What is Aphasia?

Hey there, everybody, and welcome to this video on what is aphasia? I'm your host, Dr. Donnellice Snipes. Have you ever had an instance where you couldn't find the word for something, used the wrong word for something, or just had difficulty communicating your thoughts? These are symptoms people with aphasia may experience much of the time and. And in many different situations to the degree that it significantly impairs their functioning. And that's something I really want you to focus on. With all of the attention given to our health over the past two years, it's a lot of people have developed health anxiety. They start noticing every ache, every pain, every this, every every that, and start expecting the worst possible cause of it. So it's really important to recognize that a lot of symptoms that people have are on a continuum. When we talk about mood symptoms, for example, it's very natural for people to occasionally feel depressed. That doesn't necessarily mean they have major depressive disorder. You know, it's on a continuum. And so it's important to recognize that if you occasionally forget a word, that doesn't necessarily mean that anything's wrong. In this video, we're going to talk about what aphasia is, the symptoms of aphasia, what causes it, what to do if you have symptoms, and prevention and treatment strategies. So let's start out at the beginning. What is aphasia? Now, we started hearing about aphasia a lot more today because a particular celebrity was diagnosed with it. But what does it really mean? Aphasia is a communication disorder caused by damage or disruption in a specific area of the brain that controls language, expression, and comprehension. Now, I say or disruption, because not all causes of aphasia involve permanent damage to the brain. Some do, but some don't. Aphasia often resolves when underlying issues are addressed, even in patients with aphasia due to stroke. Now, when I say it resolves for a lot of people, it resolves completely if the underlying issue was something that was nutritional or metabolic. For example, for people who've had a stroke, many people who've had a stroke experience significant improvement and resolution of their symptoms. Maybe not 100%, but there are a lot of treatments out there that are very effective at addressing aphasia that's caused by a variety of different things. According to the National Aphasia association, aphasia impacts about 2 million people in the US at any point in time and is more common than Parkinson's disease. Well, that kind of makes sense because aphasia is often a symptom of Parkinson's. But aphasia can be caused by a whole bunch of other things. When you look in what mental health professionals use for diagnosis, called the Diagnostic and Statistical Manual of Mental Disorders, or the dsm, you'll find that aphasia is a symptom of a variety of different mental disorders or can be a symptom of a variety of different mental disorders. It can also be caused by something that's not a mental disorder, that's not, you know, catastrophic. Symptoms of aphasia may happen suddenly, such as after a traumatic brain injury, a stroke, or even after or during when somebody has a virus, such as equine encephalitis, Lyme disease, Wernicke's encephalopathy, or Covid. Now, let's talk about some of those. Equine encephalitis is a virus that some people get, and it does cause a lot of inflammation. And what we see in a lot of these things is that, like with Lyme disease and equine encephalitis and Covid, people are experiencing systemic inflammation, which they believe is contributing to the aphasia. And generally, when the condition resolves and the brain is back to, quote, normal, their symptoms largely remit. Now, I have a friend who had equine encephalitis a couple years ago, and she was really, really bad off for several months with a variety of symptoms that resulted from it. And as she got further away from the acute illness, she gradually improved. We're seeing in long tail Covid, we. We are seeing symptoms of brain fog and some cognitive dysfunction. That can go on for a while, but I'm getting ahead of myself. Symptoms may also slowly progress, as in the case of neurodegenerative disorders like Alzheimer's or brain tumors. Okay, so let's put that out there, because if you go online, you're going to see that it can be caused by neurodegenerative disorders like Alzheimer's or Parkinson's, brain tumors or stroke. Those are the worst case scenarios. Okay? And I want you to really digest that for a second. Just because it can cause aphasia doesn't mean that's what is causing any particular person's aphasia. Slowly progressive aphasia may also develop as a result of hormone changes, metabolic issues, or nutritional deficiencies. As somebody becomes progressively deficient in something like B12 or iron, their cognitive abilities may progressively get worse in accordance with that. So as the person's nutritional needs are restored or as their metabolic issues are balanced out, like thyroid issues, then we often see a corresponding change in their cognitive functioning. But those things often, you know, you don't just suddenly one day become anemic and then start having problems. Anemia develops over time, and the cognitive consequences of anemia or B12 or B12 deficiency can also develop, will also develop over time. It's not just going to be a sudden. I wake up one morning and