In recent weeks, the family of actor Bruce Willis (Die Hard, Pulp Fiction, The Sixth Sense) announced that he would be stepping away from his acting career due to an ongoing struggle with aphasia. We spoke with Neurotrack clinical researcher and speech-language pathologist Jennifer Myers, PhD, MS, CCC-SLP, about this condition, its connection to dementia, and what people should do when they’re struggling to find words.
Neurotrack:
What exactly is aphasia?
Dr. Myers:
Aphasia is primarily a language disorder. It’s often a result of some type of brain injury, most notably a stroke or a head injury. Aphasia affects someone’s ability to express themselves. So, for some individuals, even though in their mind they know exactly what they want to say, the connection between those thoughts and ideas, and actually forming them into words is lost. For others, it’s the ability to understand language, which would include the ability for someone to follow directions. Some people can also have a mix of expressive and receptive language difficulties which is called global aphasia.
Something I want to note is that while it is primarily a language disorder, cognition can be impacted by aphasia as well, typically to a lesser degree. Cognitive processes, like language, memory, attention, are all overlapping, so there’s no surprise there.
Neurotrack:
Now that we’ve read some of the coverage, especially the Los Angeles Times article where Bruce Willis’s colleagues chronicle his decline, what do you, in your professional opinion, suspect is going on?
Dr. Myers:
Right. So, as I mentioned, aphasia is primarily a language disorder, but there’s also some cognitive overlap. I do suspect, given his line of work as an actor, that his word finding ability is likely affected. He may know the line that he’s supposed to say, but he’s having difficulty saying his lines.
There is also an aphasia called primary progressive aphasia. This type of aphasia is a progressive disease that starts primarily as a language disorder, but then other cognitive processes become affected. That includes things like memory. And in fact, about half of the people who are diagnosed with progressive aphasia go on to have what we call frontotemporal degeneration, which is a type of dementia. So it’s possible that he’s also experiencing that type of aphasia where things are getting worse and could explain the possible confusion he has been experiencing as reported in the media. However, I do want to emphasize that without knowing his other symptoms, his medical history, and other important information, I can’t definitively say what form of aphasia Bruce Willis was diagnosed with.
Neurotrack:
Trouble finding the right words seems to be a common complaint as people get older. What’s a normal word-finding episode, and when is it cause for concern?
Dr. Myers:
We all occasionally have word finding difficulties regardless of age. And having some cognitive issues is common as we get older. Every now and again, you may see someone you know and can’t recall their name. You might even forget your own phone number once in a while, it can happen! But when you start noticing that throughout the day, you have continuous word finding issues, or if you often notice that you see something and can’t find the words to respond or react to it, that’s when you should start documenting what is going on and when it’s happening. Following up with your healthcare provider would be the next step.
Neurotrack:
And what would the healthcare provider do to sort out what’s going on?
Dr. Myers:
There are quite a few healthcare providers that can lend support when you’re having language and cognitive symptoms. If you talk to your primary healthcare provider, they can give what we call cognitive screeners that assess things like memory, attention, language, and orientation in a few questions. This would involve around 10 to 20 minutes of testing that would allow them to see if there’s a need for further evaluation. If there is concern based on the results, family history, and medical history, then you may be referred to a few other people. A neurologist, neuropsychologist, or psychiatrist could do a lengthier battery to assess what exactly could be going on. And if there’s intervention or treatment needed, a speech-language pathologist,psychiatrist, or psychologist might work with you to develop helpful strategies.
Neurotrack:
And here at Neurotrack, we’re actually working on something to help make cognitive screening more accessible!
Dr. Myers:
Yes, Neurotrack has a digital health platform with various assessments for the detection of cognitive impairment. So regardless of where you are, you have the opportunity to assess and monitor your cognitive health. If you have any concerns or just want to check in, Neurotrack provides the opportunity to do so in the comfort of one’s own home.
Neurotrack:
This seems like it would be helpful, especially for older adults who might be kind of nervous about getting tested.
Dr. Myers:
Absolutely. Unfortunately, there’s a lot of stigma about cognitive impairment. Neurotrack’s app provides a means for our older population to feel a sense of control and a sense of privacy when they want to know more about their cognitive health. At the same time, it gives them the ability to share their scores and progress with their primary care physician when they’re ready.
Neurotrack:
I think a lot of people wonder if digital tests like this are reliable and accurate?
Dr. Myers:
Yes, we have tested our assessments to make sure that first, you’re going to get a consistent result. So it’s reliable. When you are at your best, it’s going to show that. And when you’re not at your best, it’ll show that to you as accurately as possible.
And then second, the tests are valid. We designed each of our assessments based on well-established, traditional assessments that are already out there to make sure it’s just as good, if not better in some instances than, than the current tests available so you can feel confident in the scores that you receive.
Neurotrack:
If you take a digital cognitive assessment because you have a few concerns, what’s next? Is there actually a way to protect or improve cognitive health if you’re just starting to have concerns?
Dr. Myers:
Of course. One of the scariest things about cognitive impairment is this sense that you’re losing control, but there are things that you do have within your control that can help minimize your likelihood of developing cognitive impairment or aphasia and dementia. And that is focusing on your lifestyle.
So when you take the cognitive assessments, if you do great, it’s a matter of maintaining cognitive health, and if you don’t do as well as you hoped, there may be a need for intervention. Things that you can do include getting more exercise and eating healthy foods from the MIND diet. Reflect on your sleep and stress patterns. Make sure that your sleep hygiene is good so you get restful, continuous sleep. Avoid things that cause stress, anxiety, and depression, and seek help when you need it. Challenge your brain, learn new things and play puzzles and games. And lastly, get some social support, whether you have 3 or 300 friends, the importance of getting out there and engaging with others is actually pretty critical to your health. We’re social creatures and it’s important to have a good, strong support system surrounding us.
Neurotrack:
And what is it that these lifestyle areas do for our brain?
Dr. Myers:
When you focus on maintaining a healthy lifestyle, you’re actually minimizing risks that have been associated with developing aphasia or dementia. So for example, we know that heart health or heart diseases are actually a significant risk for dementia. By eating healthy, by exercising, you’re reducing the risk for heart disease, which in turn reduces your risk for developing cognitive impairment. All of these efforts act as ways to reduce your risk for disorders that could lead to cognitive decline.
Photo credit: Denis Makarenko / Shutterstock.com
