Baptist HealthTalk

Learning About Aphasia

April 19, 2022 Baptist Health South Florida, Jonathan Fialkow, M.D., Felipe De Los Rios La Rosa, M.D., Denise Vargas
Baptist HealthTalk
Learning About Aphasia
Show Notes Transcript

Aphasia is an acquired condition that affects a person's ability to speak, write and understand language. The condition has been in the news ever since it was cited as the reason for Bruce Willis' recent retirement from acting.

What do we know about aphasia; its causes, symptoms and what can be done to help those who are affected by it?

A recent episode of Baptist Health's Resource Live program, hosted by Jonathan Fialkow, M.D., delved into this complex and debilitating condition.

Guests:

  • Felipe De Los Rios La Rosa, M.D., director of the stroke program at Baptist Health's Miami Neuroscience Institute
  • Denise Vargas, speech pathologist at Baptist Health. 

Annoucer:

At Baptist Health South Florida, it's our mission to care for you when you're injured or sick and help you stay healthy and fit. Welcome to the Baptist Health Talk Podcast, where our respected experts bring you timely practical health and wellness information to improve your family's quality of life.

Dr. Jonathan Fialkow:

Welcome Baptist Health Talk Podcast listeners. I'm your host, Dr. Jonathan Fialkow. I'm a preventative cardiologist and lipidologist at Baptist Health Miami Cardiac and Vascular Institute, where I'm also a chief of cardiology at Baptist Hospital and the chief population health officer at Baptist Health. Fans of actor, Bruce Willis was shocked recently when his family announced that he was retired from acting due to a condition called aphasia. Aphasia is an acquired condition that affects a person's ability to speak, right and understand both verbal and written language. What do we know about aphasia? It's causes symptoms and what could be done to help those who are affected by it. Two experts from the Baptist Health family, join me on an episode of the re source live program to shed some light on this debilitating condition. My guests were Dr. Felipe de Los Rios director of the stroke program at Miami Neuroscience Institute and Denise Vargas, speech pathologist Baptist Health. Let's hear what they had to say.

Dr. Jonathan Fialkow:

Felipe, let's kick it off with a question to you for this important subject that recently became very prevalent regarding Bruce Wilson's condition and how the press picked up on it. We'll talk about aphasia, which is a medical condition. We learned a little bit at the beginning of discussion, but could you explain a little bit more, what is aphasia and what causes it if you can.

Dr. Felipe de los Rios:

Yeah, sure. Aphasia by itself really same in neurologic symptom of a diseases and the disease that drives the symptom, there's multiple and we'll go into more detail in a bit, but aphasia refers to any problem with language. Language is the main problem that you have when there is aphasia and it could be any aspect of language. It could be understanding language, so people that have aphasia have problem understanding language would feel like you're speaking a different language. They don't understand what it is that you're saying. It could be expressing, so you're not able to express yourself appropriately you should like you've been doing before. Again, kind of if it was a new language, you can't find words or you're making errors when you're speaking or making the sentences. And it usually affects both spoken and written language.

Dr. Felipe de los Rios:

And then what drives that problem with language that aphasia there's a whole myriad of conditions that can do it. I think it's easier to understand if we say that aphasia is for you to have neurologic injury. In aphasia it's the cortex, so it's the outer part of the brain that is involved with language that is injured and anything that produces injury on that area will produce the language problem. One of the common things that can do that is stroke, for example. But there's other conditions that can do it that are within the neurodegenerative realm, even trauma. If you have a trauma or a TBI and it's affects that area of the brain, then you would have problems with language as well.

Dr. Jonathan Fialkow:

And again, I know we're going to get into some more detail regarding some of the components you mentioned which I think will be very worthwhile for the viewers. Denise of aphasia is an injury to a part of the brain that controls speech and Felipe did mention an express of aphasia, you can't communicate, can't understand what are the more common symptoms and signs that you see in both your space as well as out in the community. Are there some forms of aphasia that are more frequent than others?

