Q: My mother is 73 and in good physical health. In the past few
years, however, she has developed a worsening word-finding problem. This has
progressed to the point where sometimes she can barely get a sentence out. Other
times she is more fluent and can make herself understood or ask a question. She
has also exhibited signs of confusion and forgetfulness. I suspect she may be
depressed, but other than that I don't know what could be wrong. Her doctor
cannot find any pathology responsible for this. She has not had a stroke. She is
aware that she has this problem. Any thoughts?
You have noticed that your mother has aphasia, a disorder in
speech and language. There are other worrisome symptoms, such as confusion and
forgetfulness, and you mention that this problem has developed over the course
of a few years. The major causes of aphasia in older adults include stroke and
neurodegenerative diseases, such as Alzheimer’s disease.
A complete history and physical examination to evaluate your
mother for subtle neurological abnormalities is necessary. Medications that your
mother is taking, including prescription and over-the-counter medications, must
be reviewed to make sure that she is not suffering from an adverse drug effect
or from an interaction between two drugs. Alcohol use must be reviewed honestly.
Certainly your mother’s mood must be evaluated as well. Many persons are worried
that this is Alzheimer’s disease, but speech in early Alzheimer’s disease is
fluent. Strokes that affect the language center of the brain can cause aphasia.
Another possibility is that your mother may have Primary Progressive Aphasia (PPA).
This disease is diagnosed in the absence of a stroke by history and extended
neuropsychological testing. Most people with primary progressive aphasia
maintain ability early in the disease to take care of themselves, pursue
hobbies, and, in some instances, remain employed. However, over time the disease
impairs expressive and receptive communication ability as well as memory too
severely to prevent independent living. A brain CAT scan, or MRI, can help
diagnose a stroke. In some cases, for instance, if the course has a rapid onset
and an infection such as Creutzfeldt-Jakob is suspected, a lumbar puncture is
performed to examine the spinal fluid.
There is no specific treatment for aphasia caused either by
stroke or by PPA. Many hospitals or communities have aphasia support groups.
Speech therapists that specialize in cognitive testing and therapy may be
helpful in mild to moderate aphasia by training the individual to utilize
gestures or other methods to communicate. Counseling and training family members
is helpful as well.
The prognosis of aphasia in stroke and PPA are different. In
stroke, persons may improve over time; emphasis is on both speech therapy to
improve communication skills, and medication and lifestyle changes to prevent
further strokes. With PPA, although expression is affected early, receptive
skills (understanding speech) are impaired eventually. Memory is usually intact
early on although both short-term and long-term memory is impaired later on.
If your mother is living alone, then you and she may wish to
speak your local office of the aging, or a social worker, to determine if she
needs more assistance to live more safely at home for as long as possible. A
neurologist may help sort out the diagnostic issues. A geriatric clinic may be
better equipped to help you and your mother evaluate the need for therapy,
support groups, and social services, since impairments may worsen over time. The
National Aphasia Association may be helpful, and information can be found at
www.aphasia.org.
I hope you find these suggestions helpful.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/1/2009...#8965
