‘Unbreakable’ Bruce Willis and aphasia: what does this diagnosis mean?

The family of Die Hard, Sixth Sense, and Unbreakable actor Bruce Willis announced today that he is stepping away from acting due to a diagnosis of aphasia. It is not clear what brought the family to announce Willis’s condition at this time, and what could be causing it. Aphasia comes in many forms, with more than one cause. For the most part, aphasia is a treatable language and speech disorder, associated with stroke and other kinds of brain injury, and can be treated with speech, language, and cognitive therapy. However, one type of aphasia is called Primary Progressive Aphasia and looks and acts more like a form of dementia. More below.

Regardless of the cause or prognosis, we wish Bruce and his family all the best.

What is aphasia?

Aphasia is an acquired communication disorder in which there is loss or impairment of the ability to use or comprehend words. It affects different aspects of language including speaking, listening, writing, and/or reading. Aphasia is one of the most common conditions caused by brain injury (including stroke and aneurysm). More than two million people in the U.S. are currently affected by aphasia according to the National Aphasia Association, but few outside the clinical world know what it is. In fact, given its prevalence, most of us have encountered someone with aphasia but just don’t know it by name.

Who is impacted by aphasia?

Nearly 180,000 Americans acquire aphasia each year, usually after stroke or other brain injury. Aphasia affects people of all ages, races, nationalities, and genders. More than 800,000 people/year have a stroke in the United States, and an estimated 1.7 million experience brain injury, both of which are common causes of aphasia. Aphasia is more prevalent than Parkinson’s, ALS, cerebral palsy, and muscular dystrophy.

What causes aphasia?

Anything that damages the language centers of the brain can cause aphasia, including:

• Stroke: occurs when a clot blocks a blood vessel in the brain, which prevents blood supply to any areas of the brain supplied by that vessel.
• Brain injury: any event where the brain is hit and damaged by trauma, or damaged by disease, such as brain tumors or encephalitis.
• Hemorrhage: when a blood vessel ruptures in the brain. If any parts of the brain are exposed to blood during a hemorrhage, those parts of the brain will be damaged.

What are the different types of aphasia?

Different components of language may be damaged more or less in each individual with aphasia, resulting in different manifestations of speech and language difficulties. Below are brief summaries of common aphasia types:

• Global Aphasia: When a brain injury affects extensive portions of the front and back regions of the left hemisphere, the result may be global aphasia. People with global aphasia may have difficulty understanding words and sentences, forming words and sentences, and may get out only a few words.
• Broca’s Aphasia: A type of nonfluent aphasia, these individuals typically present with damage that affects the brain’s frontal lobe. This aphasia can be called a “nonfluent” or “expressive” aphasia because they may understand and know what they want to say, but speak in short phrases produced with much effort. They may also omit grammatical words such as “is,” “and” and “the.” This is called “agrammatism”. Why “Broca’s Aphasia”? French physician, Pierre Paul Broca, specialized in the study of language in the 1860s. He treated an individual who presented with symptoms of speech loss, yet maintained his intellect. Broca named this new disorder, aphémie – the ‘loss of articulated speech’.
• Wernicke’s Aphasia: A type of fluent aphasia, these individuals typically present with damage that affects the brain’s left temporal lobe. This aphasia can be called “fluent” or “receptive” aphasia because although people with this aphasia can produce many words (are “fluent”), and use grammatically correct sentences, what they say may not make sense, or their speech may include non-existent or non-relevant words. They also may not be fully aware that what they’re saying doesn’t make sense. Why “Wernicke’s Aphasia”? It’s named after 19th-century German neurologist Karl Wernicke, who first related this disorder to damage in the left posterior temporal area of the brain.
• Anomic Aphasia: This is the mildest aphasia type – people with Anomic Aphasia have relatively preserved speech and comprehension, but difficulty in finding words. Interestingly, low-frequency words are typically more difficult for these people to retrieve and produce than frequently used words.

What is primary progressive aphasia?

Primary Progressive Aphasia (PPA) is a type of frontotemporal degeneration in which symptoms begin gradually, sometimes even before age 65, and worsen over time. People with PPA can lose the ability to speak and write, and eventually, understand written or spoken language. Speech therapy can be provided throughout the course of the disease, with the goal being to maximize communication ability for as long as possible.

How is aphasia treated?

Many treatment options are available, often through speech-language pathologists (SLPs) in outpatient rehab centers, skilled nursing facilities, clinics, or at home. These treatments seek to help those with aphasia to reclaim their lives, and to return to work when possible. How the aphasia treatment is carried out depends on each patient’s unique circumstances. For example, intensive speech therapy may be recommended for some people, involving a number of sessions given in a shorter period of time. For others, shorter and less intensive sessions may be recommended.

For primary progressive aphasia, although it is degenerative, it does not mean the end of communication. A diagnosis can be the first step to identifying ways to regain or maintain communication abilities for as long as possible. Speech-language pathologists are the front line in the treatment of this kind of aphasia also. And like other forms of aphasia, a science-based online app like Constant Therapy can help maintain speech and language skills.

Aphasia in the news – Constant Therapy founding scientist is lead expert

With news of Bruce Willis’ diagnosis, several media outlets reached out to one of Constant Therapy’s founding scientists, Dr. Swathi Kiran, who is also the director of the Aphasia Research Lab at Boston University. Here is some of what she said:

• Understanding aphasia, the condition impacting Bruce Willis’ acting career [NPR]
• What it’s like living with aphasia—and how to support a loved one with the condition [TIME]
• What is aphasia, exactly? [GQ]
• Bruce Willis’s aphasia diagnosis brings awareness to communication disorder [Boston 25 News]
• What is aphasia? An expert explains the condition forcing Bruce Willis to retire from acting [the Conversation]