Neurocognitive Disorders

Searching for the Right Words: Living with Aphasia

Imagine waking up one morning and forgetting how to speak your native language, the one you have spoken for most of your life. Your loved ones try speaking to you, and while you know how you’d like to respond, you just can’t seem to find the words to say. You become tongue-tied, embarrassed, and increasingly frustrated when no one can seem to understand the words that you do get out of your mouth. Trying to write what you are thinking is to no avail as well. You feel isolated in your inability to communicate, stranded on an island with no way to get off. Now, imagine living like this every day.  For close to two million Americans, this, or something similar to this, is their everyday existence. This is known as aphasia.

Aphasia is a cognitive disorder that involves the loss of language function, particularly in regards to speaking, reading, and writing. Though commonly considered to be a speech disorder and treated by speech-language pathologists, aphasia has origins in the brain. Aphasia is most often the results of a stroke, but can also come from other traumatic brain injuries, brain tumors, or other neurological issues. There are several different treatment options available, but recovery is often very slow and laborious, and a full recovery is not often seen.

As language is something that many people take for granted, it may be hard to conceptualize the cognitive difficulties that these individuals are facing.  Wheeler E. Hubbard, a man who has been suffering from aphasia, describes what his personal experience with aphasia:

“Imagine that you are playing bingo. My brain is like the drum that they turn to pick a number.  I have about 2,000 words in my brain. To speak, I have got to go into the “drum” and find the word that I want, concentrate on it, bring it to my mouth and figure out how to say it, what tense to make it, then get it in the right order in the sentence.  Something you take for granted takes all my effort, energy, and concentration to do.”

While this is one individual’s experience with living with aphasia, aphasia can actually mean different things depending on what area of the brain is impacted. There are three major categories of aphasia: Wernicke’s, Broca’s and Global aphasia. Wernicke’s aphasia is the most common type of fluent aphasia, meaning that a person ’s sentences may sound completely fluent, but the word choice can have no meaning, contain extra words, or even use made-up words. Individuals with Wernicke’s aphasia do not often recognize that they have made any mistakes in their sentences, and often have difficulty understanding what others say. Broca’s aphasia, on the other hand, is nonfluent aphasia. This means that they may understand speech and know what they want to say, but have a hard time producing sentences. They may omit smaller words and speak in shorter phrases. They are more likely to recognize their mistakes and become frustrated. Global aphasia is a more severe type of aphasia. These individuals may only be able to say a few words, repeat the same phrase over and over again, and have severe difficulties understanding others.

Now that you are well armed with the knowledge of aphasia, a question you might be having is “How can I communicate with someone with aphasia?” Though it depends on every individual, here are a few suggestions!

  1. Allow the individual time to speak. Trying to offer up words and finishing the individual’s sentences, may make them feel like you are rushing them or do not care about what they have to say.
  2. Try to find non-verbal ways to communicate, such as gestures, facial expressions, or even drawings. This will allow for the conversion to rely not so heavily on language.
  3. Give them praise when they are able to say or pronounce something clearly, and downplay any mistakes that they might make. This does not mean pretending that every single word is perfect if it isn’t; lying to them will not make the situation any better, especially if they can tell that you are lying.
  4. Make sure that you do not come across as speaking down to them. Though it may seem like you are trying to be nice and use simple words to communicate, as if talking to a child, it’s important to remember that this individual is still an adult, and should be treated as one.

Ultimately, the most important thing that you can do is to be empathetic. Understand that however frustrated you are with your inability to communicate with an individual with aphasia, that they are most likely frustrated with themselves. Showing the individual that you care by including them in conversations and allowing them the space to talk reminds them that they do have people who care about them and want to communicate with them.


Aphasia. (2018, June 15). Retrieved September 30, 2018, from

Aphasia FAQs. (n.d.). Retrieved September 30, 2018, from

Communication Tips. (n.d.). Retrieved from

My Story of Aphasia. (2015, February 25). Retrieved from

Bipolar Disorder

Use and Abuse: Overlap in Bipolar and Substance Use Disorder

While there is a high rate of comorbidity among mental illnesses in general, there is perhaps no other combination of disorders more dangerous to the individual and those around them than mental illness paired with substance use disorder (SUD). Together, these two illnesses can work in powerful combination, exacerbating the vulnerability and instability already experienced by individuals with poor mental health.  Those with bipolar disorder are particularly at high risk for a comorbid diagnosis of SUD. These two disorders occur together so often that some even believe it should be common practice to screen bipolar individuals (specifically young adults) for drug use as soon as a diagnosis is made.

Why is it, then, that these two illnesses, seemingly distinct and unrelated to each other, are so often linked together?  A recent article on the common prevalence of comorbidity between bipolar and substance use proposes that this phenomenon is due to one or a combination of three different reasons: genetic factors underlying aspects of both diseases occurring in the brain, overlapping neurobiological pathways in the brain, or one disorder fostering another.

