Aphasia in Alzheimer’s Disease

Alzheimer's disease can cause aphasia, which is a decline in language function due to brain disease. Alzheimer's disease is progressive dementia that causes impaired memory, judgment, and general cognitive functioning.

Aphasia in Alzheimer's disease often begins with word-finding problems, such as difficulty choosing or recalling the right word. It can progress to affect your ability to express yourself, and it can involve comprehension too.

What Is Aphasia?

Aphasia is a language deficit caused by brain disease or brain damage. There are several types of aphasia, each caused by damage to a specific region in the brain that controls certain features of language.

Aphasia is usually associated with a stroke, head trauma, or dementia. It is rarely associated with other diseases, such as multiple sclerosis or Parkinson's disease.

• Dementia-associated aphasia is gradual and it is associated with other effects of dementia, such as personality changes and memory loss.
• Aphasia from a stroke happens abruptly, and it occurs when an area of the brain that is supplied by a certain blood vessel becomes damaged.
• Aphasia due to head trauma can have fluctuating symptoms.

Symptoms

Aphasia can manifest with difficulty in comprehension and/or expression. Aphasia that's associated with dementia includes word-finding problems. It may cause a person to hesitate at length before speaking.

When they try to speak, they may use an incorrect word that starts with the same letters of the desired word ("floor" instead of "flower" or "sack" instead of "sand"), or give a description of what the word means ("You know, the thing on the wall with the numbers and the time").

Word-finding aphasia may manifest with:

• "Tip of the tongue" experiences
• Difficulty finding the right words
• Difficulty naming objects or people
• Impaired understanding of spoken or written words or instructions
• Diminished ability to write or writing the wrong words
• Hesitancy in speaking

If you are speaking with someone who has early dementia, the comprehension issues might not be as obviously apparent as the speaking issues. They might be able to figure out what you are trying to say, or they might appear as if they understand.

Other early signs of dementia can also begin along with aphasia—these include forgetfulness, confusion, emotional outbursts, personality changes, and a lack of inhibition.

When to Seek Medical Help

If you've been noticing some difficulty lately with finding the right words, pay attention to when and how often this occurs. Does this happen when you're tired and multi-tasking, or is it truly interfering with your ability to communicate effectively?

It can also be helpful to ask a family member or close friend if they've noticed any changes in your word-finding ability. This can help you sort out if you're just not finding the perfect word to describe a specific situation or if you're having trouble on a regular basis. You should talk to your healthcare provider if you start to notice signs of aphasia.

Causes

Aphasia occurs when areas of the brain that control language are damaged. With common types of aphasia, the language impairment corresponds to the damaged area—often with preserved function of the areas that aren't damaged.

Aphasia due to dementia is caused by the gradual degeneration of cells in the frontal lobe and limbic system of the brain. These areas control memory, judgment, problem-solving, and emotions.

Common causes of aphasia:

• Motor aphasia: Broca's aphasia causes choppy speech with normal language comprehension. It is usually caused by a stroke in the area of the brain that controls fluency of speech rhythm.
• Fluent aphasia: Commonly called Wernicke's aphasia, it manifests with misuse of words, impaired language comprehension, and near-normal speech fluency.
• Transcortical aphasia: A notable characteristic is an unusual repetition of words. This uncommon type of aphasia is associated with damage to the area of the brain that relays messages between the Broca's and Wernicke's regions. It can occur as a result of severely low blood flow to the brain, such as due to major trauma or a heart attack.

Aphasia due to Alzheimer's dementia generally does not follow the speech pattern of other types of aphasia. With dementia, impairment of semantic memory (the memory for understanding and recognizing words) is a significant contributor to word-finding difficulties.

Diagnosis

Word-finding aphasia is a common symptom of early-stage Alzheimer's disease, but there are other possible causes.

Your healthcare provider will ask about your symptoms and may want to speak with your family members as well. Often, aphasia affects a person's second language before it begins to affect their first language.

Your healthcare provider will also consider your baseline language ability during the assessment. For example, you would be expected to demonstrate familiarity with words in your field of work, and forgetting words in your area of work could be a sign of dementia or aphasia.

Your evaluation will include;

• A physical examination, including a comprehensive neurological examination, will help distinguish different causes of aphasia.
• Your healthcare provider might evaluate your language impairment by using tests such as the Verbal Fluency Test or the Boston Naming Test.
• You might be advised to take an online, at-home dementia test called the Self-Administered Gerocognitive Exam SAGE test.
• You might also have diagnostic tests, such as brain imaging tests if there is a concern that you could have had a stroke.

Treatment

Treatment for aphasia involves a multidisciplinary approach that can involve medication and therapy.

• Your healthcare provider can prescribe medication, such as Aricept (donepezil), for the treatment of dementia, which may help slow disease progression.
• If you are at risk of stroke, lifestyle factors and medication can reduce your risk. Even if your aphasia is caused solely by dementia, having a stroke can substantially worsen your symptoms.
• You can work with a speech and language therapist to improve your ability to communicate with others. This should be an ongoing process, especially if the underlying cause of your aphasia continues to progress.

Coping

Keep in mind that some decline in the ability to find the correct word can be considered normal with aging, especially in low-frequency words (those that aren't used as often as others).

If you have been diagnosed with aphasia, coping strategies you and your loved ones can use include:

• Let the person who is experiencing aphasia decide how much help they want with their communication, and abide by their wishes.
• Make an effort to incorporate facial cues, gestures, and visual aids into communication rather than just relying on words.
• When someone is having trouble with a word, don't offer guesses of multiple words, as that can further frustrate and overwhelm the person.
• Ask for verbal and non-verbal clarification. If the person says that her "fig" hurts, for example, ask her if her finger hurts, and point to it.

When you or someone you care about has aphasia, try to appreciate just being together, even when you aren't talking.

Frequently Asked Questions (FAQs)

Is it common to use the wrong words as you get older?

Sometimes people use the wrong words when speaking, due to mild dementia, strokes, or simply distraction. This can become more common as you get older.

Does aphasia indicate a memory problem?

Some types of aphasia indicate a memory problem, and some do not. Your healthcare provider will have to examine your language and cognitive functions to determine whether a memory problem is a contributing cause of your aphasia.

What is it called when you use the wrong words when speaking?

When this happens repeatedly, it is called word-finding aphasia.

How do you treat word-finding difficulty?

You can work with a speech and language therapist. You can practice using more words when you speak and when you write. You can also read, talk to people about a variety of topics, and listen to programs about topics of interest to keep your vocabulary strong.