Denise Vargas:

Living with aphasia is commonly compared to being in a foreign country. You don't speak the language, so it's very difficult to understand people what they're saying and to respond to questions, to even read signs. The symptoms that we see do depend on the extent of the injury and also where exactly in the brain it affected, but the most common symptoms would be, for example, inability to follow conversation, or using incorrect or unrecognizable words, as well as unable to read and comprehend written language and difficulty even maybe writing your name and your address.

Dr. Jonathan Fialkow:

Denise does the individual know that they're unable to, if they come out and you're talking to someone and they start coming out with words that don't make sense, is the person aware that those words are inappropriate or not?

Denise Vargas:

Not always but it, since it is a language deficits, they do know for the most part, what is going on with them, yes.

Dr. Jonathan Fialkow:

Felipe and I appreciate that. Is aphasia always associated with a cognitive impairment can then happen in an isolation?

Dr. Felipe de los Rios:

Yeah, it can definitely happen in isolation as well. There's many causes for it. But for example, specifically stroke always happens very suddenly. A person is fine and then all of a sudden there isn't, and when a stroke happens it can injure it specific, very pinpoint areas of the brain. You could potentially just have problems with understanding language or just problems with expression, but you understand fine. It can be very isolated and the damage can be very, very specific. But there's other conditions that affect the brain in a more global way. And then you have other things that are affected as well and not just language. For example, you can have this as part of a progressive neurologic degenerative conditions, for example, Alzheimer's.

Dr. Felipe de los Rios:

You can have that in the context of a lot of severe short term memory loss, or you can have it in context of other forms of brain injury problems, like for example, you can have it as part of TBI and you can have problems with multitasking and paying attention. And then there's other things that go with it. Or front of temporal dimension, which is another form of a progressive neurological commission, where you can have behavioral problems and problems with executive functioning. So just planning ahead, managing tasks, doing mathematical problem. I mean, it can all be together with language.

Dr. Felipe de los Rios:

It can present in different ways. And for first... Do you have another question before that regarding just, word finding problems. Sometimes you're like, oh, I can't remember this and that. And I think we all have a little bit of that and that is normal as long as it's not affecting your day to day functioning. And you can definitely notice it more for example, if you are very anxious or your sleep deprived or your multitasking. And I think some of that is expected and not to worry.

Dr. Jonathan Fialkow:

Denise, again, you guys have both elaborated on aphasia, what it is, where it comes from and certain causes. As a speech pathologist what options do people have when they have aphasia and maybe split that up into, let's say the two main causes, which might be a stroke and then might be a cognitive decline or I'll leave it to you, which are, let's say the two main causes of aphasia that you deal with and are they managed the same from a speech pathology standpoint?

Denise Vargas:

Treatment for aphasia should start early and seeking out the services of a speech therapist is the most common approach. As a speech therapist, my role is to evaluate the patients and determine exactly what their deficits are, so that then we can develop goals that are functional for the patient realistic to address in the therapy sessions. We aim of course, to restore these deficits, which we mentioned in this case is more the verbal expression and the comprehension, the reading, and the writing, but also if it's a cognitive patient to include those goals as well.

Denise Vargas:

A huge part is educating them on strategies to assist in their everyday communication and also educating the family, which is helping them to communicate with their loved one that now has aphasia. It is important for them to know that the individual is the same person inside. And for the most part knows what's going on. If it's a true aphasic patient, we also develop home exercise programs so that the patient and the family can work at home because therapy, of course, isn't forever. And overall the main goal is to improve the quality of life for the patient.

Dr. Jonathan Fialkow:

You bring up a great point, which is the family could be part of the treatment and acceptance of the patient with aphasia, Felipe, following up on that, what communications do you have regarding the family member's role and acceptance of a patient who might develop aphasia?

Dr. Felipe de los Rios:

Yeah, I think what Denise mentioned is very important. And that's why partnering with speech language pathologists and therapists is very important because it also goes to the quality of life of both the patient and the family. Understanding what the barrier is and how to effectively communicate is very important. Sometimes some people can recover more and some others have a progressive disorder that will get worse, no matter what we do. The symptom can intensity and severity and prognosis can vary, but if the family understands what the problem is, and they can have a lot of patients on the communication piece, because it's much more difficult to communicate with someone who has aphasia, if you're trying to do things fast. And if you're throwing a lot of things at them at the same time.

