Caregiver Training Blog

It can be devastating to lose the ability to communicate using the language you have always spoken.

Aphasia—the impairment of language that is a result of injury to the brain—is frustrating and difficult for the person experiencing it. They can lose the ability to find or form words, read, or write.

It is also hard on caregivers, who need to learn new ways of communicating with their loved ones.

Aphasia affects millions of people, especially older individuals with dementia or people who have experienced strokes or other brain injuries.

When we understand the basics of how aphasia works, we can do a better job of caring for and communicating with loved ones who are experiencing this challenging condition.

What Is Aphasia?

Put simply, aphasia is a language impairment that affects people’s ability to speak, read, or write. It most commonly happens after a stroke (about one-third of the time), and it cam also be caused by head trauma, brain tumors, or infections.

Aphasia can be mild or severe. Some people just have trouble finding the names of familiar objects, while others have trouble understanding language or talking at all.

When someone is diagnosed with aphasia, the doctor will help determine what type of aphasia they are experiencing and will indicate whether it is possible to regain some language function.

Common Causes

The most common cause of aphasia is having a stroke. Between 25% and 40% of stroke survivors experience aphasia. Head injuries and other neurological issues are also common causes of aphasia.

Almost 2 million Americans are affected by aphasia, and nearly 180,000 are diagnosed with it each year. 

Even though many people aren’t familiar with the term aphasia, it is more common than Parkinson’s disease, cerebral palsy, or muscular dystrophy.

One particular type of aphasia, primary progressive aphasia, results from the deterioration of brain tissue caused by diseases such as Alzheimer’s.

Types of Aphasia

The National Aphasia Association identifies several different types of aphasia: Global, Broca’s, Wernicke’s, Primary Progressive, Anomic, and Mixed Non-fluent aphasia. The following is a brief description of each type:

• Global aphasia is when someone has very little ability to make words or understand spoken language. They can’t read or write. When someone has a stroke, they might have global aphasia right afterwards but recover some ability as the brain heals. The more damaged the brain is, the more lasting the aphasia will be.

• Broca’s aphasia (non-fluent aphasia) is when a patient has a limited vocabulary and uses short, four-word utterances. They still understand other people’s speech and might be able to read, but their language is halting and clumsy.

• Mixed non-fluent aphasia is similar to Broca’s, but people with this type of aphasia have limited ability to comprehend, and their reading and writing are at the elementary level.

• Wernicke’s aphasia (fluent aphasia) is when the ability to understand the meaning of speech is affected. People are still able to speak, but their speech is jumbled and includes irrelevant words. The ability to read and write is severely diminished.

• Anomic aphasia is when people cannot find the words for the things they want to talk or write about, especially nouns and verbs. They might use fluent grammar, but they are trying to substitute words and get frustrated. They understand others well and can often read.

• Primary progressive aphasia (PPA) is caused by neurodegenerative diseases, not by stroke or brain injury. It is often a result of Alzheimer’s disease or frontotemporal lobar degeneration. The first symptoms of this type of aphasia are speech and language problems.

• Other types of aphasia include combinations of deficits that don’t fit neatly into any of the categories.

No matter what type of aphasia a person has, they are still experiencing a major and difficult life change. Aphasia does not affect intelligence, but sometimes people assume people with aphasia are cognitively impaired because of their difficulty communicating.

Dementia Caregiver Tips

In the mmlearn video How To Talk to Someone with Dementia, Diana Waugh, BSN, RN, CDP, shares dementia caregiver tips.

Waugh focuses on memories, explaining that there are three types of memory.

1. Functional memory relates to reasoning, comprehension, and conscious memory. How do I get from the grocery store to home? How do I use the checkbook or microwave?

2. Procedural memory is the memory of automatic tasks like eating, driving, and riding a bike. 

3. Emotional memory is unconscious, gut reactions, cued by something else that is going on. 

When someone has dementia, says Waugh, they are having trouble with control. But our brains want us to stay in control. 

“Play to the big strengths,” Waugh adds. “Sometimes family members are so distraught by what’s missing that we forget there’s a lot of stuff still there.”

Waugh’s main advice is to avoid saying “no” and “Do you remember….?” to people with dementia. Reframing questions by stating your own memory is a better conversation starter.

Aphasia Communication Tips

Most of the time, aphasia affects language, not thoughts.

One of the most important things to know when communicating with someone with aphasia is that their intelligence is intact, even when they have difficulty finding words and names. 

The National Aphasia Association has a list of dos and don’ts for communicating with someone with aphasia.

• Make sure you have the person’s attention before talking to them.

• Eliminate background noises: TV, radio, other people.

• Speak at a normal volume, unless the person asks you to be louder.

• Keep sentence construction simple and slow your pace, but don’t “talk down” to them.

• Give them time. Don’t finish their sentences or offer words.

• In addition to speech, use drawings, gestures, writing, or facial expressions.

• Use “yes” or “no” questions to confirm that you are communicating successfully.

• Encourage their attempts to speak, even when it is not perfect.

• Engage in normal activities such as group conversations and decision-making. Don’t ignore them or exclude them. Keep them informed without burdening them with too many details.

• Encourage independence and don’t be overprotective.

Many Ways to Communicate

No matter how much your loved one is affected by aphasia, they are still in there. 

Even when language is impaired, they still want to spend time with you. They appreciate efforts to keep them connected with what is happening in their lives, families, and communities.

When caregivers and families learn about how aphasia works, exercise patience, and expand their communication strategies, people with aphasia can live their best lives.