Aphasia Awareness Month Interview with Kenneth Heilman, M.D.

For a devastating language disorder that affects almost two million people in the US alone, about 85 percent of people in a national survey have never heard the term “aphasia.” More common than Parkinson’s disease, cerebral palsy, or muscular dystrophy, it does not discriminate according to age, race, or gender. With June being Aphasia Awareness Month, we asked Kenneth M. Heilman, M.D., to help us get the word out.

Heilman, who is an expert in language and speech disorders, was Chief of Medicine at NATO Hospital in Turkey during the Vietnam War and currently is a Distinguished Professor Emeritus of Neurology at the University of Florida (UF) and a staff neurologist at the Malcom Randall Veterans Affairs Medical Center. Heilman has also been a member of the Dana Alliance for Brain Initiatives since 2003.

Aphasia is more common than other well-known brain disorders, with an estimated 180,000 people predicted to develop it each year. Why do people know so little about it?

KH: In neurology, there are several means by which disorders can be classified including by signs and symptoms, as well as by pathology. Aphasia is a sign or a symptom and can be caused by many diseases, such as stroke, Alzheimer’s, and other degenerative diseases, as well as traumatic brain injury and brain tumors. In general, the public is more informed about the names of the diseases than the names of signs and symptoms.

One of the symptoms that people do recognize is memory loss, and often, whatever the cognitive defect with which a person is suffering, family and friends will call this disorder a “memory disorder.” For example, a patient with a form of Alzheimer’s disease called posterior cortical degeneration may have an inability to recognize well-known faces as their first symptom. It is unlikely that this patient and his or her family will come in and complain about “prosopagnosia,” but rather say, “He forgot what his family looks like.” This is why clinics that evaluate and treat people with neurobehavioral disorders are usually called, “Memory Disorders Clinic.”

Stroke is a main cause of aphasia, with about 25 to 40 percent of stroke survivors developing the disorder. A recent study on regenerating brain tissue immediately after a stroke may suggest an eventual new therapy. How promising are these new findings?

In neurology clinics, we are now seeing many patients who have an aphasia from degenerative diseases. For example, there are patients with Alzheimer’s disease who are impaired in finding names and repeating, and this disorder is called “progressive logopenic aphasia.” Others have degenerative disorders that causes them to have trouble finding and understanding words (semantic dementia), and even others can hardly produce any words (primary progressive non-fluent aphasia). Hence, stroke is not the only cause of aphasia.

“An ounce of prevention is worth a pound of cures.” To help prevent aphasia, disorders such as high blood pressure, hyperlipidemia, diabetes, and cardiac arrhythmias should be treated. If someone does exhibit the sign of a stroke, they should immediately be seen. If it is not a hemorrhage, they should be treated with a clot-busting medication (tPA) and, if possible, have the clot removed with a retriever.

Even with these new treatments, there are many patients with strokes who have a residual language defect. There is now much exciting research about repairing damaged brain tissue by using human fetal brain-derived neural progenitor cells. However, this is still at the experimental stage. Fortunately, many people with aphasia can be helped with speech therapy.

Even though the cause is from injury to the brain, the symptoms of aphasia vary based on the individual. There are eight types of aphasia as we know it, but it’s possible there are other varieties that have yet to be defined. What are the differences, and is there a kind of therapy that has proven to be more successful than others?  

When neurologists, speech therapists, and neuropsychologists test patients for aphasia, they listen to their spontaneous speech. This is to determine if they are fluent or not fluent and the types of errors they make (e.g., function words not used, errors in the speech, sounds of words, use of incorrect words, and trouble finding words). They also test their ability to understand speech, to repeat sentences, and to name objects. Based on the results of these tests, patients are classified into a type of aphasia.

For example, patients with Broca’s aphasia are non-fluent, fail to use grammatical words, are impaired in naming and repetition, but they can comprehend. Patients with Wernicke’s aphasia are fluent but make many errors in the words they use and even use non-words. They have impaired comprehension, and impaired naming and repetition.

There are many forms of speech therapy that have demonstrated some success, and often the specific therapy is based on the patient’s major defects. There have been very few studies, however, that have compared different forms of therapy.

In your role as director of the Memory Disorders Clinic and the Center for Neuropsychological Studies at UF, is aphasia on your radar as a research initiative?

Yes! Aphasia is a major cause of disability, and I see many patients with this disorder. If you go to Pubmed on your computer, type in “Heilman K” and “aphasia,” you will see that I have been an author on more than 80 papers about aphasia. These include describing new forms of aphasia and treatments. However, currently we have no funded research programs on aphasia.

Are there impairments other than speech that are associated with aphasia?

Aphasia from stroke is often associated with many other disorders including impairments in reading (alexia), writing (agraphia), calculating (acalculia), and even knowing how to use tools (apraxia). But, there might be many non-verbal activities that these patients can perform. For example, Bruce Miller, M.D., who is director of the Global Brain Health Institute, described several patients with aphasia, from degenerative diseases, who developed into wonderful artists. In addition to treating the aphasia, it is important to find activities that patients can perform and enjoy. This helps give their life more meaning.

To learn more about his continued dedication to cognitive research and education, you can listen to this “People Behind the Science” podcast featuring Heilman. Help promote this awareness month with the National Aphasia Association’s #TalkAboutAphasia challenge. If two million people in the US are experiencing this disorder, the goal is to make two million more people “aphasia aware” by talking about it.