Aphasia is an acquired disorder of language. It can manifest in various ways, including difficulty speaking or difficulty understanding speech or language. Stroke is the most common cause of aphasia with up to 40% of stroke patients experiencing some sort of aphasia. Depending on the nature of the injury (e.g., stroke, tumor, trauma), aphaisa can be temporary or permanent. Even in cases of severe stroke, some types and aspects of aphasia are treatable, with language improving over time. While language does not usually return to pre-morbid functional levels, many people with aphasia benefit greatly from speech therapy.
The following videos demonstrate two different types of aphasia – Broca’s aphasia (or non-fluent) and Wernicke’s aphasia (or fluent). Notice the differences between the aphasias.
Here is the video PBS recently made about Parkinson’s disease called My Father, My Brother, and Me. From what I’ve watched so far, it’s done a good job putting a face to Parkinson’s disease while also focusing on the research and clinical aspects of it.
Yesterday I posted a video clip about Clive Wearing. Here is the first part of a different documentary about Clive. This video goes more in-depth about his condition. Clive is sometimes referred to as the man with the shortest memory. Not only were his two hippocampi destroyed, but also surrounding areas of the his temporal lobes as well as portions of his left frontal lobe. He also remembers very little from before his illness, which is quite rare; this condition is called retrograde amnesia. Clive lives in an ever-present now, without connection to past or future. Come back for more about his case in the coming days.
Clive Wearing is a 70 year old British man who contracted herpes simplex encephalitis in 1985. The virus destroyed his hippocampi bilaterally (as well as surrounding areas). He has complete anterograde amnesia and can only remember up to about 20 seconds. He retained the ability to play the piano and conduct a choir (which he did previously to his illness); this is because this procedural memory involves different areas of the brain, including the basal ganglia and the cerebellum. I’ll revisit this case over the coming days. Meanwhile, here is a clip from a BBC production that presents part of Clive’s story.
Sen. Ted Kennedy, one of the last of the siblings of JFK and Bobby who is alive recently was diagnosed with a malignant brain tumor in his left parietal lobe. His first symptom was a seizure. As soon as I heard that he had had a seizure I started wondering about a tumor. There aren’t too many reasons someone would have a seizure out of the blue at the age Sen. Kennedy is. Too much stress possibly could cause a seizure as could an adverse reaction to certain medications but those are not likely. Children often can have a seizure at random with no other symptoms or no specific underlying problems but it’s very rare for older adults to experience seizures without very specific reasons, such as a brain tumor (it’s very common to have seizures if you have a brain tumor).
Sen. Kennedy’s tumor, as stated earlier, is in his left parietal lobe. Depending on its specific location and size, the tumor could disrupt his ability to comprehend language (if it disrupts Wernicke’s Area). It could also affect his ability to integrate visual and motor information as well as affect his motor or sensory functioning on his right half of his body. All of those symptoms are speculative without neurological testing, of course, but the parietal lobes are involved in a number of functions, including sensory and cognitive integrative functions.
The good news is that this form of cancer – a glioma – does not spread to other parts of the body (although it could continue to grow in the brain). It is also treatable by resection and chemotherapy. Chemotherapy is far from an enjoyable process (it’s a treatment that practically kills people) but it can be very successful. While Sen. Kennedy’s prognosis is uncertain he could survive the cancer with relatively few lasting effects. I don’t think anyone can survive brain surgery and chemotherapy without at least some lasting cognitive deficits (although the deficits might be very hard to detect) but the outcome of gliomas is not always grim.
As people age, it is common for their brain white matter to change. These changes often appear as bright white spots on T2-weighted MR scans. These areas or spots of hyperintensity (i.e., white matter hyperintensities {WMH}) are also called leukoaraiosis (LA). Researchers are still investigating the exact nature and pathology of these abnormalities but our understanding of them is increasing. They most often seem to start around the lateral ventricles and spread from there, although it is possible to have punctate WMH throughout the brain white matter (i.e., WMH that are not connected to other regions). WMH on brain MRIs represent rarefaction of the white matter, including swelling, demyelination, and damage, although the exact nature and combination of the white matter changes is not known. These WMH can interfere with normal cognitive functioning, including processing speed, attention, inhibition, as well as global executive functioning (although these claims are still being investigated).
