Aphasie

Aphasia is a loss or impairment of language caused by damage to the language areas of the brain, in most people the left hemisphere. It can affect speaking, understanding, reading and writing in any combination.

Aphasia is not a loss of intelligence, and it differs from slurred speech due to weak muscles (dysarthria). Its commonest cause is stroke, after which about a third of people have it. Recovery is fastest in the first 3 to 6 months but can continue for years with practice.

Symptome

• Struggling to find words, or using the wrong word or a made-up word
• Short, effortful, telegraphic sentences (non-fluent or Broca type)
• Fluent speech that makes little sense, with poor awareness of errors (Wernicke type)
• Difficulty following conversation, especially in groups or when speech is fast
• Problems with reading, writing, spelling or numbers
• Inability to repeat phrases
• Slowly worsening word-finding over months or years in primary progressive aphasia

Ursachen und Risikofaktoren

Sudden aphasia is caused by ischaemic stroke or brain haemorrhage in the great majority of cases. Head injury, brain tumours, brain infections such as herpes encephalitis, and abscesses can also damage language networks. Brief episodes occur with transient ischaemic attacks, seizures and migraine aura. A gradual onset points to primary progressive aphasia, a form of frontotemporal degeneration or atypical Alzheimer's disease in which language fails first.

Wie es diagnostiziert wird

• Emergency stroke assessment: Sudden language loss is handled as a stroke until proven otherwise, with immediate CT or MRI.
• MRI of the brain: Shows the site and size of damage, or patterns of shrinkage in progressive forms.
• Speech and language therapy assessment: Standardised testing of naming, fluency, comprehension, repetition, reading and writing defines the type and severity and sets therapy goals.
• Vascular work-up: Carotid imaging, heart rhythm monitoring and echocardiography to find the cause of a stroke.
• EEG: When seizures are suspected.
• Neuropsychological testing and PET: In suspected primary progressive aphasia.

Behandlungsmöglichkeiten

• Treating the cause: Clot-dissolving drugs or thrombectomy for acute stroke, surgery for a tumour, antivirals for encephalitis.
• Speech and language therapy: The core treatment. Evidence favours higher intensity, several hours a week, tailored to everyday needs.
• Intensive comprehensive programmes: Blocks of several weeks combining individual, group and computer-based therapy. They can help even years after a stroke.
• Communication partner training: Teaching family to use short sentences, writing, gesture and pictures. It improves communication reliably.
• Apps and communication aids: Useful for home practice and as a back-up means of expression.
• Brain stimulation: Transcranial magnetic or direct current stimulation alongside therapy is under study, with modest and inconsistent benefit so far.
• Mood support: Depression is common after aphasia and is treatable.

Wenn es dringend ist

Sudden difficulty speaking or understanding, with or without facial droop or arm weakness, is a stroke emergency. Call an ambulance immediately: clot-removing treatments work only within hours. Never wait, and never travel, to have new aphasia assessed.

Reisen nach Türkiye zur Behandlung

Once you are medically stable, a block of intensive therapy is something a visit can offer, typically 2 to 4 weeks. Language is the limiting factor: therapy must be in the language you use daily, delivered by a therapist fluent in it, so check this before anything else. Gains depend on continuing practice at home. Progressive aphasia needs long-term local follow-up; a visit can only clarify the diagnosis.

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