The Wernicke's aphasia , Also called sensory aphasia or receptive aphasia, is part of the group of fluent aphasias. An individual with this type of aphasia Will have trouble understanding the language heard, or repeat words or phrases that others have said; While the pronunciation is going to be correct.
Therefore, Wernicke's aphasia is the inability to understand the words or Speaking producing a coherent meaning, Having preserved the articulation of speech sounds. In this way, there is a mutual lack of understanding between the patient and his interlocutor; Having this to make a great effort to understand the affected.
When a patient with this problem arrives for consultation, their speech speaks quickly and without cuts, which requires that the other person intervene to stop. In fact, the affected does not usually realize that what he says does not make sense and do not feel that there are problems in the dialogue (or attempt of dialogue).
According to Luria, this disorder has three characteristics:
- The first, which does not distinguish the different phonemes (The sounds of the tongue). That is, in order to hear and properly sound the sounds of speech, you must first be able to recognize the sounds existing in your own language. People with this problem are not able to isolate the characteristic sounds of their language and classify them as known phonemic systems.
- Defect in speech : Does not have problems to articulate the speech, however, when confusing the phonetic characteristics produces the"salad of words"(to utter words without connection with each other, giving rise to an incoherent speech, but without losing the fluency).
- Problems with writing : As a consequence of the problem of poor recognition of phonemes, it will not be able to evoke graphemes (graphic representations of phonemes, as a written letter).
Where are you from?
It may be acute (due to Traumatic brain injury , cerebral stroke, Neoplasms , Etc.) or chronic (concomitant with Alzheimer's ).
In Wernicke's aphasia the injured areas are found in the Parietal lobes And temporal regions of the dominant hemisphere (usually the left), depending on the severity of the deficit of magnitude of injury.
At first it was thought to be due to damage or malfunction in the Wernicke area , Where does your name come from. A Brain area Responsible for the processes of language comprehension, located at the back of the temporal lobe of the dominant hemisphere (usually the left).
It appears after the German neurologist Karl Wernicke associated in 1874 functions to this zone of the brain after studying patients with injuries.
However, it appears that the key deficits in this type of aphasia are not only due to damage in that area; But it is something more complex since:
- Most brain structures are involved in language in some way, that is, this function is not limited to a single place in the brain.
- It appears that most patients with such disorders have had a stroke or obstruction in the middle cerebral artery, which irrigates several areas of the brain such as the basal ganglia that can also influence language.
- Wernicke's aphasia seems to give rise to a number of different symptoms, each probably having a distinct neurological basis.
- In addition, there are researchers who have stated that lesions in this area do not directly connect with fluent aphasia; rather, they seem to affect the storage of sentences in memory from the time they are heard until they have to be repeated, also affecting the rhyme of Words (memory for sounds affected).
It has been suggested then that the main difficulties of this disorder come from damage to the medial temporal lobe and the underlying white matter. This zone is adjacent to the auditory cortex.
It has also been seen by alterations in some part of the upper convolution of the temporal lobe, affecting the connections with other nuclei responsible for language located in Occipital regions , Temporal and parietal (Timothy, 2003).
On the other hand, if the Wernicke area is damaged, but in the non-dominant hemisphere (usually the right), aprosody or dysprosy will appear. This means that there are difficulties in capturing the tones, rhythm, and emotional content of language expressions.
This happens because the right hemisphere generally takes care of the regulation of speech comprehension and production, affecting the interpretation and emission of intonation and rhythm.
Usually Wernicke's aphasia is usually due to a Stroke , Although it can also occur due to a closed trauma due to an accident.
In conclusion, it is best to consider the Wernicke area as a very important area in this type of aphasia, forming part of a much broader process and encompassing more structures and their connections.
Types
According to Rabadán Pardo, Sánchez López and Román Lapuente (2012) types depend on the extent of injury in the brain. There are patients with small damages in the superior convolution of the temporal lobe and others; On the other hand, have lesions also in nearby structures such as the subcortical white matter and the angular and supramarginal convolutions. The latter will have the language much more harmed.
In this way, there are two types:
- Pure deafness for words : There is only damage in the Wernicke area. Many authors think that this is not a type of aphasia, since it only affects the reception of oral language and classifies it as a type of Agnosia . These patients usually understand written language better than oral.
- Wernicke's Aphasia : Injuries in the Wernicke area and other adjacent areas. Not only are there difficulties in recognizing sounds, but there are also deficits in oral and written expression and comprehension.
Manifestations
This type of aphasia can occur in different ways and at different levels of severity. Some sufferers may not understand any spoken or written speech, while others may have a conversation.
