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, including difficulty choosing or recalling the right word. It can progress affect someone's ability to express themselves, and it can involve comprehension too. Brain tumors, infections, and injuries can also cause aphasia, 

This article explains some of the characteristics, symptoms, and causes of aphasia. It also describes how aphasia is diagnosed and treated.

What Is Aphasia?

Aphasia is a language deficit caused by brain disease or brain damage. It ranges in severity, meaning it can be very mild or so severe that communication is nearly impossible. 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 stroke, head trauma, or dementia. It is rarely associated with other diseases, such as multiple sclerosis or Parkinson's disease. The condition takes several forms:

• Dementia-associated aphasia is gradual and is associated with other effects of dementia, such as personality changes and memory loss.
• Aphasia from a stroke happens abruptly, when an area of the brain becomes damaged due to insufficient blood supply.
• 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, and mentally search for the right word, before speaking.

Alternatively, when they try to speak, they may use an incorrect word that starts with the same letter of the desired word ("floor" instead of "flower" or "sack" instead of "sand"). Or they may describe 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 naming objects or people
• Impaired understanding of spoken or written words
• Diminished ability to write or writing the wrong words
• Hesitancy in speaking

Someone with early dementia may have greater difficulty speaking than comprehending. But sometimes, it's hard to be sure. They may simply appear as if they understand (for example, by nodding their head).

Other early signs of Alzheimer's dementia can also appear along with aphasia. These signs include forgetfulness, confusion, emotional outbursts, personality changes, and a sudden lack of inhibition.

When to Seek Medical Help

Many adults can relate to the feeling of being unable to retrieve a word. They may call it a "brain jam" or "brain fog." But if you've noticed this happening to a loved one with greater frequency, start taking note of when and how often it occurs. Does it happen when they're tired, multi-tasking, or extremely stressed? Or does it happen when they're calm and relaxed?

If you see a pattern that is truly interfering with their ability to communicate effectively, it may be helpful to ask a mutual acquaintance if they've noticed any changes in your loved one's behavior before consulting a healthcare provider.

Types and Causes

Aphasia occurs when areas of the brain that control language are damaged, making it difficult to speak, read, and write. The four main types of aphasia are:

• Anomic aphasia, or when someone has difficulty remembering the correct word for objects, places, or events
• Expressive aphasia, or when someone knows what they want to say but have trouble saying or writing what they mean
• Global aphasia, or when someone lacks the ability to speak, read, write, or understand speech
• Receptive aphasia, or when someone hears someone speaking or reads something in print but cannot make sense of the words

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. It 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.

Primary progressive aphasia is a specific type of aphasia caused by dementia that results from degeneration of the frontal and temporal regions. It typically occurs in frontotemporal dementia (FTD), and also in Alzheimer's disease. It starts gradually, usually with word-finding difficulty and problems with naming and pronunciation. As it progresses, people develop problems with comprehension, reading, and writing. They may also lose their ability to speak. 

Diagnosis

Word-finding aphasia is a common symptom of early-stage Alzheimer's disease, but there are others. Your doctor will ask about your loved one's symptoms and may want to speak with family members. Interestingly, aphasia affects a person's second language before it begins to affect their first language.

The doctor will also consider your loved one's baseline language ability during the assessment. For example, your loved one would be expected to demonstrate familiarity with words in their field of work. Forgetting words that they've presumably used often and easily could be a warning sign of dementia or aphasia. The evaluation might also include;

• A physical examination, including a comprehensive neurological examination, to help distinguish different causes of aphasia
• The Verbal Fluency Test or the Boston Naming Test
• An online dementia test called the Self-Administered Gerocognitive Exam SAGE test. It evaluates thinking abilities.
• Diagnostic tests, such as brain imaging tests, if there is a concern that your loved one might have had a stroke.
  

Prevention

The best ways to try to prevent aphasia mirror prevention tips for many other diseases. And they all boil down to one point: Live a healthy lifestyle. In this case, your loved one should focus on reducing the risk of stroke. By now, you may know the drill:

• Eat a healthy, balanced diet.
• Maintain a healthy weight.
• Exercise regularly.
• Quit smoking and drinking (if applicable).
• Be proactive about keeping blood sugar, cholesterol, blood sugar, and blood pressure levels low.
• Stay mentally active with activities like puzzles and word games.
• Prevent falls and head injuries.
  

Treatment

If your loved one is at risk for stroke, lifestyle factors and medication can reduce the risk. Even if aphasia is caused solely by dementia, having a stroke can substantially worsen the symptoms.

Treatment for aphasia involves a multidisciplinary approach that might call for medication and therapy. A doctor can prescribe medication for the treatment of dementia, which may help slow the progression of the disease.

Otherwise, aphasia is treated by working with a speech and language therapist to improve your loved one's ability to communicate with others. This should be an ongoing process, especially if the underlying cause of the aphasia continues to progress.

Coping

No one ever said that it's easy to care for or even be in the presence of someone whose communication skills are faltering. Being patient and supportive is your best coping strategy. For example:

• Maintain eye contact and adopt a calm tone of voice.
• Use short, simple words.
• Don't offer guesses, rattle off word choices, or finish sentences. It's easier than you think to frustrate and overwhelm someone with aphasia. Give your loved one time to speak.
• Don't rolls your eyes, snicker, or show any other signs of impatience when you know your loved one is doing their best to communicate.
• Incorporate facial cues, gestures, and visual aids into communication rather than relying only on words.
• Ask for verbal and non-verbal clarification. For example, if your loved one says that their "fig" hurts, ask if their finger hurts and point to it.
• Don't argue, even if your loved one baits you. Try to appreciate just being together, even when you aren't talking.

Summary

Aphasia occurs when areas of the brain that control language are damaged. This impairs the ability to speak and understand. The symptoms often include an inability to understand spoken or written words and difficulty speaking or writing, The four main types of aphasia include expressive aphasia (someone knows what they want to say but have trouble saying or writing it); receptive aphasia (when someone hears a voice or sees the print but can't make sense of the words); anomic aphasia (difficulty using the correct word for objects, places, or events); and global aphasia (when someone cannot speak, understand speech, read, or write). Prevention and treatment for aphasia involve a multidisciplinary approach that might call for medication and therapy.

A Word From Verywell

Aphasia can keep loved ones guessing, but you can eliminate one of the mysteries by taking your loved one to get their hearing and vision checked. If these senses are deteriorating, your loved one may feel more confused, agitated, or withdrawn than necessary. Faltering hearing or eyesight may also explain some behaviors that you've been attributing to aphasia. Plus, hearing and vision problems are usually simple to improve.