boom. You cannot make a diagnosis based on one symptom. A clinical history is required. What other things are going on? What has led up to this and getting a good picture of what's going on. Something like aphasia or any cognitive symptoms can have physiological as well as psychological consequences and in some cases, even toxins. But I didn't even go into that. Today, as we age and when we're under physical or emotional stress, our mental processing slows. So let's think about this for a second. In other videos, I've talked about how as we age old, a lot of our gonadal hormones, estrogen, testosterone in particular, tend to go down. And changes in our functioning and our cognitive abilities also seem to go down as we age. And there may be a correlation. There may not be, but it's important to recognize that things change. Our body changes as we age. So there may be some things that happen and are just a normal part of aging. And we'll talk about what you can do for prevention and to maintain cognitive acuity towards the end. Emotional stress can also make it more difficult to process things mentally. If you are stressed out, your brain is flooding itself with glutamate and other things that fight or flight reaction. When you're in fight or flight, your brain is not interested in higher order cognitive processing. Your brain is interesting in getting you the heck out of there. So if you are frustrated. I remember when my kids were little and sometimes they do something that frustrated me and I couldn't find their name. I'd be like, the girl child, get over here. Was I experiencing aphasia? No. You know, it was just a momentary lapse because glutamate was in my system and I was having a difficulty calling her particular name. I only have two children. It shouldn't be that hard to remember, but my grandmother did the same thing. My. My great grandmother did the same thing. So, you know, I've seen it in other people. Physical stress can also slow your emotional processing, especially if inflammation is involved. Think about when you're sick, though. When you've got the flu or a cold, when you're not getting enough sleep, when you're malnourished, your cognition is likely going to be impaired. Your brain requires energy and nutrients in order to function well. When you are under physical stress, that HPA axis may not be as, you know, intense in its activation as when you're under emotional stress, but it's still activated. So you've still got some of that glutamate and norepinephrine and stuff floating through that may make it harder to concentrate on certain things as we age, you know, some normal changes, misplacing things, forgetting why you walked into a room or if you took your medication or needing to write notes to yourself to remember things. These are all very normal changes with aging, during chemotherapy, after chemotherapy, when you have children. And I'm not talking about just that immediate postpartum period. I'm talking about, you know, until they're much older, when you're getting good quality sleep, like when they move out. However, it's important to see your doctor if there's a sudden change in your cognitive abilities or if you notice that they're gradually getting worse. If they're gradually getting worse, it could be something nefarious or it could be something like thyroid dysfunction, but it's going to continue to be problematic. If that underlying physiological issue is not addressed, and if it's nothing, then your doctor can say, you know, it's normal aging or whatever. One of the things that you're going to see online, because I know a lot of people go online, is that the most common cause of aphasia is stroke. And, Well, I'm not going to argue the data on that because I don't know what the data is for aphasia due to all those other things combined. But I think the most common single cause of aphasia may be stroke. But if you consider all the other myriad of things that can cause aphasia, you know, there's probably a bunch of other stuff and stroke may pale in comparison. If you add all those things together, there's probably a greater preponderance that it's caused by something else. But the mnemonic to use, and I did not come up with this one, the mnemonic to use for early identification of stroke. Because the earlier you identify it, the earlier you get help, the less damage that's going to happen to the brain. Act fast. Face numbness or unevenness in smile or muscle tone. A lot of people who are having a stroke, one side of their face may droop, their eyes may droop, they may have difficulty making expressions. Arms numbness or weakness Causing inability to steadily raise the arms. They either can't raise them at all, both or one. Or when they do raise, it's very unsteady, very shaky. Speech difficulty. This is where the aphasia comes in. If you sudden. Have a sudden onset of aphasia, confusion, slurring your words, that is something to take very, very seriously. If all of a sudden you're eating dinner and then you begin having symptoms of aphasia, that's cause for going to the emergency room. You know, that's, that's something to be worried about. Time is of the essence, so f a s t. Other symptoms that are not accounted for in the mnemonic include vision, sudden vision problems. All of a sudden your vision gets really, really blurry, trouble walking or coordination, or a severe headache. Sudden onset with no known cause. All of