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Aphasia u-!fA-zh(E-)u

by Juebin Huang, MD, PhD

Aphasia is partial or complete loss of the ability to express or understand spoken or written language. It results from damage to the areas of the brain that control language.

  • People may have difficulty reading, writing, speaking, understanding, or repeating language.

  • Doctors can usually identify the problem by asking the person questions.

  • Imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI), are done.

  • Speech therapy can help many people with aphasia.

In most people, language function is controlled by the following areas of the brain:

  • Part of the left frontal lobe called Broca area

  • Part of the left temporal lobe called Wernicke area

  • The lower back part of the parietal lobe (next to the Wernicke area)

  • The connections between these areas

Damage to any part of these areas interferes with at least some aspect of language function. Usually, writing and speech are affected similarly.

Aphasia usually results from disorders that do not cause progressive damage, such as a stroke, some tumors, a head injury, or a brain infection. In such cases, aphasia does not worsen. But if it results from a progressive disorder (such as an enlarging brain tumor), aphasia can progressively worsen.

People with aphasia have difficulty expressing or understanding language. But the nature and degree of the difficulty vary. The variety reflects the complex nature of language function. There are two main types:

  • Wernicke (receptive) aphasia: If the Wernicke area is damaged, people have difficulty understanding spoken and written language. They usually speak fluently and with a natural rhythm, but the sentences come out as garbled, confused strings of words (sometimes referred to as word salad). They may not know that they are speaking nonsense.

  • Broca (expressive) aphasia: If the Broca area is damaged, people may mostly understand the meaning of words and know how they want to respond. However, they have difficulty finding the words to say. Their words are forced out slowly and with great effort, sometimes interrupted by expletives. Most affected people are also unable to write words.

Aphasia may also involve

  • Loss of only the ability to comprehend written words (alexia)

  • Loss of the ability to recall or say the names of objects (anomia): Some people with anomia cannot remember the right word at all. Others have a word in mind but cannot say it. Most people with aphasia have anomia. This type of aphasia is called anomic aphasia.

  • Loss of the ability to repeat words, phrases, or sentences (conduction aphasia): People with conduction aphasia cannot repeat what they hear. They often use the wrong word or use word combinations that do not make sense. However, they can speak fluently.

  • Loss of almost all ability to understand, speak, or write language (global aphasia): Global aphasia occurs when the left temporal and frontal lobes are damaged. People may be able to utter expletives because the right side of the brain, which is more involved in emotions, is not damaged.

Anomic aphasia, conduction aphasia, and global aphasia are considered specific types of aphasia. Most people with aphasia have more than one type, although one type is often more severe than the others. Most people who have expressive or receptive aphasia have both types to some degree. Some people have only one type of aphasia.


Usually, doctors can identify aphasia by talking with the person and asking a few questions. However, they need to make sure that the apparent problems with language are not caused by problems with hearing or vision or by muscle or nerve problems that affect speaking or writing, including dysarthria. Dysarthria is a speech problem, which affects the nerves and muscles that control the ability to speak—the ability to physically pronounce sounds and words. Aphasia is a language disorder, indicating a brain problem, and affects comprehension, thought, and word finding.

Doctors evaluate how fluently people speak, whether starting to speak is difficult, and whether people have difficulty finding words, naming objects, or repeating phrases. Doctors also check how well people understand what is said to them—for example, whether they can understand and carry out a command. People are asked to write and to read aloud.

Testing a Person With Aphasia

What Type of Aphasia

What the Person Has Trouble Doing

What the Doctor Might Ask

How a Person With Aphasia Might Answer*

Broca aphasia

Answers to questions are given hesitantly but are sensible.

“What is this a picture of?” (dog barking)

"D—d—d—dg, eh, no...d-d... damn...p-p-pet, yeah, yeah, pet, pet, pet...b—b—...makes noise.”

Wernicke aphasia

Answers to questions are given fluently but are nonsensical.

“How are you today?”

“When? Easy for my river runs black boxes wizzel abata on when boobles come.”

Conduction aphasia

Words, phrases, and sentences spoken or written by others cannot be repeated, and people often use the wrong words, although they can speak fluently.

Repeat the following: “No ifs, ands, or buts about it.”

“No nifs nand nor but...”


Naming things is difficult.

“What is this?” (pointing to a jacket lapel, watch band, or pen)

“What you wear, thing for time, you write with it."

*Doctors can usually identify the type of aphasia based on how the person answers a few questions. The answers listed are typical for people who have a specific type of aphasia.

Standardized tests of mental function may be given by a neuropsychologist or speech and language therapist. They can help doctors identify aphasia that causes only subtle symptoms. These tests also help doctors plan treatment and determine how likely recovery is.

Imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI), are done to find out what type of brain damage caused the aphasia. Other tests may be done depending on the suspected cause.


Treating certain causes can be very effective. For example, if a tumor causes swelling in the brain, corticosteroids can reduce the swelling and improve language function.

Speech therapists can help people who develop aphasia after brain damage due to disorders that do not cause progressive damage (see Aphasia). Therapy is usually started as soon as people are able to participate, but it is helpful even when started much later. Usually, most recovery of language skills occurs during the first 3 months, but it can continue for more than 6 months.

If people with aphasia do not recover basic language skills, they may be able to communicate using a book or a communication device, such as a board with pictures or symbols of often-used words or daily activities or a computer-based device with a keyboard and message display.

Family members and other people who care for a person with aphasia can become frustrated. Remembering that aphasia is a physical disorder and that a person has little control over it can help.

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