Wernicke’s Aphasia: Symptoms, Causes and Treatment

The Wernicke aphasia also called sensory aphasia or receptive aphasia, is part of a group of fluent aphasia. An individual with this type of aphasia will have trouble understanding the language heard or repeating words or phrases that others have said; while the pronunciation is going to be correct.

Therefore, Wernicke’s aphasia is the impossibility of understanding words or of 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 one to make a great effort to understand the affected.

aphasia of wernicke

When a patient with this problem comes to consultation, their rapid and uncut speech attracts attention, which requires the other person to intervene to stop. In fact, the affected person does not usually realize that what he says does not make sense and they do not feel that there are problems in the dialogue (or attempt at dialogue).

According to Luria, this disorder has three characteristics:

  • The first, which does not distinguish the different phonemes (the sounds of the language). That is, to properly listen and emit the sounds of speech, you must first know how to recognize the sounds 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: has no problems articulating speech, however, by confusing the phonetic characteristics produces the “word salad” (emit words without connection to each other, resulting in an incoherent speech, but without losing the flow).
  • Problems in writing: as a consequence of the problem of little recognition of phonemes, it will not be able to evoke graphemes (graphic representations of phonemes, such as a written letter).

Where are you from?

It can have an acute character (due to traumatic brain injury, cerebral infarction, neoplasms, etc.) or chronic (concomitant with Alzheimer’s ).

In Wernicke’s aphasia, the damaged areas are found in the parietal and temporal lobes of the dominant hemisphere (usually the left hemisphere), with the severity of the deficit depending on the magnitude of the lesion.

Wernicke's Aphasia: Symptoms, Causes and Treatment

At first, it was thought to be due to damage or malfunction in the Wernicke area, from which its name comes. An area of the brain responsible for the processes of language comprehension, located in the posterior part of the temporal lobe of the dominant hemisphere (usually the left one).

It appears after the German neurologist Karl Wernicke associated in 1874 functions to this area of the brain after studying patients with injuries.

However, it seems that the key deficits in this type of aphasia are not only due to damage in that area; but it is something more complex because:

  • Most brain structures participate in some way in language, that is, this function is not limited to a single place in the brain.
  • It seems that most patients with disorders of this type had 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 result in a good number of different symptoms, each probably having a different neurological basis.
  • In addition, there are researchers who have affirmed that the lesions in this area do not connect directly with the fluent aphasia, but it seems to affect the storage of sentences in the memory from the moment they are heard until they have to be repeated, also affecting the rhyme of words (memory for the affected sounds).

It has been suggested then that the main difficulties of this disorder stem from damage to the medial temporal lobe and the underlying white matter. This area is adjacent to the auditory cortex.

Its appearance has also been seen by alterations in a certain part of the superior convolution of the temporal lobe, affecting connections with other nuclei responsible for language located in occipital, temporal and parietal regions (Timothy, 2003).

On the other hand, if Wernicke’s area is damaged, but in the non-dominant hemisphere (normally the right hemisphere), aprosodia or dysprosody 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 is generally responsible for regulating the understanding and production of speech, affecting the interpretation and emission of intonation and rhythm.

Normally Wernicke’s aphasia is usually due to a stroke, although it can also occur due to a traumatism closed due to an accident.

In conclusion, it is better to consider the Wernicke area as a very important area in this type of aphasia, forming part of a much broader process that encompasses more structures and their connections.

Types

According to Rabadán Pardo, Sánchez López and Román Lapuente (2012), the types depend on the extent of the lesion in the brain. There are patients with small damages in the superior gyrus of the temporal lobe and others; however, they also have lesions in nearby structures such as the subcortical white matter and the angular and supramarginal gyri. The latter will have the language much harmed.

In this way, there are two types:

  • Pure deafness for words: there is only damage in Wernicke’s 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 tend to 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, gestural and written expression and comprehension.

Manifestations

This type of aphasia can occur in different ways and at different levels of severity. Some affected 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 not even understand the sentences they say. However, the understanding can deteriorate in very different 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 can understand several words or that is talking about a topic, but only for a very short period of time. If you talk more about the account, the patient can not understand it; increasing the problem when there are other distractors such as noises or other conversations.

– The marked contrast between a fluid discourse and the lack of meaning of the message is surprising.

– They emit sentences or sentences that are incoherent because they add non-existent or irrelevant words.

– Phonemic paraphasias  which are difficulties in choosing and organizing the letters or syllables of a word or good; 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 can be taken literally as: “it’s raining cats and dogs” or “seeing everything in pink”.

– Sometimes, they string a series of words that sound like a sentence, but together they make no sense (American Stroke Association, 2015).

– Neologisms or invention of words.

