Actor Bruce Willis has a condition that affects speech and comprehension. Our experts give the ABCs of this brain disorder.
Last week, the family of legendary actor Bruce Willis of Die Hard fame announced his retirement from Hollywood—despite being just 67 years old. The reason? His recent diagnosis of aphasia, a brain condition that affects how you communicate. While the details of Willis’s condition have not been released, let’s look at what we do know about this neurological disorder.
“Aphasia causes a disturbance in language, in comprehension, speaking, and listening,” explains neurologist James Galvin, MD, a professor of neurology, psychiatry, and behavioral sciences and director of the Comprehensive Center for Brain Health at the University of Miami Miller School of Medicine in Florida.
The National Aphasia Association estimates that aphasia affects more than two million Americans. Nearly 180,000 develop the disorder each year. While it can be diagnosed at any age, middle-aged and older adults have a higher risk, primarily because it results from health conditions that typically occur later in life, such as stroke and Alzheimer’s disease. We asked Dr. Galvin and other experts to unpack the specifics about this condition and how they may be related to why Willis is suddenly stepping away from the spotlight.
Are There Different Types of Aphasia?
Aphasia is a complicated condition that affects different people in different ways, says Dr. Galvin. Its symptoms can range from mild to severe. It can be temporary or permanent. And depending on its cause, the degree of damage it does can remain stable, or it can get worse over time. Broadly speaking, aphasia can be divided into two main categories: fluent and non-fluenthe adds.
What Is Fluent Aphasia?
The fluent, or receptive, form is less common. People with this type of aphasia produce words without difficulty but they lose their ability to understand what the words mean. They may also use made-up, nonsensical words when speaking.
“At the extreme, it’s just a gobbledygook of words, a word salad,” says Dr. Galvin. “And they don’t realize that they’re not making sense as they’re speaking.”
This type of aphasia also affects their ability to comprehend what they hear and what they read.
What Is Non-Fluent Aphasia?
The more common type is called non-fluent, or expressive aphasia. People with this manifestation of the disorder have difficulty expressing themselves, but they do understand what they say and hear.
“Their speech and writing become broken up,” says Dr. Galvin. “They tend to search for words, substitute words, or make up words.” For example, they may refer to a watch as “the thing you tell time with,” he explains. Someone with this type of aphasia may also speak in short phrases rather than full sentences, dropping words like is, andand theper the National Institute on Deafness and Other Communication Disorders (NIDCD).
“The typical situation is difficulty in social or interpersonal interactions, having conversations, and interacting with others,” says Mario Mendez, MD, a professor of neurology and psychiatry at UCLA and director of the behavioral neurology program at the UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior in California. “It can be very frustrating or lead to misinterpretations and depression.”
While Willis and his team have not expressly identified which type the actor is living with, a lot of people with aphasia have a blend of both types, fluent and non-fluent, says neuropsychologist Erica Dawson, Ph.D., the director of the neurocognitive wellness and therapy program at the Ohio State University Wexner Medical Center in Columbus, OH.
“That’s the hardest [version of this disorder],” says Dr. Dawson. “If you have trouble both understanding and expressing yourself, communication breaks down pretty rapidly.”
What Causes Aphasia?
Aphasia develops when damage occurs in the parts of the brain responsible for language: the frontal lobe and the temporal lobe, as well as the connections between them. “Aphasia can result from disorders disrupting the center for understanding words and sentences, or the center for making and expressing them,” says Dr. Mendes.
The most common culprit? Stroke. When a stroke occurs, blood flow to parts of the brain gets cut off. This causes the death of brain cells and permanent brain damage. If the stroke occurs in the brain’s language centers, aphasia can occur.
Traumatic brain injuries—think the repetitive, severe blows to the head that pro football players endure on the regular—can also cause aphasia. Retired US Representative Gabby Giffords was diagnosed with aphasia after surviving an assassination attempt in 2011. She was shot in the head at close range during a public event, and spent years in recovery. (She is officially retired from Congress in 2012.) According to the National Aphasia Association, Giffords continues to experience non-fluent aphasia, and speaks with single words and short phrases.
Both are considered acute causes, meaning they happen suddenly: “You have a stroke, and you immediately have aphasia,” says Dr. Galvin. “You’re fine one day, and you’re not fine the next.”
In some cases, aphasia comes on more slowly. Alzheimer’s disease and other conditions that cause the brain to degenerate over time can cause aphasia, as can infections and tumors in the brain. “The symptoms get worse over time, due to the growth of the tumor or the spread of the dementia,” say Dr. Galvin.
Speech-language pathologists are the keystone of aphasia treatment, says Dr. Dawson. They design individual programs that address each person’s needs. If you have trouble finding words, for example, your pathologist can teach you strategies to find similar words that you can substitute.
Dr. Mendez points to several other strategies you might be taught, such as learning to maximize the words you do have; emphasizing one mode of communication, such as writing, over others if it is better preserved; and using gestures and other non-verbal methods to convey meaning.
Your pathologist also may introduce you to technology that can help you better communicate with others. Tablets are commonly used, for example. If you have the ability to write, you can type your words into your tablet and let it speak the words for you.
Or, if you’re incapable of speaking, you can use images on your tablet to convey what you’re trying to say.
“That’s incredibly helpful, as basic as it is,” says Dr. Lawson.
Dr. Galvin says that treatment is typically most effective after a stroke or head injury, or after the treatment of a brain infection or brain tumor. Why? Because the damage to your brain is static, meaning the aphasia won’t get worse, so your brain may be able to compensate for some of its lost functions through new activity in brain tissue near the damaged area, while the strategies you learn from your speech-language pathologist can help fill the gaps.
In some cases, aphasia may only be temporary.
“If it’s due to a stroke, it may improve on its own as your brain heals,” says Dr. Dawson.
It’s much different if your aphasia has been caused by a degenerative disease like Alzheimer’s disease, which means your aphasia will keep getting worse over time. That makes treatment ineffective.
“You’re essentially chasing a moving train,” says Dr. Galvin.
According to the Mayo Clinic, medications are sometimes used to help treat aphasia. These drugs may help improve blood flow to the brain, enhance the brain’s recovery ability, or help replace depleted neurotransmitters, which are chemicals in the brain that are released as nerves send messages to one another.
Several medications, including Namenda (memantine) as well as Nootropil and Lucetam (piracetam), have shown some promise in small studies. But more research needs to be done, per the Mayo, before these treatments can be widely recommended.
How Can I Help a Loved One With Aphasia?
Family members and friends play a crucial role in caring for people who have aphasia.
“Be reassuring and supportive,” Dr. Dawson emphasizes. And do your best to manage your own stress. “This is very stressful for family members, too, because they want to understand [their loved ones], but can’t,” she adds. Such stress can be contagious, and your family member with aphasia may become more agitated—making communication even more difficult. “The calmer the person is, the better they can use the communication strategies they’ve learned.”
Encourage talking slowly, advises Dawson. Your loved one with aphasia will be able to enunciate better so that their words are clearer. “Slowing down is one of the most important things for both the patient and the family members,” she says.
Keep in mind that your loved one is struggling and that patience should not be in short supply. “It’s crucial that caregivers understand that their loved ones may not understand or be able to express their thoughts, feelings, or beliefs,” says Dr. Mendes. If you need help staying strong for your loved one with aphasia, connect with the National Aphasia Association and its support group.