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How aphasia steals the ability to communicate


Bruce Willis, the prolific action-movie star, in New York, Sept. 1, 2015. Willis, the film star known for his roles in “Die Hard” and “Pulp Fiction,” will step away from his decades-long movie career in the wake of a recent aphasia diagnosis.

By Dani Blum


Bruce Willis, the film star known for his roles in “Die Hard” and “Pulp Fiction,” will step away from his decades-long movie career in the wake of a recent aphasia diagnosis. His ex-wife, Demi Moore, shared the news in an Instagram post on Wednesday, saying the disease was “impacting his cognitive abilities.”


Dr. Borna Bonakdarpour, a behavioral neurologist with Northwestern Medicine, said about 1 million people in the United States currently have aphasia, which disrupts the ability to speak, read and write.


Here’s what we know about the condition.


What is aphasia?


Aphasia is a constellation of symptoms that make it difficult or impossible to express or comprehend language. The disorder stems from damage to the parts of the brain that are responsible for language functions, which are typically housed on the left side of the brain. Aphasia can be devastating for patients, disrupting their ability to take part in everyday life.


All cases of aphasia stem from neurological changes in the brain. Strokes resulting in brain damage are the number-one cause, said Dr. Shazam Hussain, director of the Cerebrovascular Center at Cleveland Clinic in Ohio. But it can also be caused by degenerative conditions like dementia and Alzheimer’s disease. According to the National Institute on Deafness and Other Communication Disorders, other triggers include brain injuries, including from severe blows to the head; brain tumors; gunshot wounds; and brain infections.


How does aphasia manifest itself?


There are several types of aphasia, all of which have an outsize impact on patients. Those with expressive aphasia may struggle to speak in complete sentences or find the words they are looking for. “It’s very frustrating,” Hussain said.


They may also have trouble remembering the words for certain objects, said Bonakdarpour, which leads them to pause for long periods of time, often in the middle of their sentences.


Other patients have receptive aphasia; they may experience intense confusion when people talk to them, and they may fail to follow conversations.


A person can experience receptive aphasia and expressive aphasia, but some experience only one or the other.


Global aphasia is a condition in which all four of the main language modalities — speaking, understanding, reading and writing — are severely impaired, leaving a person unable to communicate, said Karen Gendal, a speech-language pathologist at NYU Langone Rusk Rehabilitation.


Are there warning signs?


While aphasia occurs mostly in patients over age 65, it can develop at any age. The condition can come on suddenly, particularly in the wake of a stroke, but some people with aphasia develop it gradually. “Their sentences become shorter and shorter,” Hussain said. “Then, they get to a point where they have difficulty expressing any language at all.” Patients may also find that their ability to read or write worsens over time.


“Everyone can have periods where they’re busy or distracted or forgetting a word,” Hussain said. But if your inability to communicate holds you back from day-to-day activities, keeps growing more severe or, crucially, if friends and family point out a pattern that you are not aware of, seek medical attention, he said. People with aphasia typically lose insight into their interactions with others.


“If it’s really preventing your communication, that’s when you should be worried,” Bonakdarpour said. “If you’re forgetting a word here and there, that’s OK.”


Are there ways to prevent aphasia?


There is no guaranteed technique to prevent aphasia, but you can take simple steps to boost your brain health in general, Hussain said. Eat a balanced diet, exercise regularly and watch out for stroke risk factors like high blood pressure, high cholesterol and diabetes. Smoking can also elevate your risk for stroke and aphasia. “The healthier you can keep your brain overall, the less a chance of these or other issues of the brain developing,” Hussain said.


Are there treatments?


While there is no cure, patients with aphasia can seek speech and occupational therapy.


The National Aphasia Association recommends two primary methods of treatment. Impairment-based therapies involve evaluating and then targeting specific reading, speaking and writing skills through activities like fill-in-the-blank exercises and training patients to remember synonyms and antonyms. Communication-based therapies focus on rebuilding conversation and cognition skills that patients use to participate in everyday activities; they may role-play scenarios like ordering a coffee or speaking on a video call, said Gendal.


Support groups are also available across the United States and online to help people cope with the toll of the condition.

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