Learning about aphasia, the condition afflicting Bruce Willis

Bruce Willis — known for an iconic career in movies like “Die Hard,” “Armageddon” and “Pulp Fiction” — will retire from acting after being diagnosed with aphasia, a condition that causes people to lose their ability to communicate verbally and through writing.

His family revealed the news March 30 on Instagram.

Northwestern faculty have spent years studying aphasia and helping improve quality of life for patients. Northwestern Now spoke to several of these experts about aphasia symptoms, treatments and how loved ones can communicate with a patient.

What is aphasia?

“Aphasia is an impairment of language in expression or comprehension that is due to a lesion or disease in the brain,” said Dr. Borna Bonakdarpour, assistant professor of behavioral neurology at Northwestern University Feinberg School of Medicine. Bonakdarpour is also a member of the Mesulam Center for Cognitive Neurology and Alzheimer’s Disease at Feinberg. “It can be caused by different diseases, the most common cause in the U.S. is stroke, in which people have an acute onset of loss of ability to express or comprehend language.” 

What’s the difference between sudden onset aphasia and primary progressive aphasia (PPA)?

“Primary progression aphasia (PPA) is usually caused by Alzheimer’s disease or frontal temporal degeneration,” Bonakdarpour said. “These individuals can have trouble expressing themselves like they can after a stroke. Or they may talk very fluently but don’t understand others.”

“It is important to differentiate between primary progressive aphasia and the other types of aphasias that occur suddenly, such as after a stroke,” said Leora Cherney, professor of physical medicine and rehabilitation, jointly appointed at Feinberg and the School of Communication. 

“People with primary progressive aphasia experience worsening language impairment as cognitive deficits begin to emerge and progress,” Cherney said. “Those with sudden onset aphasia can expect to improve their language skills over time and with speech and language therapy. Therefore, there will be differences in the best approaches to treatment and the long-term management of these disorders.” 

“Aphasia really needs a spotlight, and this gives us an opportunity to talk about it,” Bonakdarpour added. 

Can aphasia be treated?

“With the more sudden onset aphasia due to an event such as stroke, speech therapy helps individuals to improve language,” said Aaron Wilkins, assistant clinical professor and speech pathologist in the Roxelyn and Richard Pepper Department of Communication Sciences and Disorders in Northwestern’s School of Communication. “In the case of a slow developing, progressively worsening aphasia, speech therapy assists individuals to learn compensations to communicate differently from traditional communication that is slowly being lost,” he said.

"Speech and language therapy not only helps people with aphasia improve the ability to communicate, it also impacts brain processing,” said Cynthia Thompson, the Ralph and Jean Sundin Professor of Communication Sciences in the School of Communication. “The brain is an organ of plasticity and has the capacity to change throughout the lifespan. Known as experience-based plasticity, the brain forms new pathways that are directly associated with experience — in the case of aphasia: language treatment."

How can it impact quality of life?

“Importantly, aphasia is not an intellectual or mental disorder,” said Thompson. “People with aphasia are able to perform many functional activities that do not rely on language. However, because language is required for daily tasks such as talking on the phone and conversing with friends, and it is needed in many types of jobs, aphasia often results in social isolation, job loss and reduced quality of life. For an actor, like Bruce Willis, language is essential; thus having aphasia will unfortunately impact the ability to perform.”

How can you communicate with someone who has aphasia?

“Friends and family members can help,” Bonakdarpour said. “But some people don’t get it, so they talk over the patient and the patient gets sad. They might just process more slowly. So it’s important for people around them to speak slowly and give them the time to talk. Sometimes the patient just wants the challenge to come up with the words themselves, so we encourage friends and family to ask them if they want help.”