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.
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 taking the patient’s history and with extended neuropsychological testing. Most people with PPA maintain ability early in the disease to take care of themselves, pursue hobbies, and, in some instances, remain employed. However, over time the disease injures communication ability and memory too severely to permit independent living.
A brain CAT scan or MRI can help diagnose a stroke. In some cases, for instance, if the course comes on quickly and an infection such as Creutzfeldt-Jakob is suspected, a lumbar puncture (spinal tap) 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 who specialize in cognitive testing and therapy may be helpful in mild to moderate aphasia by training the patient to use gestures or other methods to communicate. Counseling and training family members is helpful as well.
The prognosis (outlook) for 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 harmed 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 to 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 (www.aphasia.org) may be helpful, as well.