The disease usually appears suddenly, while the symptoms appear gradually. The main characteristics of a person with Wernicke's aphasia are:
Inability to understand spoken and written language: problems to understand the language, even if they are single words or simple phrases. They may even not understand the prayers they say. However, comprehension can deteriorate to varying degrees and the patient will have to use extralinguistic keys (tone of voice, facial expression, gestures...) to try to understand the other.
- The effect of fatigue: the affected person can understand several words or that they are talking about a subject, but only for a very short period of time. If more is spoken of the account, the patient fails to understand it; Increasing the problem when there are other distractors like noises or other conversations.
- It is surprising the marked contrast between a fluid discourse and the lack of sense of the message.
- They utter phrases or sentences that are incoherent because they add non-existent or irrelevant words.
- Phonemic paraphasias , That these are difficulties in choosing and organizing the letters or syllables of a word or; Verbal paraphasias, In which a real word is replaced by another that is not part of the semantic field.
- A common symptom is the incorrect interpretation of the meaning of words, images or gestures. In fact, colloquial expressions such as"it is raining in pitchers"or"seeing everything in pink"can literally be taken.
- Sometimes, they chain a series of words that sound like a sentence, but together they are meaningless (American Stroke Association, 2015).
- Neologisms or invention of words.
- Anomia: difficulty in finding words.
- Change tenses, forget to say the keywords.
- Anosognosia , That is, they do not realize that they are using words that do not exist or are not correct in that context. They do not know that what they say may not make sense to the receiver.
- In some cases, lack of pragmatic skills. They may not respect the turns of a conversation.
- Pressure of speech or verbiage: excessive increase of the spontaneous language, that is, the person does not realize that he is talking too much.
- Jergafasia: incomprehensible oral expression, due to the large number of paraphasias present.
- The level of errors they make in speech expression of these patients may be variable, some may only have 10% errors while others 80% (Brown & Jason, 1972).
- Curiously, words of affective type or associated with emotions are preserved (Timothy, 2003). Therefore, it seems that the words that are forgotten or replaced are those that have no emotional content for the person, without depending so much on the meaning of the word itself.
- Difficulties in repetition, which reflect their comprehension problems. Sometimes they add more words or phrases (this is called enlargement) or introduce invented words or paraphasic distortions.
- They have deficits in the denomination of objects, animals or people; Although they can do so with the help of the examiner (if he says, for example, the first syllable of the word).
- Problems in reading and writing. When you write substitutions, rotations and omissions of letters are presented.
- In some cases mild neurological signs such as paresis on the face, which tend to be temporary, may appear. They may present with cortical sensory problems, such as deficits in the recognition of objects by touch. These symptoms, among others, are associated with the acute phase of the disease and are resolved over time in parallel to the recovery of brain lesions.
- Problems can be observed to perform simple gestures like saying goodbye, asking for silence, throwing a kiss, combing... which is a symptom of ideomotor apraxia.
- Copy of drawings with missing details or totally unstructured.
- Normal rhythm and prosody, maintaining adequate intonation.
- They do not present any motor deficit, because as we said the articulation of the speech is conserved.
- Intellectual capacities that are not related to language are completely preserved.
Here you can see how language is in a patient with Wernicke's aphasia:
Differential diagnosis
It is not surprising that Wernicke's aphasia is not correctly diagnosed, as it is easily confused with other disorders. It is necessary to first make a differential diagnosis with a thorough neurological examination.
This is important because a bad diagnosis will have the consequence that the real problem is treated late or not treated and thus the patient can not improve.
Therefore, Wernicke's aphasia can not be confused with psychotic disorder, since the way of expressing and behaving may be similar, as the incoherence of the language or the appearance of disorganized thinking.
How can it be treated?
As each person presents the disorder differently, the treatment will depend on the affectation and severity that is present. In addition, the existing treatments are varied.
The first 6 months are essential for improving language skills, so it is important to detect aphasia and intervene early. It is important because the cognitive alterations would stabilize in a year and after that time, it is difficult for the patient to improve significantly.
However, there is no definitive method that is always effective for Wernicke's aphasia. Rather, experts have focused on offsetting impaired functions.
Many times patients with aphasia do not demand treatment on their own, because they are not aware that they present problems. In order to be able to intervene, it would be very useful to first motivate the person by understanding their deficits and inviting them to treatment. Thus, cooperation with therapy is facilitated and the results are better.
- First of all, it is going to Try to improve patient communication . To do this, the sooner you will be taught to communicate through signs, gestures, drawings or even using new technologies (provided that their damage is lighter).
