“Aphasia is incurable”: what Bruce Willis suffers from

Aphasia is a speech disorder that can occur with stroke, focal brain damage (stroke, trauma, tumors) and neurodegenerative processes, when gradual atrophy of areas of the cerebral cortex occurs – for example, with frontotemporal dementia, which often occurs in older people.

“The local classification of aphasia types was proposed by the Soviet neuropsychologist Alexander Luria,” Andrey Zyryanov, a young researcher at the HSE Language and Brain Center, told Gazeta.ru. – They are distinguished on the basis of any type of speech deficiency.

With sensory aphasia, the patient loses the ability to distinguish near-sounding sounds, for example, “b” and “p”, so speech is difficult to understand. With efferent motor aphasia, the patient suffers from the ability to pronounce words and phrases.

Kind of like a stutter. For example, loops a sound and repeats it. The same patients have impaired grammar processing, as opposed to those who simply stutter. For example, the patient loses the ability to put words in sentences in the correct order. Or it mixes up the endings of words and puts them into wrong forms.

Zyryanov explains that the form of aphasia that occurs depends on where the lesion is in the brain. If the areas responsible for the motor aspects of speech in the left frontal lobe are affected, efferent motor aphasia occurs more often or dynamically, characterized by difficulties in pronouncing detailed spontaneous speech – the patient can pronounce individual words without discomfort, but speak in detail – no.

“Aphasia often occurs in adults,” adds neurologist Marina Kalinkina. – I encountered motor or sensory aphasia most frequently in my neurological practice. With the first, the fluency of speech decreases, the ability to repeat and write is impaired, with the second, the fluency of speech is preserved, but again, comprehension, reading and writing are impaired. Less common is spherical, that is, moto-sensory. There is also hysterical aphasia when a person loses the ability to speak due to a neurological disorder. We call it dysfunction.”

Aphasia itself does not affect intelligence or thinking.

“We often think to ourselves to solve a complex math problem, and if a person’s speech is impaired, it is natural that the complex ways of thinking that speech mediates suffer as well. But overall, nonverbal thinking and cognitive abilities are relatively intact in these patients. Zyryanov emphasizes that aphasia is not a violation of intelligence, it is a violation of speech processing.

“It is impossible to say that one form is reversible and the other is not. It is impossible to cure aphasia, because that would mean, for example, removing damage to the cerebral cortex, which is impossible.”

If aphasia is caused by neurodegenerative processes, treatment should be aimed at slowing this degeneration – then speech will deteriorate more slowly. It is possible to restore speech with aphasia, but success depends on many factors: the extent of brain damage, whether a person engages with a speech therapist, whether therapy is suitable for the type of aphasia.

“If the aphasia is severe initially and is associated with extensive brain damage, speech may be improved if given the opportunity to use basic communication skills, but full recovery is unlikely,” says Zyryanov. “Spontaneous healing is possible if the lesion is small and not in the speech areas but nearby.”

Kalinkina adds that aphasia can be completely reversed, especially in the case of strokes and transient ischemic attacks.

“A person has suffered a stroke, but due to the bypass pathways of blood flow, due to the body’s reserves, blood circulation has improved, and in three days he begins to speak literally normally,

– explains the doctor. “Furthermore, if a person has a brain tumor removed and is working with a speech therapist or has a good neural network to begin with, speech is restored due to neuroplasticity.”

With dementia, getting rid of aphasia no longer works. With the help of drugs there is a chance to slow down its development, but there is also no specific treatment – the result depends on how effective drugs such as memantine are used for dementia in general.

Speech disorders in dementia may not be obvious to the patient. Dementia rarely begins with aphasia, says Kalinkina – most often, speech disorders occur when higher mental functions suffer.

With aphasia caused by stroke or trauma, the patient usually immediately notices speech disorders, but there are exceptions here too – brain damage is often accompanied by denial of the disease, and the patient claims that he has no complaints and is healthy, even if he has paralyzed half the body.

If the patient cannot speak but understands speech, he can continue his communication by addressing his loved ones in writing. If understanding is broken, the chances of maintaining contact are significantly reduced. With the help of classes with a speech therapist, it is possible to preserve speech abilities, singing also gives a good effect.

“If we talk about aphasia as an element of dementia, there is an irreversible progression of neurodegeneration,

– concludes Kalinkina. – The only question is whether a person will regularly take medication, work with a speech therapist – in this case, the process most likely will not go so quickly. And if he refuses therapy, applying sporadically, it can quickly disappear within a few years.

If aphasia is caused by stroke or other damage to the cerebral vessels, in addition to classes with a speech therapist, physical activity and exercises of fine motor skills are also useful – its development also includes the cerebellum. stimulates speech rehabilitation.