HYDERABAD: Wendy Williams, a 59-year-old former talk show host in the US, was recently diagnosed with primary progressive aphasia, which is a communication disorder where individuals are unable to use their speech and language effectively to express themselves. Occurring in middle age or later, the disorder is caused by an injury to the part of the brain responsible for language. CE gets in touch with city-based neurologists to know more about the disorder, its types, causes and how it can be managed.
Dr Murali Krishna CH V, Sr Consultant Neurologist, CARE Hospitals, Malakpet helps us understand how this disorder develops. “Most often, aphasia follows a brain injury or stroke and develops abruptly. However, it can also develop gradually due to a brain tumour that grows slowly or a degenerative condition that damages the brain gradually and permanently,” he said.
Highlighting the symptoms of the disorder, Dr Krishna said that the degree of brain injury and its source are two factors that affect how severe aphasia is. “It may affect how you write, comprehend, and speak. A person with aphasia may speak in short or incomplete sentences or speak sentences that don’t make sense. They might substitute one word or sound for another, speak unrecognisable words, or have difficulty finding words. They may not understand what they read or write or are unable to participate in conversations with others effectively,” he added.
Types of aphasia
There is not one but many different types of aphasia, according to Dr Joy Mounica, Consultant Neurologist, Renova Hospitals, Langar House. “In Broca’s aphasia, which is caused by damage to the Broca’s area in the brain, a person primarily has trouble saying words and sentences, limiting a person’s speech to just one or two words,” she said.
“Whereas, the person experiences severe comprehension difficulties even with simple speech when diagnosed with Wernicke’s aphasia, which is caused by damage to the Wernicke’s area in the brain,” she added.
Primary Progressive Aphasia, the type with which Wendy Williams is suffering, is seen in frontotemporal lobar degeneration. “It is further divided into two sub-types: Nonfluent / agrammatic variant, where the patient has non-fluent, hesitant and telegraphic speech with misuse of pronouns and sentence errors; and semantic variant, where the patient sees difficulty in comprehending nouns,” Dr Mounica explained.
Diagnosis and treatment
Dr Mounica specified that in our country, aphasia persists as a disability in around two million people with an incidence of 43 persons/lakh and a prevalence of 3,000 persons/million.
Shedding light on the diagnosis and treatment of aphasia, Dr Krishna said, “Speech and language therapy, along with treating the underlying illness, are the main treatments for aphasia. The aphasic acquires new language abilities, practices them, and discovers alternative forms of communication. Family members frequently assist the person in communicating by taking part in the process.”
He told CE that a speech therapist does a language evaluation to determine whether the subject is capable of naming common objects, understanding and using words correctly, responding to open or close — ended questions or those about something read or heard, repeating words and sentences, following instructions, reading and writing.
Adding to his inputs, Dr Mounica specified that the intensity and duration of therapy are individualised. “The early referral and intervention of therapy are always beneficial and proportional to the recovery,” she said. “However, in the Indian context, discontinuation of therapy is common due to several factors like cost of therapy, access to therapy, availability and commutation problems,” she added.
Certain drugs may improve blood flow to the brain, enhance the brain’s recovery ability or help replace depleted chemicals in the brain. “Several medications, such as memantine, donepezil, galantamine and piracetam, have shown promise in small studies. However, more research is needed before these treatments can be recommended. Among other treatments, brain stimulation is being studied and may help improve the ability to name things. But no long-term research has been done yet,” Dr Krishna concluded.