The first symptoms of aphasia. “The sick themselves notice that something is wrong”

– In Poland, a patient with aphasia usually ends up on a disability pension and sits in an armchair. Usually, relatives care more about physiotherapy, so that they would be able to go to the toilet on their own, because it means that you can leave him alone at home and go to work. If people with aphasia do not have any social function, they often fall ill and do not try to fight back, says Dr. adult aphasia.

1. Bruce Willis recently announced that he is retiring. As he revealed, he suffers from aphasia which prevents him from continuing to appear in movies
2. Aphasia is most often associated with a stroke. Then its onset is sudden and the patient suddenly loses language skills due to brain damage. It’s 80 percent. cases – explains Dr. Siudak
3. In the case of progressive aphasia, it is very often the patient who first notices changes in himself: he forgets words, loses orientation, and complains about difficulties in concentrating. Often, relatives calm him down and downplay the problem. This is a mistake – notes Dr. Siudak
4. The expert also refutes the myth that aphasia is irreversible and affects only the elderly and sick. – Young people, even before the age of 40, who have small children, financial obligations, loans and companies, come to me more and more often. Returning to full fitness is possible – he explains
5. More information can be found on the Onet homepage.

Karolina Świdrak / Medonet .: More than two weeks ago, Bruce Willis announced that he was ending his acting career due to ill health. The official announcement stated that he was suffering from aphasia.

Dr Anna I am: He’s an important actor for me. Since I first saw him on the screen as a young girl (in the series “On crazy papers”), I have followed his career. He has acted in a lot of good movies. The more I am sorry that such a serious disease has struck him.

What exactly is aphasia?

Aphasia is a speech disorder associated with damage to the brain. It most often occurs in people who have had a stroke – it’s about 80 percent. cases of aphasia. Sometimes it is also the result of craniocerebral damage – it occurs after traffic accidents, accidents in workplaces, but also under the influence of diseases, e.g. encephalitis or as a result of contact with toxins. It also happens that such speech disorders also occur on a neurodegenerative basis. This is called primary progressive aphasia (ang. Primary progresive aphasia – PPA), i.e. progressive language disorders caused by a neurodegenerative process.

I do not know Bruce Willis’ medical history, for obvious reasons I do not have access to his records, so I cannot comment. In the case of aphasia, the lack of information on previous strokes or accidents indicates primary progressive aphasia.

1. Bruce Willis suffers from aphasia. This disease prevents him from continuing to appear in movies

Can you explain in simple words what the neurodegenerative process you mentioned is about?

Aphasia is most often associated with a stroke – then its onset is sudden and the patient suddenly loses language skills due to brain damage. In the case of neurodegenerative changes observed in PPA, the onset of the disease is insidious and its course depends on many factors. Much depends on whether the patient was quickly taken care of by a specialist. Most often, however, initially the patients experience deterioration of linguistic functions, such as loss of fluency, the use of incorrect grammatical forms or difficulties in building sentences.

There are three types of PPA. They differ quite significantly. In first (agramatic) the greatest difficulties are observed with regard to the variety of words and the fluency of speaking. However, the understanding of the meaning of words is preserved. In the second (semantic) the patient does not make grammatical mistakes and maintains fluency, but gradually loses knowledge about the meaning of words. They start to get confused, his vocabulary is impoverished, problems may arise with distinguishing objects – first from the patient’s further environment, and then even those that are close: a cup, glasses, home, plate, knife, etc. There is also a third subtype of aphasia, originally progressive – subtype logopenic. This is where problems with recalling words arise. Then, instead of using the surname, we say, for example, “The actor, the one, the one who played this actress in this movie”. Importantly, the latest research by the team of prof. Emilii J. Sitek indicate that the first two variants fit into the clinical picture of frontotemporal dementia, while the speech variant may indicate developing Alzheimer’s disease. That is why early diagnosis is so important.