Dr. Felipe de los Rios:

If you keep it simple and you keep it at a good pace and you take your time and you let them communicate the best way they can, usually that goes a long way of managing anxiety, frustrations, and people can enjoy understand what it is and then move forward from it. And for some patients, especially if there is naming or reading, sometimes you can use even, and Denise can talk more about this, but you can sometimes use, use like templates where there's pictures of common things. So you don't necessarily have to try to come up with the word, but you can point to what is that you want. And then you can make communication flow easier. There's different approaches and it really depends on what it is, what part of language is affected. And I've had patients that are able to sing, like for example, they have a hard time talking, but they can sing a lot better. And sometimes you can use tricks and things to circumvent the neurologic injury so that communication can flow better. I know Denise, do you have anything else to add to that?

Denise Vargas:

Yeah. If the residual deficits, progress or are on for life, then we could take the option of using alternative means of communication, device that can at least help them communicate their basic needs and wants. Fortunately smart phones now have so many tools, so many apps that Siri can become your best friend and do everything for you. Again, it depends also where the main language deficit is reading, writing, whichever it is, then we shape the therapy towards that.

Dr. Jonathan Fialkow:

That is interesting with the development of technologies that can also support these patients with these conditions, as well as you mentioned. If someone's aphasic and I'm asking this to Denise first, it depends on the cause of the aphasia to some degree, but what do you see the outcomes of the people you work with is it, they don't get worse, which is in and of itself can be okay, do people get better? Can people resume normal lives again, broad question, give us some of your experiences.

Denise Vargas:

So yes, people with aphasia can return to a normal life. But again it does depend on the severity of the aphasia and the diagnosis that cause the aphasia. If the residual deficits continue, then the strategies that they've learned with us are crucial. And in regards to going back to work, for example, it depends on the type of work that they have. Does that person have to interact all day and communicate, such as being a teacher that would be difficult. However, a patient that works as a male carrier, that doesn't really interact so much with people and doesn't have to communicate, yes, that is a possibility. I had a patient that had a stroke and was completely nonverbal and was not able to recover that, but she went back to living alone, driving with strategies and accommodations, go ahead.

Dr. Jonathan Fialkow:

I'm saying that particular case, the person cognitively was intact was going to communicate, but was still able to return to a normal, go back to work and have a good quality.

Dr. Felipe de los Rios:

I would add to that stroke in particular, that is one of the leading causes of aphasia generally does improve. And most of the improvement happens during the first six months to a year, depends on the severity. But the rule is that people get better as opposed to a progressive neurologic degenerative condition, such as frontotemporal dementia, primary progressive aphasia, or even if it's associated with Alzheimer's. Then those tend to rather get worse as time goes by.

Dr. Jonathan Fialkow:

Believe by stroke neurogenerative conditions, trauma obviously is in and of itself, not something very predictable, but do you see aphasia or the neurological conditions that can cause aphasia more prevalent in any groups? Is there a genetic component for some of these, are there any patterns that we see in populations?

Dr. Felipe de los Rios:

There can be, but thankfully the vast majority of them are not inherited conditions. But there is a small group of them and there are some genes that have been identified so it can follow different inheritance patterns. If there are multiple family members that have, or develop language problems later in life, it might be useful to screen for some of those genetic conditions. But the vast majority know there is no family history of this for most. And for stroke in particular, the people that would be at higher risk for that are those that have uncontrolled cardiovascular risk factor. One of them is, well, we divide them in modify mindful and non-modifiable and you, Jonathan you can actually tell us all the details about this, but older, it's a non-modifiable, but then if you have uncontrolled diabetes, uncontrolled blood pressure, hyperlipidemia, if you smoke during, blood quantic, alcohol don't do exercise, this group would be at higher risk for stroke cardiovascular disease and therefore aphasia.

