And a few hours ago the announcement that Bruce Willis , a well-known Hollywood actor and ex-husband of Demi Moore, will abandon acting due to the onset of a disorder: aphasia . In a post that appeared on the actor’s and ex-wife’s social media, the family announced that
“Bruce has had health problems and was recently diagnosed with aphasia , which is affecting his cognitive abilities. Consequently and with a lot of consideration Bruce is moving away from the career that has meant so much to him. ”
Let’s go to deepen what aphasia isand the different forms that may affect the patient’s health, to better understand the differences, characteristics and symptoms.
What is aphasia? Aphasia
is a language disorder characterized by the total or partial loss of the ability to understand or express words , both in written and spoken form, in subjects who had previously acquired language.
It is a condition that can have numerous negative repercussions on the quality of life of those affected, as with aphasia one or more of these abilities are lost:
- speak
- understand others when they speak,
- write,
- read aloud,
- understand what is being read.
Aphasia represents the consequence of a lesion affecting the centers of the central nervous system that preside over the understanding and / or production of language. These centers are located in the left hemisphere in 96% of right-handed and 70% of left-handed people.
Based on the site of the lesion, aphasia can be divided into two main types:
- Broca’s or expressive aphasia (also called non-fluent aphasia )
- Wernicke’s or receptive aphasia (also called fluent aphasia )
to which are added different types of aphasia involving both sectors.
Broca’s aphasia or expressive aphasia Broca
‘s aphasia owes its name to Paul Broca (pronounced: Broca), the French neurologist who was the first to find a link between a brain injury and a language deficit . The area affected by the brain lesion of his patient Louis Victor Leborgne , who was only able to pronounce the word “tan”, is located in the frontal area of the brain located in the dominant cerebral hemisphere, usually the left, now known as the area by Broca. Injuries in this area cause the patient to have difficulty producing words while maintaining the ability to understand what they hear or read. Broca
‘s aphasia is therefore an ” expressive ” and ” non-fluent ” aphasia, whereby the subject is able to understand the meaning of the words he hears or reads, but is unable to produce coherent and meaningful responses himself.
The patient suffering from Broca’s aphasia becomes aware of his condition and this awareness therefore leads him to a state of strong discomfort, frustration, insecurity and in some cases anger, which impact on the quality of life.
Those affected cannot express themselves fluently or cannot express themselves at all in both spoken and written language. Other neurological disorders are often associated with this condition such as hemiplegia, a condition for which it is difficult to coordinate complex movements and to move the muscles of the face to articulate words ( motor aphasia ), not to be confused with sensory aphasia with which it indicates the inability to understand words.
In the most serious cases, the only sound that the subject is able to produce is limited to a single syllable or only to a vowel. Patients also have difficulty in writing long and error-free thoughts ( non-fluent handwriting and dysgraphia ).
Wernicke’s aphasia or receptive aphasia Wernicke’s aphasia
is caused by lesions that affect a more posterior part of the brain than Broca’s area, located at the temporoparietal junction. Lesions in Wernicke’s area cause symptoms that are mirror image of those located in Broca’s area. In fact , Wernicke ‘s aphasia is a “receptive” and “fluent” aphasia , whereby the subject has a partial or total loss of the ability to understand words by listening to the voice of other people, while his ability to produce spoken language remains intact.
Often the subject, who has the ability to pronounce words but without fully understanding their meaning, is not aware of his problem and this can cause paranoia or episodes of anger.
The patient may present at the same time:
- impaired written and spoken comprehension
- difficulty in reading ( alexia )
- difficulty performing calculations ( acalculia )
- ability to write fluently, but with many errors ( fluent agraphy )
Amnestic aphasia
Patients affected by “ amnestic aphasia ” have difficulty finding the correct term (nouns, verbs, adverbs). This condition, called ” anomia “, forces them to find generic replacement terms from a very restricted vocabulary (frequent use of words like “thing”, “stuff”).
Sometimes, however, the subject invents random words and nonsense phrases or even pauses several times during the conversation and finds the right term after numerous attempts. In this case, however, apart from the difficulties related to lexical retrieval, there are no deficits in understanding or pronunciation of the words.
Global aphasia Global
aphasiaand caused by extensive lesions affecting the frontal and temporal lobes of the dominant hemisphere, therefore there is the sum of the manifestations of both types of aphasia, with difficulty both in understanding and in producing language.
What are the causes of
aphasia Aphasia is caused by a focal brain lesion at the level of the centers responsible for understanding, processing and producing language, usually located in the left hemisphere. The cause of this cerebral damage is often of a cerebrovascular nature and in particular to the middle cerebral artery (also called the Sylvian artery), which constitutes a branch of the internal carotid artery and runs in the Silvio’s cleft that separates the frontal lobe. , the temporal lobe and the parietal lobe.
