Bruce Willis' aphasia diagnosis draws attention to cognitive disorder

Until the recent news that Bruce Willis had been diagnosed with aphasia and was retiring from acting, many people were unfamiliar with the condition. Despite its low profile, aphasia is not uncommon.

Across Canada and the United States, it’s estimated that more than two million people are living with aphasia and its associated challenges in communication and in using and understanding language.

Aphasia affects language abilities, including listening, speaking, reading and writing. Some common language symptoms that occur in individuals living with aphasia are: Difficulty coming up with the right word. An individual might use a related word (for example, they may say or write “daughter” when trying to find the word “niece”) or even use a made up word (for example, say or write “pitsy” when trying to find the word “niece”).

Making mistakes in grammar or syntax such as omitting word endings. Examples include leaving off the plural “s” or “ed” to indicate past tense, or putting words in the wrong order, such as: “The cat was his ran house out.”

Needing more time to process what is said to them and to formulate a response.

Difficulty understanding individual letters, speech sounds or words when listening or reading, even though prior to the onset of aphasia, these letters, sounds and words were automatically understood.

For individuals with aphasia who use sign language, their ability to use and understand signs is also negatively affected. Some people with aphasia may also experience problems using and understanding nonverbal means of communication, such as gestures and facial expressions.

Aphasia is not a disease, but rather a consequence of damage to the language-dominant regions of the brain. This brain damage is typically caused by a stroke (interruption of blood flow to or within the brain), or sometimes by a traumatic brain injury, a brain tumour or an infection, such as meningitis. Stroke is the most common cause, with aphasia affecting approximately 30 per cent of stroke patients.

Aphasia is also a key component of a progressive neurodegenerative disease called primary progressive aphasia, a type of frontotemporal dementia.

Because the parts of the brain that support language also support other cognitive abilities, individuals living with aphasia may experience some difficulties in attention, memory and thinking skills like problem-solving or planning. People living with aphasia may be challenged in these other cognitive functions because we often use and understand language in concert with these other functions. For example, rehearsing out loud or using your inner mind’s voice to repeat silently the items you have been asked to pick up at the store.

There is great variability in the language symptoms experienced by individuals living with aphasia. For example, one individual may experience significant difficulties equally across all language modalities. Another person may experience difficulties primarily in their verbal output and few difficulties with understanding what is said, written or gestured.

Likewise, there is a spectrum of aphasia severity. Some people with aphasia may only be able to understand short, common words. Others may only experience comprehension difficulties when reading books or following complex podcasts that include, for example, technical jargon or complex stories.

Variability also is common among those living with aphasia who are bilingual or multilingual. One individual with aphasia might experience similar difficulties in all of their languages while another might struggle more in one versus another of their languages.

Regardless of the breadth and severity of the language symptoms, aphasia is challenging for those living with the language disorder, as well as for their family and friends. Having aphasia can make it difficult to complete daily activities like reading prescription medication labels, booking an appointment or using a phone.

Like Willis, many individuals with aphasia will not be able to remain in their vocation of choice. Aphasia also can lead to negative consequences for social roles, relationships and activities. Consider how many components of parenting involve language (listening to your child’s day at school, reading with your child, reprimanding) and how essential communication is to maintaining close relationships with family and friends.

Most leisure activities similarly involve language, whether it is reading for pleasure, watching movies or travelling. Because of these daily struggles, many individuals with aphasia also experience mental health issues such as depression.

However, there is help and hope for those with aphasia. Decades of aphasia research indicate there are many interventions to improve individuals’ language abilities and help them compensate for their language impairments. An important first step for getting help is seeking an assessment from a speech-language pathologist.

Given the various manifestations of aphasia, a comprehensive assessment is needed to determine its presence and an individual’s language and communication strengths and weaknesses. The assessment also will help the speech-language pathologist identify interventions that can help individuals living with aphasia and their family and friends achieve their language and communication goals.

In addition to assessment and intervention services, family and friends can find other ways to support someone living with aphasia.

By sharing his diagnosis of aphasia, Willis and his family are helping increase awareness of this complex and often debilitating language disorder. Increasing awareness among the public and health-care professionals is an important step in ensuring that individuals living with aphasia can participate in their community and receive appropriate health-care services.