Amnestic aphasia - I see and know an object, but I cannot name it!

Article:

Transient ischemic attacks, stroke and other brain damage can lead to the development of aphasia. The main symptom of this pathology is acquired speech disorders of varying severity. The disease develops as a result of damage to areas of the central nervous system responsible for speech function. Amnestic aphasia is observed when the parietal or temporal region of the cerebral cortex is damaged and is associated with the patient’s inability to name an object while maintaining the ability to describe it. Diagnosis and treatment of pathology is complex. Therapy uses medications, as well as long-term speech and social rehabilitation.

About the disease and its classification

Aphasia is manifested by speech impairment as a result of organic damage to nervous tissue in various parts of the brain. The localization of the damaged area determines the clinical manifestations of the disease. Based on the nature of the speech disorder, neurologist A.R. Luria identified several types of aphasia:

1. Motor, which is further divided into efferent and afferent. Appears when the pre- and postcentral gyri are damaged. Characterized by difficulties in selecting the correct sounds and disruption of the motor articulation process.
2. Sensory, manifested by a violation of the perception of the speech of others and one’s own, as a result of which it becomes illegible and ungrammatical. Develops in patients with damage to Wernicke's center.
3. Acoustic-mnestic occurs in patients with damage to the fibers connecting the hippocampus, responsible for memory, with the auditory cortex. The patients' speech is poor, with a large number of omissions of nouns and paraphrases.
4. Semantic aphasia occurs when the frontal areas of the cerebral cortex are damaged. A person stops understanding complex grammatical structures and begins to use simple sentences in his speech.
5. Amnestic, characterized by the patient’s inability to name a specific object. Occurs with damage to the temporal and parietal parts of the brain.

Amnestic aphasia occurs in 5-10% of patients with damage to the cerebral cortex. The disease leads to a decrease in the level of quality of life due to difficulty communicating with other people. In addition, difficulties arise in the patient’s professional life and the likelihood of loss of ability to work.

Diagnostics

Amnestic dysphasia is difficult to diagnose. Dialogue speech is relatively preserved, and at first glance it may not raise questions or suspicions among the doctor. The phrases are constructed correctly, the words are in the correct order. The first thing that may cause concern is difficulties in finding words and small pauses between them, but after a hint the patient quickly remembers and names the word.

Aphasia almost never occurs as an independent pathology. Most often, amnestic dysphasia is combined with Gerstmann syndrome, which manifests itself as a violation of arithmetic counting, writing, finger agnosia, and a violation of orientation between the spatial concepts of “right-left”. These pathologies, pauses between words and difficulties in naming objects suggest amnestic aphasia to the doctor.

The following diagnostic techniques identify the disease:

1. Test for memorizing 6 words in two groups, each of which has 3 words. Memorizing two sentences and two short stories. To identify amnestic aphasia, you should ask to reproduce these two stories after they have been voiced and 2-3 hours later. Typically, delayed repetition produces more information.
2. A test in which the doctor presents pictures of objects and asks the patient to name them.
3. Test for description. The neuropsychologist tells the essence of the object, and the patient needs to name it. For example, 4 legs, a rectangular wooden surface, plates, forks and spoons are placed on it. What is this? If the patient cannot name “table”, there is a possibility of amnestic aphasia.

Main reasons

The occurrence of amnestic aphasia is observed when the brain is exposed to any damaging factors. It should be noted that for right-handed people to experience symptoms, the damage must be localized in the left hemisphere, while for left-handed people the opposite is true. The main causes of organic changes in the central nervous system include:

• traumatic brain injuries occurring as a result of a traffic accident or a direct blow to the temporal or parietal region (such an impact causes mechanical damage to the nervous tissue);
• encephalitis and meningitis, characterized by the development of purulent or serous inflammation and destruction of nerve cells, as well as their fibers (observed with bacterial, viral or fungal infection);
• benign or malignant tumors with intracranial localization;
• surgical interventions performed in the area of ​​the temporal and parietal cortex (when removing tumors, vascular aneurysms and other formations, damage to the functional cortical areas responsible for speech is possible);
• transient ischemic attacks and strokes of any type, manifested by necrosis of certain areas of the cerebral cortex;
• acute intoxication with poisons and drugs (similar changes develop against the background of liver and kidney failure, due to the accumulation of toxic metabolic products in the blood);
• neurodegenerative diseases - Pick's disease and Alzheimer's disease, characterized by the gradual destruction of neurons in the cerebral cortex.

In addition to these reasons, there are predisposing factors to the development of amnestic aphasia. These include hereditary predisposition and old age.

Clinical manifestations

Symptoms of amnestic aphasia develop slowly, and therefore the patient himself and his loved ones may not be aware of the disease for a long time. The periodic inability to name an object is often associated with a person's age, which leads to a late diagnosis. The main clinical manifestations include the following clinical signs:

• a person cannot name an object, however, he can easily describe its external characteristics and purpose;
• due to the difficulty of selecting the names of things, the patient’s speech is slow and has a large number of pauses (the opposite situation may be observed - fluent speech with frequent errors in the use of words);
• repetition of the same words and phrases (typically a large number of descriptive constructions and paraphrases);
• the number of nouns decreases (most often, speech consists of adjectives that describe an object);
• speech is logical and grammatically correct;
• reading and writing skills do not suffer and remain at the same level;
• the pronunciation of sounds and their combinations does not change;
• articulation changes are not detected.