Dr. Jonathan Fialkow:

It's well said, point we're talking about aphasia, which is a symptom, the result of another circumstance which is the stroke and what are the risk factors for stroke or as you elucidated. And we've certainly gone through another Facebook live sessions as well. Denise, do you see people who fully recover? Do you work with people and they really have full recovery, or generally for the conditions we discussed as well, it's more adapting to live with aphasia.

Denise Vargas:

It is possible for them to recover. I think if not I wouldn't be doing this. But many patients will have some residual deficits like I've mentioned, but they can get to the point that they are functional in their communication with strategies. In rehab we focus here on helping live successfully and helping them to return to participate in all or most of their activities as close to independent as possible.

Dr. Jonathan Fialkow:

I'm going to ask you guys a couple of quick questions, some of them coming from the audience, and again feel free to take it the way you wish. Felipe, have we seen in any increase or is there a correlation with aphasia over the last two years specifically related to either COVID or the COVID vaccine?

Dr. Felipe de los Rios:

Not so much with the COVID vaccine, but COVID can increase the risk of stroke. Thankfully, the increased risk is small. Most of the case larger studies have shown that stroke can be associated with COVID 19 in about between one and 4% of the cases that are diagnosed and followed. There's a lot of mild cases that we never necessarily diagnose because they don't have symptoms or so. So it's probably even lower than that. But any effect can increase not only COVID 19 other respiratory infections, even urinary tract infections can increase the risk of stroke and cardiovascular disease slightly within the next even six months or so from the infections. So there is some association there, thankfully it's not a super frequent occurrence, but not so much with that vaccine, no.

Dr. Jonathan Fialkow:

And Filipe as well, just like physical activity, physical exercise can decrease the risk of stroke and cardiovascular type of components and exercise decreases obviously aphasia, but stroke related because you're not having a stroke. What about mental exercises, crossword puzzles, things like that. Is there any truth at reading and keeping the mind active will decrease the chances of a cognitive decline?

Dr. Felipe de los Rios:

Yeah, absolutely. One way of looking at this is what we call cognitive reserve. And you can imagine, it makes intuitive sense. If you get symptoms, as you lose brain tissue brain function from whatever process, it may be stroke, aging, genetics, and the narrative neurologic conditions, symptoms because you're losing neurons and brain reserve. But if you have more brain reserve, then you have a higher margin where you can lose some brain cells, but you're still able to function well because you have a higher cognitive reserve. So you can get higher cognitive reserve by, we know more studies, higher level of education being cognitively active, all of that keeps your cognitive reserve higher and you're able to tolerate better a brain injury. Yes, I would say there is truth to that.

Dr. Jonathan Fialkow:

Denise, a question for you, if you're comfortable answering, and I'm going to ask Felipe as well, any components of diet that can aid in avoiding aphasia, avoiding conditions for aphasia and treating aphasia. And to that end, any supplements that have been shown to have any benefit in people with components of aphasia

Denise Vargas:

That I'm not aware of. I would refer to Dr. De los Rios.

Dr. Jonathan Fialkow:

Not part of what you use in speech therapy service?

Dr. Felipe de los Rios:

No specific supplement, but eating well goes a long way. I mean, you're going to absorb nutrients and vitamins and everything a lot better when you eat well, because if there's other cough factors that are in the food that allow you to absorb then nutrients better than just taking a vitamin. I would never recommend replacing a good balanced diet by just taking a multivitamin, which some people kind of prefer that. So I'm taking a multi mean I'm safe. That doesn't really work that way. But there are some diets that have been associated with lower risk of cardiovascular disease so there's the dash diet from American Heart Association. And Jonathan, I would give this back to you as well as the next part on this. I want to hear your thoughts, but dash diet, the Mediterranean style diet can help as well, low fats, low sweets, more fruits and veggies, but what do you think, Jonathan?