PPA is an unstoppable disease. Pharmacological treatment may slow it down, but also very intensive speech therapy with a speech therapist. Although research on this disease has been conducted since 1982 (it was initiated by an American professor – Marsel Mesulam), we still do not know the direct cause of this type of aphasia. Recently, e.g. genetic factors have been mentioned among possible reasons. We should also mention the progress of medicine – on the one hand, we live longer thanks to it, but on the other hand, we are struggling with diseases of old age, which we did not know before or did not occur on such a scale. The percentage of people suffering from progressive diseases, such as Alzheimer’s disease or Parkinson’s disease, paradoxically increases with the development of medicine.

1. Parkinson’s can attack from the age of 21. A neurologist with four symptoms

After Bruce Willis revealed that he had aphasia, interest in the disease increased. But in Poland there is an actor who has been familiarizing us with this phenomenon for years. This is Krzysztof Globisz.

Yes, professor Krzysztof Globisz has been fighting for several years – with the help of physiotherapists and speech therapists – to regain mobility and speech. Despite his illness, he decided to return to the stage, to the film, and supports initiatives to help other sick people. I had the opportunity to participate in the performances in which Mr. Globisz played as a person affected by aphasia and I must admit that it is a great experience – beautiful, but also very difficult.

You said aphasia is not just a speech problem. What does the disease process look like? In what order do symptoms appear?

In aphasia as a result of a stroke or an accident, it all depends on which part of the brain has been damaged. If the frontal lobe, the patient understands a lot, but it is very difficult for him to articulate even basic words. He has a spastic hand, usually his right hand, that requires physical therapy. Most often, such a patient also has disorders in the area of ​​gross motor skills – he or she rides in a wheelchair or uses a cane. This type of aphasia is called motor aphasia. If, on the other hand, the stroke affects the posterior regions of the brain, the temporal lobe, you are sick has problems with understanding speech, including his ownj. Often then patients use the “word salad” – not only do they not know what is said to them, they do not understand the messages, but also their speech lacks sense and logic. This patient usually speaks fluently – this is called sensory aphasia. Ill retains the melody of the language, expresses itself in complete sentences which, however, do not make senseand most often there are no movement disorders. Neurology, however, is not simple and the most common are mixed types.

It should be emphasized that aphasia is not only a disorder of the language system – patients often experience emotional problems that may be psychological, because the world of the patient and his family suddenly collapses. Often the patient requires constant care – help in basic activities: getting dressed, washing, going down the stairs. Sometimes these emotional problems and catastrophic reactions – bursts of crying and even uncontrolled aggression – have a neurological background related to damage to the brain structures. Patients have the so-called disinhibition and are unable to control negative emotions. This, in turn, translates into their functioning – sometimes the family has to prepare that it is a new personality and that behavior changes are not the fault of the patient or his relatives. It is also not uncommon for patients to have additional neurological symptoms, e.g. vision problems, side skipping, seizures. Often, relatives are not able to see them, and patients with aphasia are unable to explain what is wrong with them.

I remember the story of one of the families – the wife was a nurse, the husband had severe aphasia. At one point during a picnic, the man snatched a woman’s watch with a bracelet from his friend and put it on his wrist. Everyone was confused, and in the end it turned out that he just wanted to announce that he could not function without a watch, but also did not know how to fasten the strap on his own watch. Due to his deep aphasia, he was unable to explain it.

I am asking about the order in which the symptoms appear because I am curious to know if there are any early warning signs of aphasia. Something that could be a clear sign that something is wrong – with us or with someone around us.

If we are talking about patients in mature, senior age, Any memory or speech disorder should worry. You must certainly not ignore sudden problems with vision, gait disturbances or difficulties with holding an object in the hand, the drooping corner of the mouth. Such signals require urgent neurological diagnosis as they may indicate a stroke.

