual field defect may occur if the lesion extends deeply into the white matter but is often absent. Pure word-deafness describes a syndrome in which there is dense incomprehension of language in the presence of intact hearing , although other language functions are intact. Two types of lesion produce this: either a single lesion lying subcortically in the posterior temporal lobe or bilateral lesions of the middle portion of the first temporal gyrus. Pure agraphia is extremely rare. It has been said that the responsible lesion lies in the posterior portion of the second frontal gyrus, but there are few convincing cases.
Causes of Aphasia
The most common cause is brain damage from a stroke, blockage, or rupture of a blood vessel in the brain. In addition, brain damage from a severe head injury, tumor, infection, or degenerative process can also cause aphasia.
Diseases such as dementia can also cause a decline in the function of brain cells, resulting in aphasia. In this condition, the disorder usually develops gradually.
Sometimes, episodes of aphasia can also be temporary. This can happen due to migraines, seizures, or transient ischemic attacks (TIAs). TIAs occur when blood flow to an area of the brain is temporarily blocked.
Risk Factors for Aphasia
Aphasia can happen to anyone, regardless of age. However, this disorder is more common in those who are middle-aged and older.
Symptoms of Aphasia
Aphasia is a sign of other health conditions, such as stroke or brain tumor. Here are some possible symptoms:
- Speaking in short or incomplete sentences.
- Speaking in sentences that are incomprehensible or do not make sense.
- Replacing one word with another or one sound with another.
- Saying unrecognizable words.
- Not understanding what other people are saying.
- Writing sentences that are incomprehensible or do not make sense.
People with aphasia also have different patterns of strengths and weaknesses. Here are the symptoms of aphasia based on its type:
1. Expressive aphasia
This is also called Broca’s aphasia or non-fluent aphasia. People with this type are better able to understand what others say than they are able to say their own sentences.
The sufferer has difficulty getting words out, often speaking in very short sentences and omitting words. For example, “Want to eat” or “Walking in the park today”.
2. Comprehensive aphasia
People with comprehensive aphasia can also speak easily and fluently in long, complex sentences. In addition, sufferers often add unrecognizable, incorrect or unnecessary words.
3. Global aphasia
This type has symptoms such as poor ability to understand other people’s speech and difficulty forming words and sentences.
4. Anomic aphasia
People with this disorder have difficulty finding words. Because of this difficulty, you may have difficulty finding the right words to speak and write.
5. Conduction aphasia
Also known as associative aphasia, this type of aphasia has symptoms such as difficulty finding words or repeated phrases.
6. Transcortical sensory aphasia
In this type, the sufferer may be quite good at repeating words and phrases. But you are more likely to repeat questions that someone may ask you rather than answer them. This phenomenon is also known as echolalia.
7. Transcortical motor aphasia
Sufferers have strong repetition skills, but have difficulty answering questions without having to think a lot.
Diagnosis of Aphasia
To diagnose, your doctor will perform a physical and neurological exam, including testing your strength, feeling and reflexes, listening to your heartbeat, and the blood vessels in your neck.
To confirm the diagnosis, the doctor will also perform the following examinations:
- Imaging tests , such as MRI and CT scans. These tests can help doctors identify the cause and areas of the brain that are damaged.
- Communication skills test. In this test, the sufferer will have a conversation, name objects, answer questions, and follow instructions.
- Sensory and nerve function tests . These tests will make sure that hearing problems or nerve damage are not the cause of problems that appear to be aphasia.
- Cognitive and memory tests. These tests ensure that the problem is not caused by a disorder in the sufferer’s thinking or memory.
Aphasia Treatment
Treatment for this condition aims to improve communication and language skills, as well as developing other communication methods as needed.
If the brain damage is mild, aphasia can usually heal on its own. However, in severe cases, the following aphasia treatments can be done:
1. Speech and language therapy
For people with aphasia, this therapy aims to improve their ability to communicate by restoring as much language as possible, teaching how to regain lost language skills, and finding other methods of communication.
2. Medicines
Certain types of drugs can also be given by doctors to treat aphasia. The drugs that are usually given are drugs that work to increase blood flow to the brain, improve the brain’s ability to recover, or help replace chemicals that are depleted in the brain (neurotransmitters).
3. Nonverbal communication therapy
If aphasia limits how well you can communicate correctly using words and phrases, you may receive nonverbal communication therapy. Treatment may include:
- An image-based communication system.
- Using communication books for drawing.
- A drawing program.
- Speaking using gestures.
- Speaking directly to improve functioning in areas that affect verbal communication.
Aphasia Prevention
Aphasia usually cannot be prevented. However, the best way to avoid aphasia is to prevent the causes of brain damage, such as stroke, and to maintain the best possible brain health with a healthy lifestyle.
Here is a healthy lifestyle to prevent aphasia:
- Eat healthy and balanced nutritious food.
- Exercise every day.
- Maintain a healthy weight.
- Reduce alcohol intake.
- Maintain normal blood sugar, blood pressure and cholesterol levels.
- Quit smoking.
- Enough sleep.
Complications of Aphasia
Aphasia can cause many quality of life issues, considering that communication is a part of everyone’s life. Therefore, communication difficulties can affect:
- Work.
- Connection .
- Daily functions.
In addition, possible complications depend on the cause of aphasia, namely:
- Depression.
- Loss of mobility.
- Loss of bladder or bowel control.
- Higher risk of infection.
- Untreated illness.
Difficulty expressing wants, needs, and problems can lead to shame, frustration, isolation, and depression. Other problems may occur together, such as difficulty moving and problems with memory and thinking.
When to See a Doctor?
Because aphasia is often a sign of a serious problem, such as a stroke, see a doctor immediately if you suddenly experience:
- Difficulty speaking.
- Poor understanding of speech.
- Difficulty with remembering words.
- Problems with reading or writing.
