Understanding Aphasia — When Words Get Lost

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Hello everyone, welcome back to another new episode of The Truth, Lies Alzheimer's Show. I'm Lisa Skinner, your host. I want to give you all a quick reminder that you can always find new and updated information and resources on our website by going to mindingdementia.com. Today I am going to explain a common symptom that we often see with dementia called aphasia. Now aphasia is a communication disorder that results from damage or injury to language parts of the brain. It's more common in older adults, particularly those who've had a stroke. Aphasia gets in the way of a person's ability to use or understand words, but aphasia does not impair a person's intelligence. People who have aphasia may have difficulty speaking speaking and finding the right words to complete their thoughts. They may also have problems understanding conversations, reading and comprehending written words, writing words, and using numbers. What causes aphasia? Aphasia is usually caused by a stroke or brain injury with damage to one or more parts of the brain that deal with language. According to the National Aphasia Association, about 25 to 40% of people who survive a stroke get aphasia. Aphasia may also be caused by a b— a brain tumor, a brain infection, or dementia such as Alzheimer's disease. And in some cases, aphasia is a symptom of epilepsy, or other neurological disorder. There are several different types of aphasia. Each type can cause impairment that varies from mild to severe. So these are the different types of aphasia. One is called expressive aphasia or non-fluent. And with expressive aphasia, the person knows what he or she wants to say, yet has difficulty communicating it to others. It doesn't matter whether the person is trying to say or write what he or she is trying to communicate. Then there's receptive aphasia, or fluent. With receptive aphasia, the person can hear a voice or read the print, but may not understand the meaning of their message. Oftentimes someone with receptive aphasia takes language literally. Their own speech may be disturbed because they don't understand their own language. There's anommic aphasia where the person has word finding difficulties. This is called anomia. Because of the difficulties, the person struggles to find the right words for speaking and writing. And there's global aphasia. This is the most severe type of aphasia. It is often seen right after someone has had a stroke. With global aphasia, the person has difficulty speaking and understanding words. In addition, the person is unable to read or write. And then finally, there's primary progressive aphasia. This is a rare disorder where people slowly lose their ability to talk, read, write, and comprehend what they hear in conversation over a period of time. With a stroke, aphasia may improve with proper therapy. There is no treatment to reverse primary progressive aphasia. People with primary progressive aphasia are able to communicate in ways other than speech. For instance, they might use gestures, and many benefit from a combination of speech therapy and medications. Now, aphasia may be mild or it can be severe. With mild aphasia, The person may be able to converse yet has trouble finding the right word or understanding complex conversations. Severe aphasia limits the person's ability to communicate. They may say little and may not participate in or understand any conversation. Additionally, aphasia also refers to the loss of spoken language or speech comprehension. Reading and writing abilities and is due to neuropathology. For example, having Alzheimer's disease. And it's caused by the deterioration of neural tissue accompanied by behavioral and functional decline, including communication abilities. As Alzheimer's disease and other related dementia continue to to destroy brain cells. A significant symptom, this one known as aphasia, develops. And aphasia does worsen as the disease progresses. It can be very common symptom to Alzheimer's disease and can not only include the loss of spoken language or speech comprehension, reading and writing abilities, but also the ability to process what other people are saying. And this is due to the brain damage caused by Alzheimer's disease. So I am going to illustrate a scenario of what aphasia might look like in real life by sharing with you a true story taken from my book, Truth, Lies, and Alzheimer's: Its Secret Faces. It's called the Pillbox Story. Well, I was called over to a client's house to assess a gentleman who had been diagnosed with Alzheimer's disease. He was living with his wife, who was his primary caregiver, but his daughter Carly, who was concerned about him still living at home, As she described him as being unable to do anything for himself and could not communicate anything with his family members. I was actually expecting to find somebody who would be, based on how it was described to me, in the later stage of Alzheimer's disease, but to my surprise, he was much more highly functioning than I expected him to be. So I was introduced to Harvey as Carly's friend who was stopping by to say a quick hello because they didn't want him to know that they had asked a professional to come over to assess him. The first thing he said to me, which I thought was so cute, "Oh, you must be Carly's friend who's going somewhere. They had told him that I was stopping by on my way to Ashland, Oregon