a sudden it feels like somebody's sticking a dagger into your head. Okay, so that sounds really scary. But again, I want you to recognize in the majority of cases, from what I can discern from looking at all the different data, there are also a lot of benign cases. And most people experience little episodes of, I call them brain cramps or brain farts, but whatever, when they can't find a word. Long tail Covid has been shown to demonstrate. Or people have been shown to have significant impairment in their cognitive functioning for quite a while. And, you know, I'm a perfect example. I had Covid back in February and I still notice myself losing words more often, having a little bit more difficulty stringing everything together. Now, I didn't have a severe case of COVID thank God. People who had severe Covid, people who, especially people who were ventilated, tend to have much more severe cognitive symptoms as well. So that's just something to note. They've. They've also noticed, though, that in people with what I guess I'll refer to as inflammation related cognitive dysfunction, equine encephalitis, Covid, those sorts of things. As the person gets further away from the illness, their cognitive functioning starts to return, especially with rehabilitation. So what are the symptoms of aphasia? One, inability to produce recognizable words. So the person is talking in gibberish. And I can't even give a good example, but the words that are coming out of their mouth aren't even words, produce recognizable words, but in nonsensical ways. And sometimes we call this word salad. So they're using words that you know, but they're stringing string, stringing them together in the wrong order. Change in your ability to use numbers or do math. If all of a sudden you can't figure out how to balance your bank account or convert simple fractions when you're working in the kitchen, then that might be a cause for concern. That is a cause for concern. Inability to speak in full sentences. Now, this is one that it's important to remember that sometimes people will have a difficult time stringing all those words together. And when they're stressed or they're sick or they're thinking about too many different things at once, they may know what they want to say but have a hard time getting it out. And they may say, get water instead of, would you please get me a drink of water? I know there have been times where I've been talking and I've been starting to say something and then I've just completely lost my train of thought. And after 20 some odd years of marriage, my husband usually knows how to finish my thoughts. But that is not necessarily a sign of anything pathological if it just occurs Occasionally. Finding the correct name for things can also be a symptom of aphasia. Now, if you are looking at something like keys and you call them boxes, that's not something that would be a normal occurrence. If you call them by something completely the wrong name, or you look at a dog and you call it an elephant, that is indicative of problem that probably needs to be assessed. Things like having words on the tip of your tongue and just not being able to say the word. That's pretty common. How does it impact your activities of daily living? Is it a significant sudden change? Those are the two questions that. Two of the questions, at least, that your doctor is going to ask. And I mentioned earlier, sometimes when I have brain fog, whether it's because of stress or lack of sleep or whatever, I will forget or I'll have difficulty finding the word and I don't do it anymore with my children because they're old enough that I don't usually have that rush of cortisol when they're doing something worrisome. But I will call the dogs or somebody. I'll be like, rat dog, not being able to remember her name. And that's our, that's our terrier. She's the smallest of all of them and we call her our little rat dog. But brain fog can contribute to aphasia. Not being able to find the words, not being able to remember things. But brain fog is bigger. Another symptom of aphasia is inability to understand spoken or written language. That can be caused by other things as well as people Age or after being in particular situations, if you went to a really loud concert, you may not be able to hear as well. And so we want to make sure to rule out healing, hearing and vision impairment. If an adult who, prior to this, was able to understand spoken and written language really well, and they're starting to have problems here and there understanding, we want to rule out hearing and vision impairment. Now. If it's a sudden change, all of a sudden you're talking to them, and they just look at you like you're speaking in a completely foreign language. But again, that is a. That's a warning sign. That's an emergency, because something that is. Is significantly impairing that happens, you know, like, that indicates that there's something larger going on in the brain. The communication effectiveness index is something that can be used to identify target areas for rehabilitation, because it talks about a lot of the activities that we do that help us function from day to day. And it helps people identify where they're at on a continuum from not able to do it at all to very effective. So what about brain fog? Aphasia is one of the many possible symptoms of brain fog. Some people refer to brain fog. It's as if they're trying to function