Symptoms of aphasia
Aphasia affects language in different ways. Symptoms vary by person and the severity of damage to the brain.
Aphasia can affect:
- Speaking
- Understanding spoken language
- Reading
- Writing
- Numbers and math
- Some people may have trouble with one aspect of language, or many of the above.
Aphasia symptoms often fall into overlapping language areas. They can also change over time and look different depending on the person and what caused their aphasia. Aphasia does not impact a person’s intelligence
Symptom severity
Aphasia symptoms can range from mild to severe. These symptoms can also change over time. How severe your aphasia is should not be considered a diagnosis. Instead, it’s a description of where your aphasia falls on a spectrum.
Mild aphasia
People with mild aphasia might process language more slowly, have a hard time finding words, and need extra time to respond. They may experience:
- Trouble understanding long messages
- Needing a little extra time to understand and respond to spoken messages
- Difficulty finding words to express or explain an idea
- Putting words in the wrong order or substituting the wrong word/part of a word when talking. (For example, calling a “train” a “car”.)
- Difficulty responding to questions on the spot
Severe aphasia
People with severe aphasia may not speak very much, might have a hard time understanding others, and may have a very hard time reading or writing.
They may experience:
- Trouble understanding spoken messages
- Little to no ability to read or write
- Unreliable in responding to “yes and no” questions
- Unaware of own errors
- Using a combination of words and jargon that is not understood by others
- Little or no speech
Difficulty with spoken language
Aphasia can make it difficult for someone to speak. In fact, difficulty with spoken language is what defines aphasia. How easily someone with aphasia can speak is called “fluency”.
In mild aphasia, a person might only have a little trouble speaking, such as finding the right word. A person with severe aphasia might not be able to communicate through speech at all. They may say the same word over and over (perseverate), but can use different intonations to convey what they mean. Some people with aphasia may speak in long sentences, but the words don’t make sense together, or might not even be real words.
Some of the most common areas of impairment are:
- Repetition: inability to repeat words/phrases
- Word-finding: difficulty with thinking of the right word, or having the word “on the tip of your tongue”
- Agrammatism: difficulty with sentence structure, word order and grammar
- Slow, halting, and/or laborious speech
- Word errors, including substituting sounds in a word, or using the wrong word
- Use of non-words: invented words that have no meaning
- Perseveration: using the same word, or few words, repeatedly. Some people use the same word with different intonation to convey different moods and meanings.
Not everyone who has aphasia will be aware that they are having trouble speaking.
Difficulty with reading comprehension
A person with aphasia may have trouble understanding written words, sentences, or longer texts. A speech pathologist may call this alexia. This may be true even when their vision has not been affected.
Some examples of this include:
- Reading more slowly than before having aphasia
- Having a hard time understanding complex information
- Having a hard time with longer texts or complex sentences
- Finding it easier to read and understand main (content) words
- Having a hard time with “functor” words (articles, conjunctions)
- Being able to recognize whole familiar words, but not being able to sound out words letter-by-letter
- Difficulty reading aloud
- Difficulty summarizing and/or comprehending what is read
- Similar words might be confused (e.g. couch and crouch)
Not everyone who has aphasia will have trouble reading.
Most people with reading comprehension issues will usually be able to understand spoken language on a similar level. Some people may find it easier to read than to understand when people speak. Others may find the reverse to be true.
Difficulty with language comprehension
People with aphasia may have a hard time understanding spoken language, such as conversations or instructions. This may true even if they can hear clearly.
Some people with aphasia are able to understand spoken language with little or no difficulty. Many people are able to comprehend as long as the messages are clear and simple. Some people have a severe impairment and are not able to understand verbal language.
The primary area of the brain that is responsible for language comprehension is Wernicke’s area, usually found in the left hemisphere. People who have had strokes and brain injuries impacting Wernicke’s area are likely to have difficulty with understanding language.
Difficulty with language comprehension is dependent on the types of aphasia. Every person with aphasia is different.
Difficulty with written comprehension
People with aphasia may have trouble writing. This can be called dysgraphia or agraphia. People with aphasia might experience difficulty with writing that ranges from none at all to severe.
This can look like:
- Having a hard time finding the right word when writing
- Having trouble writing longer or more complex information
- Trouble spelling long words
- Writing without grammar or sentence structure
- Not being able to write at all
- Some people will find writing easier than speaking, or the reverse.
Agrammatism
Agrammatism means it’s hard to use basic grammar and syntax, or word order and sentence structure. It is a common feature in people with aphasia, especially Broca’s (non-fluent) aphasia.
People with aphasia are often able to use “content” words like nouns and verbs. However, they find it difficult to use “little” words, or function words, like “the”, “in”, or “is”.
It can also be hard for people with aphasia to use grammatical structures and word “inflections.” Inflections are how we change a word to change its meaning or tense.
Agrammatism also makes it hard to put words in the right order.
Because of this, people with aphasia often speak in mostly nouns and verbs. This is called “telegraphic speech”, because it resembles the writing that was used in telegrams. For instance, someone with aphasia might say: “Daughter go store, buy ice cream.” It is easy to understand the main message although it is not a complete sentence.
Dysprosody
Dysprosody means a person speaks with an atypical rhythm, intonation, melody, or start/stop pattern. People with dysprosody may have halting speech, speak in a monotone, or don’t talk in a typical speech rhythm. To others, it can sound like their speech is flat or unusual.
Dysprosody is most common in non-fluent, or Broca’s aphasia. Dysprosody is also very common in people with apraxia, which can often co-occur with aphasia.
Paraphasias
When someone has paraphasias, they will make word or sound substitutions. This means they might say the wrong word or use sounds that do not form the word they mean to say.
There are three types of paraphasia:
Phonemic (literal) paraphasia – The person uses a different sound, but the stated word resembles the word they mean to say. (E.g.: “dat” for “hat” or “tephelone” for “telephone)
Verbal (semantic) paraphasia – The person will use an entirely different word that has a similar meaning. (E.g. “son” instead of “daughter”.) They might sometimes use a word that is only loosely connected, or not related at all. The word they use will always be a real word.
Neologistic paraphasia – The person will use non-real words instead of the word they mean to say. These invented words don’t sound like the intended word. They also don’t mean anything to the user. (E.g. “spralah” for “drink”.)