Dr. Jonathan Fialkow:

If you really look at the confluence of all the diets that are purported to have cardiovascular benefit, I think the reality is avoid processed foods and refined foods and specifically simple sugars and starches and everything else becomes in the background but if you avoid things that have a lot of artificial components in them, and then the simple sugars and starches, which can create inflammatory state, you're probably going to be good to go. And all the diets out there, Mediterranean dash, even Keto, they're just different manipulations of that message. And the reason is they do decrease the inflammation in your blood vessels and the inflammation in your body, thus decreasing your risk of cardiovascular disease, stroke, and heart attack. Appreciate that opening there, Filipe. Last question and I'll ask both of you and then give you a chance to add, to either reiterate or anything we missed.

Dr. Jonathan Fialkow:

And it's a tough question and if you're speaking to an audience who's healthy, when we have a moment where you forget where you put your keys, or you can't remember a word or a name that you know, you should have, how do we advise to differentiate between a normal thing that happens again, maybe stressed, maybe the brain's filled versus something that might be a sign of getting a checkup. When would you advise someone seek an evaluation by a primary care doctor or a neurologist is that a fair question, but how would you address that? And I'll start with again, Filipe.

Dr. Felipe de los Rios:

I think it's a very fair question. The first thing that I would say is listen to your family members and friends, because the vast majority that I think of people who truly have an underlying condition, when you see them in the office is doc, I have nothing, I am fine. It's my relative, my wife, my friend, or who thinks I'm crazy, but I'm fine. I would pay attention because I would say that is that those are the ones that we worry about the most. And part of that is you lack the insight. The disease process itself might make it hard for you to realize that you actually do have a problem, but I would say pay attention to your friends and family as to what it is that they are noticing. Don't disregard that.

Dr. Felipe de los Rios:

And then if you are having a lot of issues with word, finding with memory pieces, I do think it's worth having a checkup or thinking about it. Many times it is that you might not be sleeping enough, your sleep pattern might be off. You might have too much on a plate. It might be stress. It might be anxiety, but all of those things there could be managed, could be improved. It could improve your quality of life. So if it's bothering your day to day, if it's affecting you on your day to day functioning, I think it's worth taking a look at. If it's just the occasional word that you forget here and there and so forth, but it doesn't really affect you on your day to day. I don't think that necessarily needs a visit.

Dr. Jonathan Fialkow:

And there's nothing wrong with keeping up on your regular checkups with primary care doctor anyway. And Denise, and answer that and answer it as you, as you see fit, but also with a little spin on do you see patients who don't think they have a problem, but the family members but you know, they do absolutely in denial component.

Denise Vargas:

Yeah. Absolutely. And sometimes we have to challenge them and let them make the mistakes so that they see, oh, okay. Maybe I do need this therapy. And the family, like we said before is huge component in the therapy process.

Dr. Jonathan Fialkow:

Any final messages or anything you want to bring up that we didn't bring up, I'll start with the Denise.

Denise Vargas:

Yeah. Just to say the process is takes time. If a patient is having aphasia due for example, to a stroke, but with appropriate care from the physicians, from the rehab team and of course the family we could see, and we have seen here in Baptist amazing results. It takes patients and the number one question patients ask is when am I going to get better? When am I going to go back to do doing everything I used to? And we always say, every patient is different, but it takes time.

Dr. Jonathan Fialkow:

We don't know much about the Bruce Will's experience other than it being a catalyst for discussion. But clearly, if you are as an individual or family member of yours, we treat every case individually and customize the approach. Filipe any similar final thoughts or anything.

Dr. Felipe de los Rios:

I would just say, be aware that this is a symptom of an underlying disease. Be patient, be kind when you encounter people, anywhere in your life as you go that has problems with language. Sometimes we tend to want to do everything fast and react and but be understand that there's people that have this as a symptom of an underlying disease and be patient.

Dr. Jonathan Fialkow:

If you have a comment or a suggestion for future topics, please email us @baptisthealthtalkatbaptisthealth.net that's Baptist Health Talk @baptisthealth.net. We'd love to hear from you. Thanks for listening and stay safe.

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