In the case of progressive diseases, it is very often the patient who first notices changes in himself: he forgets words, loses orientation, and complains about difficulties in concentrating. Often times, relatives reassure him, saying: “Grandma, I would like to have a memory like you”. The problem should not be underestimated, but you should seek the help of a neurologist who, if necessary, will implement the treatment and refer you to appropriate specialists. Modern science has tools, pharmacological and therapeutic methods that can slow down the disease process. All signals related to memory, vision, sudden behavior changes (personality changes are also observed in some dementias) should also raise our concern.

1. This test will detect early symptoms of Alzheimer’s. A few sentences are enough

Let’s say we noticed the symptoms of the disease early enough. What can we do to stop its progress? What can patients really count on?

Patients should have access to intensive daily language and cognitive therapy as well as physical therapy. Many hours of regular exercise are needed to predict success in an aphasia patient. Unfortunately, only half of the patients in Poland benefit from speech therapy. As part of the National Health Fund, they can usually count on 30-45 minutes once a week. I work at the ORIGIN private neurological rehabilitation center in Krakow and I know how big the difference is in the quality of treatment. Here, the sick for many hours every day are looked after by a team of qualified specialists – speech therapists, neurologists, physiotherapists, neuropsychologists, psychologists and nurses. We all meet once a week to discuss the situation of each patient as a team. We set up a treatment program, sometimes we ask for an additional specialist to consult with you. This is how the standard of therapeutic care in Poland should look like.

How is it different – specifically and visually – a patient who has received quick and good therapy from one who is left alone with aphasia?

If the patient receives intensive care early enough, has well-chosen therapeutic methods, we can predict success, even a return to the so-called normal life or significant minimization of symptoms. But neurology is complex, and you need to be humble with it. Unfortunately, it happens that the patient, even with the most professional help, will get epileptic seizures, for example. Sometimes a second stroke occurs. This changes the treatment plan and outlook.

It is difficult to say with certainty how the recovery process will go, but we want the patient to start it as early as possible. Then it is known that we have a better chance to help him return to normal functioning. We have patients who have returned to health and their previous life – to function in the family, to the companies they ran. It is possible.

What is the worse scenario if the therapy is insufficient?

Unfortunately, most often such a person goes on a disability pension and sits in an armchair. Usually, relatives care more about physiotherapy, so that the patient would be able to go to the toilet by himself, because it means that you can leave him alone at home and go to work. Fortunately, social awareness is increasing and families are increasingly taking care of speech therapy. But what happens outside of therapy hours is also extremely important: if people with aphasia have no social function, they often fall ill and do not try to fight back. If patients get a remote control in their hands and watch TV all day, it does not help to recover. The brain needs movement, intellectual challenges, social contacts.

You should be aware that in the background of the disease there are huge tragedies not only for the patient, but also for his family. These people lost overnight not only the ability to speak, but all their lives. What’s worse more and more often I am visited by young people, even before the age of 40, who have small children, financial obligations, loans, companies …

Some of us became interested in aphasia only on the occasion of the sad story of Bruce Willis. But it’s not a rare disease, is it?

Professor Maria Pąchalska in 2005 in the book Aphasiology estimated that in Poland, in large urban centers, aphasia constitutes 1-4 cases per 1000 inhabitants, and some statistics say even six cases. Unfortunately, some of the patients die due to complications, and some live with permanent disability. It is a large group, although not very visible. When we meet someone with a speech problem and a contracture of the hand, most often the right hand, we can presume that they are post-stroke problems. However, many patients do not function in the social space because they are locked up at home. This is a huge problem.

Fortunately, in recent years, social awareness has increased. Not infrequently thanks to famous people who have been affected by this disease themselves – so they give interviews, write books, and set up foundations. It is very important. In Poland, you can read the autobiographies of outstanding personalities struggling with speech disorders, incl. Sławomir Mrożek entitled Baltazar or Andrzej Zaorski, who – together with Katarzyna Ciesielska – wrote the book “Hand, leg, brain on the wall”. I heartily recommend the interviews given by Mr. Zaorski after his stroke. The effects of the stroke were also overcome by the late, unfortunately, a great music expert, Bogusław Kaczyński, who returned to his professional life.