under anesthesia, or they're trying to function, and there's just a bunch of white noise going on constantly. A lot of people have different ways of expressing it. But ultimately, brain fog affects your ability to think clearly, concentrate any cognitive abilities. Brain fog may occur as the result of sleep deprivation, thyroid issues, depression, behavior 12 deficiency, anemia, hormone changes, autoimmune issues, migraine, chemotherapy, or long Covid, and probably some other things that I didn't find research for. But, you know, I put this together in an hour. A report published in October of 2020 found that more than a third of people had cognitive difficulties. Months with an S on the end, months after recovering from COVID 19. We want to see the cognitive impairment improving, not getting worse in people who've had COVID 19. But it's important to recognize that that is a very common symptom of people who have had COVID 19 or equine encephalitis or who have lyme disease or potentially even autoimmune issues, because autoimmune causes systemic inflammation. So what do you do about it? As I mentioned, since 2019, when we first learned about COVID people have become very acutely aware of every sniffle, every itch, every this, every that, every ache, every pain. And many times it triggers an extreme stress response. So the first thing to do if you're finding that it's hard to string together words or something, and you're like, oh, my gosh, what's going on? Stop. Get grounded. Square breathing. Breathe in for four, hold for four, exhale for four, hold for four, do that two or three times. So get grounded. Get that glutamate down or, or out of. Out of your brain, trigger the rest and digest, which helps you get into your wise mind, you know, then you can start thinking more clearly. And then use what I always call fcp. What are the facts in this situation? What's going on with me right now? Is it something significant and severe? Okay, probably need to get it looked at. Is it something that is. Has suddenly come on? Okay, if it's suddenly come on, but it's not significant and severe, is there anything else that might be causing it? You know? And what is the probability? Because remember I said there are a ton of things that have aphasia, for example, as a symptom. So taking. Bearing that in mind, what is the probability that what's causing your aphasia at that moment or your inability to find a word at that moment is a result of the two or three really nefarious things? Or how. What is the probability that it's one of the others? So think about it this way. Take a deck of cards and imagine with the jokers, and imagine that the jokers are the bad things that could cause like Alzheimer's, park neuro, neurodegenerative diseases, or brain tumors. Okay? So imagine that the jokers are the bad things and all the other cards represent other things that could be causing it. Throw the cards on the floor and pick up one of them. How likely is it that you're gonna pick up the joker? You know, I think there's 52 cards in the deck, if I remember. So that means if there are four jokers, worst case is one in 13. But so recognizing all of that is important to allaying health anxiety. What is the probability? Yes, there's a possibility. There's a possibility of anything. But what is the probability that it is something devastating? And see your doctor if you're concerned. That's what they get paid for. Prevention. Get an annual physical to assess your thyroid, your hormone levels, your B12, your vitamin D, your iron levels, all that stuff. Because any of those things can contribute to cognitive dysfunction. You address those a lot of times, the cognitive dysfunction gets a lot better. Good nutrition with antioxidants and water. So what do I mean? I've said in multiple other videos. What you eat provides the building blocks for your brain, for your body to make the neurotransmitters and the hormones and everything else that allows your body to function crap in, crap out. It's important to have good nutrition to fuel all those processes. Now, you don't have to get crazy with it, but it is important to try to get your recommended daily allowance. Antioxidants are those things that we eat that help our body fight inflammation. And those are the colorful things, things that, or the things that make fruits and vegetables colorful. So eating colorful fruits and vegetables can be very, very helpful. And water. Why water? Well, water flushes out stuff, you know, it helps our body get rid of the toxins and detoxify what's going on, which can help reduce inflammation as well. A lot of people drink a lot of coffee or a lot of caffeinated beverages and don't drink enough water to compensate because caffeine's a diuretic. So when we start to get dehydrated, 1% dehydration has been shown to affect cognitive functioning. 