Aphasia

Overview

Aphasia is a disorder that results from damage to areas of the brain responsible for language. For most people, this damage happens in the left side of the brain. The condition weakens the expression and understanding of language, as well as reading and writing.

Aphasia usually happens suddenly, often following a stroke or head injury. But it may also develop slowly, as the result of a brain tumor or a progressive neurological disease. Aphasia may happen alongside other speech disorders that also result from brain damage such as dysarthria or apraxia of speech.

Most people who have aphasia are middle-aged or older, but anyone can develop it, including young children. About 2 million people in the United States are living with aphasia, according to the National Aphasia Association, and nearly 180,000 Americans acquire the disorder each year. Men and women are equally affected.

Related Terms: Dysphasia

Signs and Symptoms

Symptoms may include:

• Trouble spelling, writing, or talking in complete sentences
• Saying the wrong word
• Using made-up words
• Trouble telling time, counting money, or doing arithmetic

The specific signs and symptoms depend on the type of aphasia a person has.

Wernicke’s Aphasia

People with Wernicke’s aphasia may speak fluently in long, complete sentences that have little meaning, adding unnecessary words and even making up words. They are often unaware of their spoken mistakes, and a sign of this type is difficulty understanding language whether spoken, written, or signed.

Broca’s Aphasia

People with Broca’s aphasia often speak in short phrases that take great effort and remove small words such as “is,” “and,” and “the”. They usually have an easier time understanding language compared to people with Wernicke’s aphasia, but they still usually experience some degree of difficulty.

People with Broca’s aphasia are usually aware of their speaking difficulties and can become easily frustrated. Because the frontal lobe in the brain also controls voluntary movement, people with this type of aphasia may also have right-sided weakness or paralysis of the arm and leg.

Global Aphasia

People with global aphasia have severe communication difficulties and may be extremely limited in their ability to produce and understand language. They may be unable to say even a few words or repeat a limited set of words or phrases. They may also have trouble understanding simple words and sentences whether spoken, written, or signed.

Conduction Aphasia

Conduction aphasia is a fluent aphasia in which a person has difficulty repeating words and simple phrases. While their fluency and ability to express themselves and understand others is better than people with Wernicke’s aphasia, they still often have problems in those areas.

Primary Progressive Aphasia (PPA)

People with progressive neurological disorders, such as Alzheimer’s disease or frontotemporal dementia, may develop primary progressive aphasia (PPA). They may develop primary progressive aphasia even before other cognitive or neurological signs become apparent.

Primary progressive aphasia happens when neurodegeneration affects the language areas of the brain, causing a gradual and worsening decline in the ability to use language. Over time, other cognitive, behavioral, and movement symptoms may also happen as the disease progresses. Primary progressive aphasia can happen across a range of neurodegenerative diseases but is most commonly linked with frontotemporal dementia and Alzheimer’s disease.

Causes and Risk Factors

Stroke is the leading cause of aphasia. According to the National Aphasia Association, about one in three stroke survivors have aphasia. A stroke happens when a blood clot or a leaking or burst blood vessel stops blood flow that carries oxygen and nutrients to brain cells.

Aphasia can appear suddenly following brain surgery or after a head injury. It can also develop gradually from the effects of a brain tumor and associated treatments. Other causes of aphasia include brain infections. In children, aphasia may result from a brain tumor, head injury, or brain infection.

Different types of dementia can also cause aphasia.

Prevention Guidance

Because stroke is the leading cause of aphasia, preventing stroke can reduce the risk of developing aphasia.

The following changes can help prevent strokes:

• Control high blood pressure
• Stop smoking
• Exercise regularly and maintain a healthy weight
• Lower cholesterol levels.
• Get checked by a doctor for heart disease
• Manage diabetes

Stroke survivors should speak to their doctor or other healthcare provider about medicines and lifestyle changes to prevent more strokes.

Diagnosis

The doctor who treats a person for a brain injury, such as a stroke, may be the first to identify aphasia. Most people with suspected aphasia will need a diagnostic scan that may confirm the presence and location of the brain injury or brain degeneration.

A doctor may also test the person’s ability to understand and produce language. They will see how well the person is able to:

• Follow commands
• Answer questions
• Name objects
• Carry on a conversation

After, the doctor will refer a person with suspected aphasia to a speech-language pathologist for a comprehensive exam.