And another myth: aphasia is not a problem for the elderly and the sick. I was personally very touched by the story of Sharon Stone, who suffered a stroke in her early XNUMXs. She was paralyzed, speech and hearing lost. Slim, athletic, at the peak of her career …

Indeed, there are more and more young people after strokes. More and more 20- and 30-year-olds come to me for therapy. Probably the pace of life, stress, drugs, lack of exercise, sleep, and probably also the quality of air and food, and of course diseases make us biologically weaker.

And the aforementioned Sharon Stone does a lot to spread awareness about aphasia. He talks openly about his story, which you can read in a book with an eloquent title “It’s Beautiful to Live Twice”. An interesting fact is that Stone strongly supports the Polish start-up Neuro Device aimed at facilitating access to therapy at home. The star of Game of Thrones, Emilia Clarke, who had a subarachnoid haemorrhage and underwent three brain operations, also tells about her experiences. She also established a foundation supporting people after stroke and brain damage. So you have to admit that more and more is happening in the area of ​​awareness, although still not enough.

1. «Doctors gave me 5 percent. chance of survival ». Her atypical case was dubbed “Sharon Stone Syndrome”

I wonder how much depends on the family and loved ones?

Incredibly a lot. You should be aware that this is a double-edged sword – on the one hand, the patient needs support and acceptance for their difficulties, on the other – to challenge them and not to overcome them, not to let them sink into illness. The wise attitude of loved ones is extremely important and for us, therapists, is a great help. I often invite families to therapy so that they understand the whole therapeutic process and help the patient to consolidate the practiced material at home. Inspired by the work of my boss, professor Jagoda Cieszyńska, who is not only a speech therapist, but also a psychologist, I put notebooks on my patients. Language is fleeting – sounds, words, sentences pass quickly over time, which makes patients unable to catch them, integrate them into a semantic whole, understand and repeat them.

Speech therapy is based, among others, on on the fact that we “keep” this language in notebooks so that the patient has time to process the information, he can return to it many times and record it. Notebooks that literally swell in the course of therapy when the tasks become more difficult, also become a testimony of development that we can show in a moment of crisis. We then say: “Look, a month ago you did such easy things, and now we are doing something so difficult!” Notebooks are an indisputable proof of the return of language skills.

I would like to end this conversation on an optimistic note. What can we do to reduce the risk of aphasia?

The power of neurobiology is still not fully understood, but it is worth emphasizing one thing: our brain likes to be surprised and likes to get involved – in movement, in cognitive tasks, in relationships with others. We should take care of ourselves, and therefore exercise the brain, but also reduce stress, healthy sleep is also important – then we certainly minimize the risk of neurological pathologies. It must be remembered that many of the neurological diseases do not have a specific provenance – we do not know what they come from or when they appear, so the prophylaxis at the moment is a healthy lifestyle.

1. How To Delay Alzheimer’s? Pleasant exercises that will immunize our brain

When I think about healthy and happy old age, I see in front of my eyes Mr. Antoni Huczyński, who appeared in the media at the age of 91 as “Dashing Grandpa”. Mr. Antonii, unfortunately, died two years ago at the age of 98, but he left behind a lot of optimism thanks to the films, the book and the profile of “Antonia Huczyński – a way to longevity”. I heartily recommend you a chilling short documentary “Cryotherapy”, in which 94-year-old Mr. Antoni enters a barrel with ice. Scientific research shows that old age can be healthy, wise and joyful. But it has to be active.

Read also:

1. In Alzheimer’s disease, the brain shrinks and shrinks. Why? Explains the neurologist
2. Parkinson’s can attack from the age of 21. A neurologist with four symptoms
3. How does COVID-19 affect the brain? Scientists surprised by the discoveries