2% dehydration slows reaction time and has even more significant effects. We don't even really start feeling dehydrated until we're 3% dehydrated. So don't assume, well, I don't feel dehydrated, so I must be fine. Don't assume that you want to get your 64 ounces of water a day. And a nutritionist friend of mine suggested the general rule of one ounce of water for every one ounce of caffeinated beverage you drink. So if you're drinking well, you can do the math. Adequate sleep is also important. Cognitive dysfunction is very common, as well as slow reaction time and impaired driving and everything else is very common in people who have inadequate quality sleep. That means you need to be able to get to sleep and get that good deep sleep that helps your brain clear out the adenosine so you can think the next day and you don't have that groggy feeling all day long. Brain activities have also been shown to be helpful if you have a mobile device. You're probably constantly getting these pop ups about. You know, this, this app can help you improve your brain cognitive functioning or, you know, reduce the age of your brain or whatever their claims are. They have found that people who continually engage in activities that stimulate their brain are able to slow their cognitive decline. So it is important. And if you don't want to do apps, I totally get that. The same thing is True. If you're engaging in hobbies, if you're reading and even socializing, talking with people and interacting, that lights up different areas of the brain. Think about the different areas you're of the brain, like different muscles in your body. You wouldn't go to the gym and just do biceps. You know you're going to go and you're going to do, you know, a full body workout. So engage in different activities. Some of the games I play on, on my mobile device and with my kids involve different areas of my brain. Scrabble involves one area of my brain. Checkers involves another. I never have mastered chess. The hobbies that I choose, like gardening, that's an entirely different area of my brain. And music, another area still. So engaging in different things stimulates different areas of the brain and keeps them active. And finally, stress management. The HPA axis, our stress response system, is designed to keep us safe. That fight or flight response is designed to keep us safe. However, when it is prolonged, we know that prolonged HPA axis activation due to pain, complex PTSD or just chronic stress actually causes the loss of neurons. It causes our brain to shrink. That's not what we want. We may want to shrink other parts of our body, but the brain is not one of them. So stress management is really important not only to keep those neurons healthy and maintain a healthy brain, but also to keep those glutamate and cortisol levels down. Loss of words and forgetfulness is something we all experience sometimes. Aphasia can be what I call static, as often seen in long Covid or after something like equine encephalitis. It gets to a point and it's not progressing after that, it actually starts improving, as opposed to progressive aphasia that just continues to get worse, like we see in Parkinson's, Alzheimer's, dementia, progress, those sorts of things. Many times aphasia is due to something quite benign and the underlying causes are easily fixable. However, if you experience a sudden onset of symptoms, it is advisable to act fast. Remember face paralysis in one side of the face or the other, or weakness, especially on one side of the face. Arms. If one arm or both arms, you have difficulty raising them or they're unsteady. Speech. If somebody has difficulty, suddenly sudden difficulty understanding speech or speaking, and obviously not because they're under the influence of alcohol. That's a cause for concern. And T stands for time. You need to act quickly. Time is of the essence. Now, I will say here, and I didn't really mention it much earlier, that People who are under the influence of alcohol, when the alcohol starts to leave their body, their blood pressure goes up. Alcohol detox puts people at a high risk of stroke. So if somebody is an alcoholic, somebody is a heavy user, somebody is heavily intoxicated, it's really important to be aware of that. And if they do start having these symptoms, be aware that that could be a result of their blood pressure going up, and it may be a medical emergency. Likewise, after a head injury, if there's a sudden change in the person's abilities, their facial features, or just even aphasia, and difficulty understanding what's going on, that is also a medical emergency because it may indicate pressure on one area of the brain or another. And this is, you know, something that the emergency room doctor or the team physician or whoever you know, does. The evaluation now will probably tell you if it's due to a sport. But there are some of us who are clumsy. And, like, if you accidentally miss a step and you fall down a couple of stairs, it's important to recognize that that could also be a head injury. So act fast. I hope this was helpful. I know I kept vacillating back and forth between, you know, scary stuff and not so scary stuff. But I do want you to remember to always consider the probability. Remember, your doctor is there to answer your questions. That's what they get paid for. And any sudden, significant change in cognition, like, and when I say sudden, I mean, they wake up one morning and all of a sudden it's different. Or you're talking at dinner, and all of a sudden, boom, suddenly something's different. Then that is a medical emergency that needs to be evaluated. But that rarely. Well, I won't say that rarely happens, but that's not something that you're typically going to see. And so I want you to be aware of that when you're thinking, oh, my gosh, I forgot where I put my keys, or today, I can't seem to find the words that I'm looking for. Take a breath and evaluate the facts and figure out what you need to do from there.