- Therapies through conversation : Promoting strategies and skills for a effective communication . They are framed in real contexts to facilitate understanding: like ordering food from a restaurant, withdrawing money from the cashier, going to the supermarket... The interlocutor should provide the patient with contextual clues, speak slower and with short sentences (and increase the difficulty little A little) and be redundant for the patient to understand better.
- Situational Therapy : Is intervened outside the query, in a real environment. This encourages the patient to use the knowledge he had before the brain injury and to use them to express and understand others. Above all, by training the preserved capacities linked to the Right cerebral hemisphere : To understand facial expressions, tone of voice, prosody, gestures, postures... Semantic memory , Which refers to concepts and definitions.
- The Intervention in the improvement of short-term memory and working memory Has proved to be effective in Wernicke's aphasia. This is based on repeating words to increase their memorization, which helps to link them with their meaning by improving the understanding of sentences and making the person include them in their vocabulary. Those who received this treatment increased the number of remembered words and even began to include verbs that had not been taught in the treatment (Francis et al., 2003).
- Comprehension training : The objective is to improve the attention to the hearing messages that come to him from others and from his own voice. It is very effective in treating verbiage because it teaches patients to listen carefully rather than speak. The specialist will give certain instructions to the patient, using discriminative stimuli that he has to learn to identify (such as gestures or certain facial expressions). The affected person will end up associating these stimuli with stopping to speak and to listen.
It is important that the affected person learn to slow down his or her own speech and supervise it.
- Höeg Dembrower et al. (2016) checked whether the so-called" Early intensive speech and language therapy "Was effective in patients with Wernicke's aphasia. They indicate that there is a spontaneous improvement of aphasia after a stroke but that communication can continue to be very deteriorated, and intervention is necessary. 118 patients were examined with radiological tests and tests prior to therapy, at 3 months and at 6 months. They received therapy for 3 weeks, finding that 78% of the patients showed significant improvements in aphasia.
- Schuell's Stimulation : Some authors consider it an effective treatment that works by increasing the activity of neurons in the affected areas. They defend that, in this way, the cerebral reorganization is facilitated and; Therefore, the recovery of language. It consists in subjecting the patient to a strong, controlled, and intensive auditory stimulation.
- Drugs : A case of a 53-year-old female patient who received donepezil treatment for 12 weeks was presented in a study by Yoon, Kim, Kim & An (2015), with significant improvement in language coupled with improved brain recovery.
- The Family help , Introducing it into the treatment programs so that the advances are better and faster. Thus, specialists will educate the family to understand the disorder and encourage the patient when and as needed. They will mainly be taught to adjust speech patterns to increase communication with the affected family member.
The prognosis of this disorder depends on the severity of the symptoms and the degree of affection of the auditory comprehension; Since the more affected it is, the harder it will be to recover the normal language.
References
- Brown, Jason (1972). Aphasia, Apraxia, and Agnosia Clinical and Theoretical Aspects . Springfield, Illinois: Charles C Thomas Publisher. Pp. 56-71.
- Francis, Dawn; Clark, Nina; Humphreys, Glyn (2003). "The treatment of an auditory working memory deficit and the implications for sentence comprehension abilities in mild"receptive"aphasia". Aphasiology 17 (8): 723-50.
- Höeg Dembrower, K., von Heijne, A., Laurencikas, E., & Laska, A. (2016). Patients with aphasia and an infarct in Wernicke's area benefit from early intensive speech and language therapy. Aphasiology, 1-7.
- Jay, Timothy (2003). The Psychology of Language . New Jersey: Prentice Hall. P. 35.
- Rabadán Pardo, M.J., Sánchez López, M.P. And Lapuente Román F. (2012). Wernicke's aphasia. In Neuropsychology through clinical cases (p.p. 127-137) Madrid, Spain: Pan American Medical Editorial.
- Types of Aphasia . (March 6, 2015). Retrieved from the Stroke Association.
- Wernicke's Aphasia . (S.f.). Retrieved on June 17, 2016, from the National Aphasia Association.
- Whishaw, I.Q. & Kolb, B. (2009). The origins of language. In Human Neuropsychology (pp. 502-506). Madrid, Spain: Editorial Panamerican Medical.
- Yoon, S., Kim, J., Kim, Y. & An, Y. (2015). Effect of Donepezil on Wernicke Aphasia after Bilateral Middle Cerebral Artery Infarction: Subtraction Analysis of Brain F-18 Fluorodeoxyglucose Positron Emission Tomographic Images. Clinical Neuropharmacology, 38 (4), 147-150.
- Image source .