What is aphasia? After Bruce Willis’ diagnosis, Milford doctor weighs in

News of actor Bruce Willis’ aphasia diagnosis sent shockwaves through Hollywood last week and put a spotlight on the relatively common — yet mostly unknown — language disorder.

Willis’ family announced on social media that the “Die Hard” actor is stepping away from acting after being diagnosed with aphasia, which is impacting his cognitive abilities.

“I think it’s one of the more frustrating neurologic symptoms, because so much of our life, for many of us, is dictated on being able to communicate and express ourselves, and to struggle with that is really problematic,” said Dr. Andrew Ferree, a neurologist with Milford Regional Physician Group.

What is aphasia?

“Aphasia is a problem with language, and that can manifest in many different ways,” Ferree explained. “It can manifest as a trouble understanding, or it could be trouble producing words and language, or it can be both.”

The disorder affects about two million Americans and is more common than Parkinson’s disease, cerebral palsy or muscular dystrophy, with nearly 180,000 Americans acquiring aphasia each year, according to the National Aphasia Association.

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“It can happen for different reasons, and it can happen to varying degrees,” Ferree said.

What are the symptoms?

There are two broad categories of aphasia — fluent and nonfluent — and several types within these groups, according to the National Institute on Deafness and Other Communication Disorders.

Wernicke's aphasia is the most common type of fluent aphasia and can cause people to speak in long sentences that are difficult to follow and may include unnecessary or even made-up words.

People with Broca’s aphasia, the most common type of nonfluent aphasia, may understand speech and know what they want to say, but frequently speak in short phrases produced with great effort, according to the NIDCD. Another type, global aphasia, may result in extremely limited ability to speak or comprehend language.

Aphasia isn’t one-size-fits-all, according to Ferree. He said the effects can be mild or profound, sometimes even happening transiently for a couple of hours or days following a seizure, migraine or mini-stroke.

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“The other flavor would be progressive, so there can be — and I think this is probably the case with Bruce Willis — a progressive disease that is fairly specific for language that gets worse over time,” he said. “And that can be something called a primary progressive aphasia.”

What causes aphasia?

Primary progressive aphasia is rare and happens when sections of the brain that are responsible for speech and language shrink, or atrophy, according to the Mayo Clinic.

The deterioration in brain tissue is often associated with dementia or Alzheimer’s disease, according to the Cleveland Clinic. Ferree said there are also rare forms of progressive aphasia that target children and can be related to seizures.

Generally, however, the most common cause of aphasia is a stroke. The National Aphasia Association reports that about 25% to 40% of stroke survivors develop aphasia. Other causes include head injuries and brain tumors.

As the risk of stroke, Alzheimer’s or dementia increases with age, so does the risk of aphasia, Ferree explained. However, he noted there are conditions that can cause aphasia at any age, and the Cleveland Clinic reports that primary progressive aphasia is most often seen beginning in patients in their 50s and only rarely after age 75.

How does it impact patients?

Aphasia’s day-to-day impact depends on the patient’s individual circumstances and lifestyle, Ferree said.

“If you are someone that lives their life as an actor, working on-screen and needing to memorize lines and have expression and things like that, it can be debilitating,” he said. “If you are someone that is fairly isolated and somewhat of an introvert and don't get out that much and don't need to communicate with other people that much, you could have major deficits and not have that big of a problem.”

More: Gabby Giffords on communicating through aphasia, with Karina Bland and Dr. Fabi Hirsch.

However, the disorder can take an “enormous” emotional toll on patients and their families, Ferree said.

“It can be devastating,” he said. “For the patient, it can be extremely frustrating to know what they want to say, to be able to point to what they’re trying to explain and not be able to get the words out.”

Likewise, language problems can be terrifying and frustrating for families, especially if it’s not clear what’s causing the aphasia, he said.

Are there treatment options?

Ferree said aphasia patients can seek out speech therapy and assistive devices like communication boards, which allow them to point to common phrases to let family members and caregivers know when they need something or how they are feeling.

The outlook depends on the type of aphasia and the cause, according to Ferree. For example, stroke survivors with aphasia may improve their communication abilities over time, while primary progressive aphasia patients will continue to decline.

A sudden change or impairment in speech warrants emergency attention, as it could be a sign of stroke, Ferree said. He also advised seeing a primary care provider if you’ve noticed a gradual change in your speech or have concerns about your language.

“The sooner you get it evaluated, the more likely that you’re going to get better results and better help,” he said.

Abby Patkin is a multimedia journalist for the Daily News. Follow Abby on Twitter @AMPatkin. She can be reached at apatkin@wickedlocal.com.

This article originally appeared on The Milford Daily News: Milford Regional doctor explains aphasia after Bruce Willis' diagnosis