Other damage to white matter includes lacunes, which are little holes in the brain, much like the holes in Swiss cheese. They are caused by mini infarcts, or strokes, or other processes. Most of the time they are due to “silent strokes”, or strokes that are small enough that the person does not have any noticeable stroke symptoms. These lacunes can have similar impact on cognition as WMH. Both WMH and lacunes are related to vascular risk factors, such as hyper- or hypo-tension, diabetes, etc.
I read a good article on CNN that details some of the problems that veterans and health professionals face when dealing with TBIs acquired during military action. The article provides a good perspective of the “human side” of TBI.
I’ve posted about this topic before but felt that we should revisit it because so many veterans are affected by TBIs (as well as mental health issues). I don’t know the exact number of veterans affected by TBIs but studies have shown that >30% of soldiers and Marines have some sort of psychological issue related to their service in Iraq and/or Afghanistan. The military and the government are realizing how salient this problem is and will be.
“Congress included $900 million in the DoD’s supplemental budget fir fuscal years 2007 and 2008 to fund more mental health services, as well as more research on the effects of traumatic brain injuries (TBI) and treatments for TBI and post-traumatic stress disorder (PTSD)” (Monitor on Psychology, Sep. 2007, pp. 38-39).
The treadmill’s two belts can move independently and even in opposite directions. Doctors and researchers are trying to find any underlying intact neural circuitry by providing unique motor challenges to brain injury patients.
An article in the most recent Monitor on Psychology (published by the American Psychological Association) [here's a link to the article that is accessible for free online: Link) reminded me of something one of my professors in graduate school told our class a couple years ago. He is a clinical neuropsychologist who occasionally does some consulting for the military. After he returned from a consultation with the military he told us that between the war in Afghanistan and the Iraq war there had been 18,000 central nervous system (brain and spinal cord) injuries of soldiers and contract employees serving in those two countries. The majority of the injuries were minor and many were not combat related but there are still thousands of people with moderate to severe CNS injuries that were acquired in war zones. Quoting from the Monitor article:
"Psychologists, particularly neuropsychologists, are stepping in to assess the damage, help patients learn new strategies to compensate while their brains recover, and raise public awareness of the increasing number of servicemen and women with TBIs. In fact, 1,977 service members were treated for them at Defense and Veterans Brain Injury Center (DVBIC) sites from January 2003 to February 2007."
One reason for high rates of traumatic brain injury in the Iraq (and Afghanistan) war(s) is the improved (compared to previous wars) body armor and other life-saving devices. The downside to fewer fatalities is that there are higher rates of people with severe injuries who survive. The mild TBI rates are shown to be: "between 10 and 20 percent [in some surveys] of soldiers returning from deployments” (Source). It’s great to have fewer fatalities but TBIs can have profound effects on people. Clinical neuropsychologists can help people with TBIs learn how to best cope with their injuries as well as understand how their lives might be different and what they can do to compensate for any difficulties. Most people with mild to moderate TBIs seem to have complete or nearly complete recoveries; however, those with moderate to severe TBIs may have deficits, many very severe, that last the rest of their lives.
There can be myriad short-term problems associated with TBIs (e.g., mental slowing, memory problems, personality changes, concentration and attentional difficulties, etc.) but there are also long-term ones. Research has shown that a person with a history of multiple TBIs is more likely to get Alzheimer’s Disease in old age (well, the research actually shows that there is an over-representation of people with multiple TBIs in the Alzheimer’s population). There is a great need for clinical neuropsychologists currently and in the future to work with and help all of our war veterans who have acquired brain injuries.
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