– Anomia: difficulties in finding words.

– Change verb tenses, forget to say the keywords.

– Anosognosia, that is, they do not realize that they are using words that do not exist or that are not correct in that context. They do not know that what they say may not make sense to the recipient.

– In some cases, lack of pragmatic skills. They may not respect the turns of a conversation.

– Speech pressure or verbiage: excessive increase of spontaneous language, that is, the person does not realize that he is talking too much.

– Laryngoscopy: incomprehensible oral expression, due to the large number of paraphasias they present.

– The level of errors they make in the speech expression of these patients can be variable, some can only have 10% errors while others 80% (Brown & Jason, 1972).

– Interestingly, the 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 extension) or introduce invented words or paraphrase distortions.

– They have deficits in the denomination of objects, animals or people; although they can do it 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 may appear, such as facial paresis, which is usually temporary. They may present 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 parallel to the recovery of brain injuries.

– Problems can be observed to perform simple gestures such as saying goodbye, asking for silence, throwing a kiss, combing hair … what is a symptom of ideomotor apraxia.

– Copy of drawings with lack of details or totally unstructured.

– Rhythm and normal prosody, maintaining adequate intonation.

– They do not show any motor deficit, because as we said the articulation of speech is preserved.

– Intellectual abilities that are not related to language, are completely preserved.

Here you can see what language is like in a patient with Wernicke’s aphasia:

Differential diagnosis

It is not surprising that Wernicke’s aphasia is not correctly diagnosed, as it is easy to confuse 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 as a consequence that the real problem is treated late or not and so the patient can not improve.

Therefore, Wernicke’s aphasia cannot be confused with a psychotic disorder, since the way of expressing oneself and behaving may be similar, such as the incoherence of language or the appearance of disorganized thinking.

How can it be treated?

As each person presents the disorder in a different way, the treatment will depend on the affectation and severity that occurs. In addition, existing treatments are varied.

The first 6 months are essential to improve 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 compensating for impaired functions.

Many times patients with aphasia do not demand treatment by themselves, because they are not aware that they have problems. To be able to intervene, it would be very useful to motivate the person first by making him understand his deficits and inviting him to the treatment. Thus, cooperation with therapy is facilitated and the results are better.

– First of all, we are going to try to improve the patient’s 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 less severe).

– Therapies through conversation: promoting strategies and skills for effective communication. They are framed in real contexts to facilitate understanding: how to order food in a restaurant, withdraw money at the cashier, go to the supermarket … The interlocutor should provide the patient with contextual clues, talk slower and with short sentences (and increase the difficulty little a little) and be redundant so that the patient understands better.

– Situational therapy: intervenes outside the consultation, in a real environment. This encourages the patient to use the knowledge he had before the brain injury and use them to express himself and others. Above all, training conserved capacities linked to the right cerebral hemisphere: understanding facial expressions, the tone of voice, prosody, gestures, postures … Semantic memory is also enhanced, which is the one referring to concepts and definitions.

– The intervention in the improvement of short-term memory and working memory has been effective in Wernicke’s aphasia. This is based on the fact that, by repeating words, the memorization of sentences increases, which helps to link them with their meaning, improving the comprehension of sentences and having the person include them in their vocabulary. Those who received this treatment increased the number of words remembered 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 attention towards the hearing messages that come from others and their own voice. It is very effective in treating verbiage because it teaches patients to listen carefully instead of talking. 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 will end up associating these stimuli with stopping talking and listening.

It is important that the affected learn to slow down their own speech and supervise it.

Also Read: Myelodysplastic Syndromes: Symptoms, Causes and Treatments

– Höeg Dembrow 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 the aphasia after a cerebrovascular accident but that the communication can continue very deteriorated, and it is necessary to intervene. 118 patients were examined with radiological tests and tests before therapy, at 3 months and at 6 months. They received the therapy for 3 weeks, finding that 78% of the patients showed significant improvements in aphasia.

– Schuell stimulation: some authors consider it an effective treatment that works by increasing the activity of neurons in the affected areas. They argue that, in this way, brain reorganization is facilitated and; therefore, the recovery of language. It consists of subjecting the patient to a strong, controlled, and intensive auditory stimulation.

– Drugs: in a study by Yoon, Kim, Kim & An (2015) presents a case of a 53-year-old patient who received treatment with donepezil for 12 weeks, finding a significant improvement in language coupled with better brain recovery.

– It is essential for the help of family, introducing in treatment programs that progress better and faster. Thus, the specialists will educate the family so that they understand the disorder and stimulate the patient when and as necessary. Principally they will 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 impairment of the listening comprehension; since the more affected you are, the harder it will be to recover normal language.

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