What is aphasia, the condition that prompted Bruce Willis to retire?

Aphasia can be devastating for patients, disrupting their everyday communication

On Wednesday it was announced that Bruce Willis will step away from his decades-long movie career in the wake of a recent aphasia diagnosis. His ex-wife, Demi Moore, shared the news in an Instagram post, saying the disease was "impacting his cognitive abilities".

Here’s what we know about the condition.

What is aphasia?

Aphasia is a constellation of symptoms that make it difficult or impossible to express or comprehend language. The disorder stems from damage to the parts of the brain that are responsible for language functions, which are typically housed on the left side of the brain. Aphasia can be devastating for patients, disrupting their ability to take part in everyday life.

All cases of aphasia stem from neurological changes in the brain. Strokes resulting in brain damage are the number-one cause, says Dr Shazam Hussain, director of the Cerebrovascular Center at Cleveland Clinic in Ohio, USA. But it can also be caused by degenerative conditions such as dementia and Alzheimer's disease. Other triggers include brain injuries, including from severe blows to the head; brain tumours; gunshot wounds; and brain infections.


How does aphasia manifest itself?

There are several types of aphasia, all of which have an outsize impact on patients. Those with expressive aphasia may struggle to speak in complete sentences or find the words they are looking for. “It’s very frustrating,” Dr Hussain says.

They may also have trouble remembering the words for certain objects, says Dr Borna Bonakdarpour, a behavioural neurologist, which leads them to pause for long periods of time, often in the middle of their sentences.

Other patients have receptive aphasia; they may experience intense confusion when people talk to them, and they may fail to follow conversations.

A person can experience receptive aphasia and expressive aphasia, but some experience only one or the other.

Global aphasia is a condition in which all four of the main language modalities – speaking, understanding, reading and writing – are severely impaired, leaving a person unable to communicate, said Karen Gendal, a speech-language pathologist.

Are there warning signs?

While aphasia occurs mostly in patients over age 65, it can develop at any age. The condition can come on suddenly, particularly in the wake of a stroke, but some people with aphasia develop it gradually. “Their sentences become shorter and shorter,” Hussain says. “Then, they get to a point where they have difficulty expressing any language at all.” Patients may also find that their ability to read or write worsens over time.

“Everyone can have periods where they’re busy or distracted or forgetting a word,” Hussain said. But if your inability to communicate holds you back from day-to-day activities, keeps growing more severe or, crucially, if friends and family point out a pattern that you are not aware of, seek medical attention, he said. People with aphasia typically lose insight into their interactions with others.

“If it’s really preventing your communication, that’s when you should be worried,” Dr Bonakdarpour says. “If you’re forgetting a word here and there, that’s okay.”

Are there ways to prevent aphasia?

There is no guaranteed technique to prevent aphasia, but you can take simple steps to boost your brain health in general, Dr Hussain says. Eat a balanced diet, exercise regularly and watch out for stroke risk factors like high blood pressure, high cholesterol and diabetes. Smoking can also elevate your risk for stroke and aphasia. “The healthier you can keep your brain overall, the less a chance of these or other issues of the brain developing.”

Are there treatments?

While there is no cure, patients with aphasia can seek speech and occupational therapy.

The National Aphasia Association in the US recommends two primary methods of treatment. Impairment-based therapies involve evaluating and then targeting specific reading, speaking and writing skills through activities like fill-in-the-blank exercises and training patients to remember synonyms and antonyms. Communication-based therapies focus on rebuilding conversation and cognition skills that patients use to participate in everyday activities; they may role-play scenarios like ordering a coffee or speaking on a video call, says Gendal.

In Ireland, a registered charity, Aphasia Ireland, promotes awareness of the disorder. It also operates a network of support groups for people with aphasia and their carers. – This article originally appeared in the New York Times