What is Aphasia, What Are Its Types, Diagnosis and Treatment
There are many different areas in the brain that control daily behavior. Various areas that enable understanding, speaking and continuing communication are among them. Difficulties in understanding and speaking may occur due to a dysfunction acquired as a result of trauma, especially in certain places responsible for this task. This anomaly, which usually occurs as a result of a disease, is called aphasia. Aphasia can vary depending on the person’s level of speaking, understanding and perceiving the means of communication. In the most common types of aphasia, patients cannot understand what is being said or may give meaningless responses to what is being said. Aphasia is one of the reversible diseases, with correct diagnosis and treatment, as well as a positive impact on the healing process of the patient and their relatives.
What is aphasia?
There are regions in the brain that help understand speech and speak meaningfully. These areas in the cortex are areas that provide communication and enable the person to maintain language functions with different tools. Generally, these areas are detected in the left hemisphere. Damage to these regions in the left hemisphere causes impairment in the person’s speech ability. The most common types of aphasia in society are those caused by traumas that cause partial malnutrition in the brain, such as stroke. Aphasia patients generally consist of middle-aged and elderly patient groups, considering the average age. All aphasia patients have common problems that vary depending on the severity of the disease. In general, these patients may not understand what is being said and may try to respond with meaningless words, or they may have difficulty understanding what is being said and putting words together. Different types of aphasia are classified according to the severity of the disease and the ability to use and understand language.
What are the causes of aphasia?
There are a wide variety of diseases underlying aphasia. It is generally known that aphasia develops due to trauma. In addition, aphasia may also develop with diseases such as dementia, which have a high hereditary development rate. In this progressive aphasia, that is, it appears and progresses over time, problems such as speaking slowly, forgetting words, not being able to produce words, speaking haltingly, and not understanding what is being said occur, just like in trauma-related aphasia. In trauma-related aphasia, which is frequently seen in society, nutritional problems occur due to damage to the brain and the areas responsible for language production lose function. The brain is an organ that consumes oxygen every second and uses glucose as its primary fuel. Prolonged lack of oxygen for minutes creates nutritional problems in the brain. Stroke is the leading brain nutritional disorder that causes aphasia. This is popularly called stroke. An infection in the brain, trauma due to injury, blow and tumors can also cause aphasia when they similarly block blood flow.
Two important areas in the cortex, that is, the main functional part of the brain, are the areas damaged in trauma. These areas responsible for comprehension and understanding what is spoken are known as Wernicke’s area and Broca’s area. Wernicke’s area, above the left ear, is located in the temporal lobe, and Broca’s area, located on the left temple, is located in the frontal lobe. Wernicke’s area is the region associated with meaning and is responsible for understanding what is spoken and written. Broca’s area is responsible for expressing and speaking the language that the brain interprets. Especially in the loss of function of these 2 areas, difficulties in understanding and speaking are observed.
What are the symptoms of aphasia?
Depending on the types of aphasia, there are different symptoms that can be effective in diagnosis. However, common symptoms are seen in patients with suspected aphasia. All of these symptoms appear as problems with language production, understanding what is spoken and written, and speech. The most common symptoms that patients with suspected aphasia show when applying to clinics are as follows:
- speaking haltingly
- inability to understand what is being said
- Inability to repeat what is said to him/her in the same way
- Inability to put meaningful words together and form meaningful sentences
- Difficulty forming words before speaking
- Inability to understand or read what is written
- Using grammatically incorrect expressions
The common problem in patients showing these symptoms is that they have difficulty speaking and understanding the language they spoke before. Depending on the type of aphasia, showing one or more of the symptoms may vary.
What are the Types of Aphasia?
Aphasia may vary depending on cortex damage. Brain damage and symptoms of the disease may also vary depending on the types of aphasia. Wernicke and Broca’s areas in the left hemisphere, which are the cause of aphasia, are the most important points. In particular, damage to each or both of these areas is an important factor that determines the severity of the disease. Aphasia types vary according to symptoms and findings as follows:
Wernicke’s Aphasia (Fluent Aphasia): Wernicke’s area is the area of understanding speech and written words. The patient who has a problem in this area listens to what is being said and when it is his turn to answer, he cannot form sentences within the context of the topic being discussed. A person can speak and write, but what he says and expresses is completely meaningless. Even if they make grammatically correct sentences, they cannot give the desired answers. For example, “Do you want a glass of water?” “I will return by bus tomorrow.” They may give an answer that is irrelevant to the topic, such as:
Broca’s Aphasia: In bilateral communication, the person listens and understands the other party, but cannot give meaningful answers. In this type of aphasia, the patient encounters problems such as pauses when making complete sentences, not being able to remember words, and producing grammatically incorrect sentences. The patient who wants to perform a speech action moves his mouth and tongue, but he shows stiffness because he has difficulty in pronouncing the words.
Global Aphasia: This type of aphasia is the most severe type of aphasia. There is a dysfunction in both Wernicke and Broca’s areas. Patients cannot understand what is written and spoken, nor can they respond to or read what is said. It is seen that these patients try to communicate only with meaningless sounds and gestures.
Progressive Aphasia: It is aphasia that develops secondary to another underlying disease. Dementia is a type of aphasia that develops over time, resulting from migraine, frontotemporal lobe damage, and atrophy in the frontal and temporal lobes.
Transcortical Aphasia: This aphasia shows findings similar to those in Wernicke’s damage. The patient can make meaningful sentences and speak fluently, even if it is not in the same context as what is being spoken. They have retained the ability to repeat what is said.
Conduction Aphasia (Conduction Aphasia): In these patients, the two areas responsible for language and expression are preserved, but the neural networks connecting these two areas are damaged. Those with conduction aphasia can speak, understand, write and read. However, sometimes sound changes are noticeable in speech and writing. Although this condition is not as severe as Broca’s aphasia, it is similar.
Anomic Aphasia: The main problem in these patients is the inability to remember the names of objects and to associate the object with the word. When making a sentence in which an object is mentioned, they talk about the object with expressions such as “thing, this, that”.
How Is Aphasia Diagnosed?
Aphasia is detected by a specialist neurologist when the person has problems with expression and perception. Different parameters such as past disease history, family genetics, diagnostic imaging methods, speech tests, grammar and expression tests are used to diagnose the disease. The definitive diagnosis is made through imaging methods performed while listening to the patient’s speech and narrative.
If there is a pathophysiological condition that causes the disease, the first goal is to correct it surgically. However, therapy is the first option for aphasia caused by stroke, infection, impact, and acquired aphasia. Treatments and strengthening behaviors such as memory enhancing tests, speech therapies, increasing verbal stimulation and repetition, and practicing speaking to the environment are recommended for these patients. After aphasia is diagnosed by a specialist neurologist, it is a disease that can be cured in a joint discipline with speech and language therapists. Although the development and recovery process and level of each patient is different, satisfactory improvements can be seen in the treatment of the disease.
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