These injuries can lead to many small heart attacks in the brain which then result in the appearance of the symptom in question.
There are 3 main types of lesions:
- haemorrhagic , which occur following head trauma or cerebral hypertension;
- thrombotic / atherosclerotic , due to the deterioration of atheromas (plaques) in the arteries;
- embolic , frequent in heart patients.
Aphasia can be the result of head trauma , stroke or rupture of an aneurysm .
In a smaller percentage of cases, brain damage is due to the presence of an expansive type tumor that as it grows compresses the areas used for language, or to processes of atrophy that lead the subject to cognitive deterioration, making comprehension difficult. and the articulation of words. Aphasia can have a degenerative origin and be one of the first alarm bells of a dementia , as well as it can be among the symptoms of multiple sclerosis .
Another factor that can cause aphasia is an epileptic attack , an event capable of temporarily inducing the subject, for a maximum duration of a few minutes, into a state of confusion and difficulty in the production of language.
Sometimes temporary aphasia can occur in subjects suffering from migraine with aura , but even in this case the disorder lasts for a few minutes and then disappears when the acute phase subsides.
Finally, we recognize forms of aphasia linked to infectious processes affecting the brain, as in the case of encephalitis (inflammation of the brain).
How to diagnose aphasia
AphasiaIt is a complex disorder that can adversely affect the life of those affected, causing social isolation, therefore the diagnosis must necessarily be made by a specialist doctor who will also exclude other disorders that have similar symptoms, but different, by means of a differential diagnosis mode and progression.
Furthermore, in many cases it is a disorder that follows vascular events, trauma or the presence of brain tumors, therefore it is necessary to ensure that there are no further complications that can endanger the life of the affected subject.
As this is a problem that can follow serious clinical pictures, the means used to evaluate the affected areas are sophisticated and complex. We use instruments such as Magnetic Resonance , PET and CT , which allow us to accurately identify the areas of the nervous system affected by the lesion and if these cause damage with temporary or permanent consequences.
The tests used to identify the entity of the problem from the point of view of the individual subject go to investigate all spheres of language. Regarding the understanding of language, the subject is subjected to questions and small exercises that are gradually more complex, if the answer is positive, assessing the consistency of the answers with respect to what was requested. This type of proof requires the collaboration of the subject.
As regards the production of language , similar tests are carried out, requiring the patient to express the name of indicated objects, lists of days of the week and months and the repetition of some words or phrases. The performance shown by the subject will then be assessed, who also in this case must be collaborative.
In subjects who have instead suffered damage in terms of written language,tests are administered in the same way that investigate the ability to read (reading sentences and words) and writing (dictating words and sentences), as well as the calculation ability (execution of simple calculations and gradually more complex if the answers they are correct).
Aphasia can be a guiding symptom in the diagnosis of other important pathologies that manifest themselves with sudden or gradual onset of language alterations.
The following pathologies are characterized by a gradual onset of language alteration :
- Alzheimer’s disease and vascular-type dementia manifested by anomic aphasia , that is, difficulty in finding words;
- Parkinson’s disease , due to the reduced facial expression which reduces the subject’s ability to express himself;
- Multiple sclerosis .
Instead, pathologies that have as their main characteristic that of having sudden onset speech disorders are:
- Stroke that can cause both Broca ‘s and Wernike ‘s aphasia ;
- TIA (Transient Ischemic Attack) in which aphasia appears suddenly but resolves within 24 hours.
What therapies are available for aphasia
The most useful and indicated therapy for aphasia and speech therapy , which is concerned with improving and enhancing the quality and quantity of words available to the patient.
In recent years the association between pragmatics and speech therapy has been introduced, in a technique that takes the name of Promoting Aphasic’s Communicative Effectiveness (PACE) which promotes and facilitates the subject’s communication, teaching him to use any available tool (gestures , objects, elements present in the environmental context) to enrich his ability to express himself, showing good results so far.
Prognosis of aphasia
The prognosisit depends on the cause that led to aphasia and the younger the patient is all the more favorable: if the lesion to the speech centers affects a subject under one year of age, the plastic capacity of the brain of such a small child and able to compensate in large part for the damage suffered.
A good chance of recovery is maintained in subjects up to the age group under 16 years.
In adulthood, on the other hand, recovery is a rather rare event and the support of speech therapy therapies aim to ensure that the subject uses all available resources to improve his ability to express himself.
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