Shakespeare Festival. Well, Harvey did not remember where they said I was going, but he did remember that I would be stopping by on my way there. Someone as far gone as Carly had described to me would not have been able to retain that much information. And that was my first clue. I then sat down at the kitchen table with him and noticed a blue pill organizer sitting on the windowsill marked with the letters MTWTHFSS. So I pointed to it and asked him what it was. He replied to me that that was his thing. I asked, "Well, what does it do, Harvey?" And he said, "Well, the things I put in there are the things that keep me alive." I was taken aback by that response. I continued with Harvey, "Well, how do you know where to put the things?" Well, he couldn't recall the word for medication or what those letters on the organizer stood for. Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday. But he did show me how he took a pill from each of his prescription bottles and placed them in that organizer, beginning in the leftmost compartment, and then the next one to the right, and so on and so on, until each pill was correctly placed in a compartment. Then I heard his wife Darlene call out and say, "Yeah, the old codger gets them right every time. I do check to make sure." Carly, as it turns out, had been mistaking her father's decline in verbal skills for a decline in his cognitive skills. But it was very apparent to me by then that he understood much more than they believed he did. He was actually incredibly, still very highly functioning. After my visit, I wrote up my assessment of Harvey with some recommendations of what they could provide for him in the way of activities and care options to keep him engaged and active to slow down his decline. Line and to keep him as independent for as long as he was capable based on his obvious skill level and to avoid the temptation to do everything for him, and they agreed to that plan. Further thoughts about this scenario: as Alzheimer's disease and other related dementias destroy brain cells, a significant symptom, the one we've been talking about known as aphasia, starts to appear. Aphasia does worsen as the disease progresses. It becomes harder to remember the right words and process what others are saying, as we heard in the pillbox story. Harvey did suffer from aphasia. And it presents itself in many different ways. But the thing to remember is this condition is a result of damage being done to the communication centers of the brain. It was evident in this story that Harvey was very highly functioning cognitively. He understood everything that was being said to him. However, he had difficulty finding the correct words to use, as well as difficulty articulating his thoughts. For example, when I did ask him what that pillbox was, he couldn't remember the correct name for it, even though it was obvious to me that he knew and understood its function. A more cognitively impaired person would not have been able to recognize what a pillbox was or what it was used for as Harvey did. There were also a lot of misperceptions from the family members in that story, which is perfectly natural and by no means a negative reflection on the family members. We all have blind spots, especially when we don't know what we don't know. And that includes me. It's important to remember that what connects us with others in the world is our ability to communicate. It's the ability to get and give information, as well as express our needs and feelings. Using language is the most common form of communication that we can all use effectively. Such as body language, facial expressions, and gestures. But sadly, with dementia, the ability to communicate is gradually lost. It is not uncommon for people with dementia to substitute words when they can't think of the words that belong, or they unintentionally make something up. There's actually a name for that. It's called confabulation. The first problem is typically with finding the right words that fit into what they are trying to tell us. Later in the disease, a person may have even more difficulty expressing thoughts and ideas. Their brains might know what they want to say, but they lose the ability to actually articulate those thoughts. This decline in the ability to communicate can often lead to frustration, understandably, and also emotional outbursts. Also, the ability to understand what's being said to them, as I mentioned, also declines significantly. Words become less effective to them, and eventually Efforts to communicate will become shorter and simpler and may be limited to single words and gestures. But we will explore several ways in which we can more effectively communicate with people suffering from dementia and aphasia in upcoming episodes. But eventually family members and caregivers will have to learn to rely on visual cues and touch. So that is the information that I have planned for this episode today of The Truth Lies in Alzheimer's. And I want to just give you another gentle reminder that if you'd like more information, please visit our website at mindingdementia.org. Thanks again for being here today. I appreciate you taking the time to listen to this informational episode. And as always, I wish you a happy and healthy week ahead, and I'll be back next week with another new episode of The Truth, Lies Alzheimer's Show. Once again, I'm Lisa Skinner. Lisa Skinner, your host.

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