Amnestic aphasia is characterized by the inability to retain the name of an object. As a result, the patient uses complex descriptive constructions consisting mainly of adjectives. It is this feature of speech that allows one to suspect a disease and seek medical help.

DYNAMIC APHASAIA

Stage of severe disorders

1. Increasing the level of general activity of the patient, overcoming speech inactivity, organizing voluntary attention:

- performing various types of non-verbal activities (drawing, modeling, etc.);

— assessment of distorted images, words, phrases, etc.;

- situational, emotionally significant dialogue for the patient;

- listening to plot texts and answering questions about them in the form of affirmative-negative gestures or words “yes”, “no”.

2. Stimulating simple types of communicative speech:

— automation in dialogical speech of communicatively significant words: “yes”, “no”, “can”, “want”, “will”, “must”, etc.;

— automation of individual cliches of communicative, incentive and interrogative speech: “give”, “come here”, “who’s there?”, “hush!” etc.

3. Overcoming speech programming disorders:

- stimulation of answers to questions with a gradual decrease in the answer of words borrowed from the question;

- constructing phrases of the simplest syntactic models based on chips and a simple plot picture;

- performing simple grammatical transformations to change words that make up a phrase, but are presented in nominative forms;

- laying out a series of sequential pictures according to the plot contained in them.

4. Overcoming grammatical structuring disorders

5. Stimulating written speech:

— laying out captions under pictures;

- reading ideogram words and phrases.

Moderate stage of disorders

1. Restoration of communicative phrasal speech:

— construction of a simple phrase;

- composing phrases based on a plot picture using the chip method and gradually “collapsing” the number of external supports;

- compiling a story based on a series of sequential pictures;

— detailed answers to questions in the dialogue;

- compiling simple dialogues like speech sketches: “In a store” - a dialogue between a buyer and a seller, “In a savings bank”, “In an atelier”, etc.

2. Overcoming perseverations in independent oral and written statements:

- display of objects in pictures and in the room, parts of the body (in random order, by individual names and by series of names);

- ending phrases with different words;

- selection of words of given categories and in given quantities, for example, two words related to the topic “Clothing” and one word related to the topic “Tableware”, etc.;

- writing numbers and letters broken down (from dictation);

- writing from dictation of words and phrases that contribute to the development of semantic and motor switching;

— elements of sound-letter analysis of the composition of a word: folding simple words from letters of a split alphabet;

- filling in gaps in words;

- writing simple words from memory and dictation.

Stage of mild disorders

1. Restoration of spontaneous communicative phrasal speech:

- extensive dialogue on various topics;

- constructing phrases based on a plot picture with a gradual decrease in the number of external supports;

— automation of phrases of certain syntactic models in spontaneous speech;

- accumulation of a verbal dictionary and “revitalization” of the semantic connections behind the predicate (with the help of questions posed to it);

- reading and retelling texts;

- “role-playing conversations”, playing out a certain situation;

- “speech improvisations” on a given topic;

- detailed presentations of texts, essays;

- drafting greeting cards, letters, etc.

Diagnostic measures

Diagnostics and treatment are handled by two specialists - a psychiatrist and a neurologist. Under no circumstances should you make a diagnosis or select therapy on your own. This can cause rapid progression of the underlying disease and the development of its complications. In medical institutions, the patient is examined according to the following algorithm:

1. The patient's complaints, as well as anamnesis of life and illness, are collected. The specialist identifies factors and possible causes of brain damage. In most cases, it is necessary to additionally talk with loved ones.
2. General clinical examinations: general and biochemical blood tests, general urinalysis, electrocardiogram, etc.
3. Due to the presence of cognitive impairment, all patients are prescribed neuropsychological diagnostics based on the study of memory, attention, ability to perceive information, etc. Such methods make it possible to clarify the nature of the speech disorder, as well as to suggest the localization of the lesion in the brain.
4. Computed or magnetic resonance imaging is used to study the structures of the central nervous system. The doctor has the opportunity to assess their integrity and identify areas of damage to the nervous tissue.
5. If a traumatic brain injury is suspected, an X-ray examination of the skull is performed. The method allows you to identify damage to bone structures that indicate a head injury.
6. In the case of neuroinfections, an enzyme-linked immunosorbent assay (ELISA) or polymerase chain reaction (PCR) of the patient’s blood and cerebrospinal fluid is performed to identify the pathogenic microorganism.
7. Ultrasound and Doppler mapping of the cervical and cerebral vessels are used if symptoms are suspected of being ischemic. During the examination, the doctor can determine narrowing of the arteries, the formation of aneurysms, malformations, etc.

An integrated approach to diagnostics allows us to determine the exact location of brain damage and make an accurate diagnosis.

