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Aphasia

Key Points ⚡

  • Aphasia: acquired language impairment caused by brain damage (stroke, tumor, injury).
  • Involves complex cognitive language processes; dominant left hemisphere for most.
  • Broca’s area: expressive language (speech production).
  • Wernicke’s area: receptive language (comprehension).
  • Broca's aphasia: non-fluent, effortful speech; relatively preserved comprehension; difficulty with complex sentences.
  • Wernicke's aphasia: fluent but meaningless speech, impaired comprehension, neologisms common.
  • Causes: primarily stroke; also brain injury, infections, neurodegeneration, autoimmune diseases, transient in migraines/seizures.
  • Management: supportive communication, speech and language therapy (impairment-based, compensatory, AAC), psychological support.
  • Recovery: greatest in early months post-stroke; may continue for years; lifelong disability common.
  • Complications: increased risk of adverse events, exclusion from decision-making, depression, employment loss, social isolation.

Introduction

  • Aphasia refers to acquired impairment in language production and comprehension caused by focal brain lesions.
  • Affects spoken language, reading, writing, but not intelligence.
  • Approximately 350,000 people in the UK affected; up to 40% post-stroke.
  • Preference to use term "aphasia" over "dysphasia" to reduce confusion.

Aetiology

Language Systems

  • Language is complex cognitive function; involves expressive (production) and receptive (comprehension) systems.
  • Dominant left hemisphere responsible for most language function.
  • Broca’s area (inferior frontal cortex) governs expressive language.
  • Wernicke’s area (posterior superior temporal cortex) governs receptive language.
  • Connected by arcuate fasciculus (critical for repetition).

Aphasia Types

Broca's Aphasia

  • Non-fluent, halting speech with omitted grammatical words.
  • Paraphasic errors (semantic, phonemic).
  • Difficulty with complex sentences; comprehension relatively preserved.
  • Lesion: frontal lobe including Broca’s area.

Wernicke's Aphasia

  • Fluent but nonsensical speech with neologisms and paraphasias.
  • Poor comprehension, mistaken for hearing or memory impairment.
  • Lesion: posterior superior temporal cortex.

Other Aphasia Syndromes

  • Conduction aphasia: impaired repetition due to arcuate fasciculus lesion.
  • Mixed presentations common; tailored assessment needed.

Causes

  • Stroke (most common)
  • Acquired brain injury
  • Brain tumors
  • CNS infections
  • Neurodegenerative disorders (primary progressive aphasia)
  • Autoimmune diseases (e.g., MS)
  • Transient (migraine, seizure)

Differential Diagnoses

  • Dysarthria: motor speech disorder affecting intelligibility.
  • Apraxia of speech: impaired planning/programming of speech movements.
  • Cognitive communication disorders.
  • Auditory agnosia: impaired word recognition despite intact hearing.

Management

Communication

  • Use supportive strategies to enable healthcare participation.
  • Provide accessible written information.

Speech and Language Therapy

  • Impairment-based therapy to improve language.
  • Compensatory strategies, Augmentative and Alternative Communication (AAC).
  • Focus on participation in meaningful life areas.
  • Education and training for conversation partners.
  • Psychosocial support and self-management facilitation.

Psychological Support

  • Assess mood and provide psychological care due to high depression risk.
  • Adapt mood assessments to communication abilities.
  • Use tools like D-VAMS and SADQ10 for severe aphasia.

Recovery

  • Greatest recovery occurs in the first months post-stroke.
  • Continued improvement may last years.
  • Some patients have lifelong impairment.

Complications

  • Increased adverse events and healthcare exclusion.
  • Depression and low mood common post-stroke.
  • Social isolation, relationship issues, employment loss.

References

  • Stroke Association, National Clinical Guidelines, expert reviews, and key research articles cited.
  • Benign Paroxysmal Positional Vertigo (BPPV)
  • Cervical Radiculopathy
  • Chiari Malformations
  • Down's Syndrome
  • Epilepsy