Speech language Pathologists and other specialists will use language assessment that may involve:

• Standard questionnaires
• Direct observation on how a person uses language in everyday, social situations
• Tests for vocabulary, language understanding, and how a person speaks

Treatment and Management

If aphasia happens from a stroke or other brain injury, changes happen in the brain that may help recovery. As a result, people with aphasia can often experience dramatic improvements in their language and communication abilities in the first few months, even without treatment.

But in many cases, some aphasia remains following this first recovery period—a condition called chronic aphasia. Throughout all phases of recovery, speech-language therapy will help patients regain and improve their ability to communicate.

Research has shown that language and communication abilities can continue to improve for many years after a brain injury. Factors that may influence the amount of improvement include:

• The cause of brain injury
• The area of the brain that was damaged and the extent of the damage
• The age and health of the individual
• Access to therapy

Aphasia therapy aims to improve the ability to communicate by:

• Helping people use their remaining language abilities
• Restoring language abilities as much as possible
• Teaching other ways of communicating—such as through gestures, pictures, notebooks, and electronic devices

Technology provides new tools for people with aphasia. Virtual meetings with speech-language pathologists give patients the flexibility and convenience of receiving therapy in their homes through a computer. Speech-generating applications on mobile devices, such as cell phones and tablets, can provide alternative ways to communicate.

Voice, speech, and language disorders often affect a person’s emotional and social life, and can compromise educational and job opportunities.

Participating in activities such as book clubs, technology groups, choirs, and art and drama clubs can help people with aphasia regain their confidence and social self-esteem. They can also help improve their communication skills and overall well-being.

Stroke clubs are regional support groups formed by people who have had a stroke and are available in most major cities. They can help people and their families adjust to the life changes that accompany stroke and aphasia.

Family involvement is often an important part of aphasia treatment because it helps family members to learn the best way to communicate with their loved ones. A strong therapy program will include communication partner training.

Family members are encouraged to:

• Participate in therapy sessions
• Simplify language by using short, uncomplicated sentences
• Repeat words or write down key words to clarify meaning as needed
• Maintain a natural conversational manner appropriate for an adult
• Minimize distractions around a person with aphasia, such as loud radio or TV
• Include the person with aphasia in conversations
• Ask for and value the opinion of the person with aphasia, especially on family matters
• Encourage any type of communication whether it is speech, gesture, pointing, or drawing
• Avoid correcting the person’s speech
• Allow the person plenty of time to talk
• Help the person become involved outside the home and seek out support groups such as stroke clubs, aphasia groups, intensive camps, and more

Find Clinical Trials

Clinical trials uncover better ways to prevent, diagnose, treat, and understand diseases and conditions. To ensure results apply to everyone, volunteers of all ages, sexes, and backgrounds, including both healthy individuals and those with specific medical conditions, are needed. NIH-funded clinical trials are also testing other treatments for aphasia. Find clinical trials on aphasia.

Community Support

The following organizations provide support and information related to aphasia and stroke recovery:

• National Aphasia Association
• American Stroke Association
• Brain Aneurysm Foundation
• YoungStroke, Inc.

Note: This resource list is for informational purposes only. It is not comprehensive, and an organization’s inclusion does not constitute an endorsement by NIH.  

Research Information

The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world. NIH invests most of its budget in medical research seeking to enhance life and to reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments helping people live longer, healthier lives, and building the research foundation that drives discovery.  

NIH supports research on the nature, causes, treatment, and prevention of communication disorders, including aphasia. This research is important because of the impact aphasia and primary progressive aphasia have on a person’s ability to communicate and their overall health outcomes.

Some NIH-funded research projects focus on using advanced imaging methods to explore how language areas in the brain are structured and how the brain processes language as it recovers following stroke. Researchers are testing new types of speech-language therapy in people with both recent and chronic aphasia to see if new methods can better help them recover word retrieval, grammar, conversation skills, and other aspects of language. Other research examines different ways to stimulate the brain through speech-language therapy to enhance outcomes.

Research on primary progressive aphasia addresses similar topics but with an additional focus on:

• Early detection
• Understanding how the brain changes throughout the course of the disease
• Effective speech-language treatments
• How communication skills can be better preserved as the disease progresses

In addition, NIH has funded more than 300 research projects involving stroke rehabilitation since 2012.  Some of this research focuses on using rehabilitation to stimulate the brain to rewire itself and compensate for functions lost as a result of stroke.

Find NIH-funded research projects using NIH RePORTER, a searchable database of current and past research projects supported by NIH and other federal agencies.