Effective treatment

The main goal of therapy is to eliminate the underlying factor that led to the development of the disease. If tumor formations, hematomas and other space-occupying structures are detected, the patient is indicated for neurosurgical intervention with their removal. For neuroinfections, etiotropic therapy is prescribed - antibacterial, antifungal or antiviral drugs.

Treatment of amnestic aphasia and elimination of its symptoms includes medicinal and non-medicinal types of treatment. The following drugs are chosen among the medicines:

• nootropics (Phenotropil, Piracetam, etc.), which improve metabolism in the nervous tissue and help improve cognitive functions;
• medications that improve cerebral circulation: Actovegin, Cerebrolysin and their analogues (increase the delivery of nutrients and oxygen through the blood to the cerebral cortex, which has a positive effect on a person’s cognitive skills).

Any medications should only be prescribed by a doctor. All medications have a number of contraindications for their use, which should be taken into account when selecting treatment. Otherwise, the patient may experience side effects from the medications. In addition to medication, methods of non-invasive brain stimulation using magnetic fields or weak electric current are used. Such procedures improve the functioning of nervous tissue and improve cognitive skills.

Like a child!

Speech is a complex process in which different areas of the cerebral cortex actively interact. Thus, Wernicke's area is responsible for understanding; signals are formed in Broca's area, which ultimately turn into words and phrases. The role of auditory and visual analyzers is important. When a person talks, the whole brain is actively working. It establishes connections, for example, between the image of a spoon and the word that denotes this object. It is these connections that are destroyed in patients with amnestic aphasia. This is the difference between patients of the NeuroSpectrum Center for Pediatric Speech Neurology and Rehabilitation, who are being treated for amnestic aphasia, and healthy children. The normal process of forming connections goes by itself, and if connections are destroyed, their restoration requires outside help. Fortunately, children's brains are plastic, and it is easier to help our patients than adults and especially older people.

Rehabilitation activities

Correct and comprehensive rehabilitation is of greatest importance in the correction of amnestic aphasia. Training aimed at restoring speech and other skills takes place in several stages:

1. First, the patient is taught to work with objects through their visual image. To do this, use cards with an image and its name. This allows you to associate a certain visual image of an object and function with its name.
2. At the second stage, the emphasis in rehabilitation is on the restoration of situationally determined speech. The patient is given a set of classes, including on-site orientation with verbal instructions from a specialist, and discussion of various everyday topics. To consolidate the results obtained, self-testing, questionnaires and classes with rehabilitation specialists are carried out.
3. The last stage is aimed at improving visual and auditory-verbal memory. The patient is asked to solve crosswords and riddles, retell passages from books or conversations, and write stories. Conduct classes to improve factual memory by remembering important dates, addresses and other information. Communication with loved ones is important, since active speech and its perception help the patient restore the functions of various parts of the brain.

In addition to these activities, all patients need constant work activity, reading books and attending physical therapy classes. The rehabilitation process lasts from several months to several years, depending on the severity of the brain damage.

Kinds

Depending on the severity of the disease, the doctor may diagnose:

• partial aphasia, in which full speech alternates with noticeable impairments;
• total aphasia, in which speech has significant impairments and requires correction.

Complications of aphasia

In the absence of timely treatment and specialist supervision, aphasia can cause:

• persistent disorder, in which there is a lack of understanding of spoken words and an inability to form one’s own speech;
• problems with social adaptation due to the inability to communicate and establish contact with others.

How to prevent the development of the disease

Prevention of amnestic aphasia is based on preventive measures that cause damage to the structures of the central nervous system. This includes the following medical recommendations:

• avoid situations that can lead to traumatic brain injuries (use a helmet and other protective equipment when engaging in hazardous sports);
• if you have a disease of the cardiovascular system or other internal organs, follow the doctor’s instructions and do not self-medicate;
• after neurosurgical operations, undergo full rehabilitation measures aimed at restoring cognitive skills;
• regularly engage in sports, including aerobic exercise and strength training;
• eliminate bad habits - drinking alcohol and smoking;
• normalize the diet by excluding from it all fatty, salty, smoked foods, and increasing the proportion of lean meats (chicken, rabbit), fish, fruits, vegetables and berries;
• in old age, continue to read books, learn poetry, do handicrafts and other hobbies (such activities prevent the development of Alzheimer's disease and Pick's disease).

If you detect any signs of amnestic aphasia in yourself or a close relative, you should immediately seek medical help. The pathology is treated by a neurologist or psychiatrist. In the absence of these specialists, it is necessary to visit a therapist who will conduct an initial diagnosis and refer the patient for further consultation to specialized medical institutions.

The prognosis depends on the degree of damage to the nerve tissue and the time of initiation of treatment and rehabilitation. With a small affected area and early initiation of therapy, the patient gradually recovers normal speech and other cognitive skills. If treatment is started late, its effectiveness is limited. Residual speech defects of varying severity are possible. The support of loved ones who are directly involved in the rehabilitation of the patient is important in eliminating aphasia.