It is commonly known that many mental illnesses are comorbid — a single diagnosis of any mental illness puts one at much higher risk for encountering another at some point in life. At any given point during a 12-month period, 50% of adults clinically diagnosed with a psychiatric disorder also had at least one other accompanying mental disorder. Anxiety and depression, for example, are two mental illnesses that have extremely high rates of comorbidity (upwards of 60%).  Similar to the current understanding of how many other mental illnesses develop in conjunction with one another, one theory for understanding the particularly high comorbidity of bipolar and SUD is that they have similar genetic causes. Biological factors that lead to genetic vulnerability toward one disorder also predisposes the person to greater vulnerability toward another disorder.

Along this same trend, some scientists point toward overlapping neurobiological pathways in the brain as the root cause for high rates of SUD and bipolar occurring in conjunction with one another. As both mental illness and substance abuse progress, both disorders display a similar pattern. In bipolar, manic and depressive episodes become more frequent with shorter symptom-free periods as the untreated disease progresses; in substance abuse, addiction becomes more all-consuming as time goes on, causing the drug user to crave the high of the drug more frequently in the case of longer duration of drug use. The theory of overlapping pathways, then, points toward greater “sensitization” from an untreated disorder in the brain as a sort of “kindling,” or fuel, for the other disorder to track down the same destructive pathway when left untreated.

Although this theory explains some of the science of what causes co-occurring disorders, it does not capture the whole picture. Current psychological research describes the development of mental illness in terms of genetic and environmental influences. The environmental contributions to bipolar disorder and SUD can be best understood if SUD is conceptualized as resulting from the bipolar disorder. In an effort to deal with the intense ups and downs and extreme mood swings, people with untreated bipolar will sometimes resort to “self-medicating” with addictive substances such as alcohol, marijuana, or other drugs. Some people rely on these substances so heavily that they can even trigger manic or depressive episodes due to their use. Cocaine, for example, has been shown to potentially send people with mood disorders into a manic or hypomanic episode because of its effect on the body and complex neurotransmitter chemistry in the brain. The person, however, may view the drug as a way to remedy intense depressive episodes experienced from a bipolar “low,” unaware that the resulting hypomanic or manic episode can be just as harmful.

Due to these complex interaction effects from both disorders, it is generally recommended that people receive treatment for bipolar and SUD together and not separately, as was common practice up until recently. The very fact that these two illnesses are linked together so frequently reiterates the importance of understanding their combined effects.  Even further, though, understanding the comorbidity and underlying causes between bipolar and SUD also empowers us with the even greater understanding that each individual and their needs are extremely unique and amazingly varied, making us more compassionate and empathetic practitioners, students, friends, and partners.


Mcgregor, S. Substance Abuse and Bipolar Disorder. Retrieved on February 18, 2018, from

Quello, S. B., Brady, K. T., Sonne, S. C., Mood Disorders and Substance Use Disorder: A Complex Comorbidity. Retrieved on February 18, 2018, from

Cameron, O. G. Understanding Comorbid Depression and Anxiety. Retrieved on February 18, 2018, from

Dual Diagnosis. Bipolar Disorder and Addiction. Retrieved on February 18, 2018, from


Autism Spectrum Disorder

What the Brain May Be Telling Us About Autism

Although there continues to be countless questions related to the cause of autism spectrum disorders (ASD), it is undisputed that rates of ASD are higher in males than females. In fact, males are nearly five times more likely to be diagnosed with ASD than females.

Some scientists believe that characteristics of the brain that vary between the sexes may explain the differential appearance of ASD. One primary difference between male and female brains is the thickness of the cortex — the outer layer of the cerebrum that plays a vital role in consciousness. Male brains tend to have a thinner cortex compared to female brains, leading Christine Ecker, a neuroscience professor at Goethe University in Frankfurt, Germany, to begin a new study that examined cortical thickness to determine whether brain anatomy differences were connected to a higher probability of autism in males.

The study, published in JAMA Psychiatry, consisted of Ecker and her co-authors examining brain MRIs of 98 adults with ASD (49 male, 49 female) and 98 adults without the disorder (51 male, 47 female), and comparing the cortical thickness. The research found that the thinner the cortex, regardless of gender, the more likely the person was to have ASD. In women, those with thinner, more “male-like” cortical thickness readings were about three times more likely to have ASD than women with thickness readings expected of unaffected women (Park, 2017).

Ecker’s primary takeaway from the study is the prospect that a thicker cortex in women might provide a defense against developing autism. Understanding the role that cortex thickness plays in developing autism could guide researchers towards more anatomy-specific factors that cause autism, and potentially offer clues about how to treat its symptoms.

In the conclusion of the study, the authors stress that  “In addition to genetic and environmental factors, normative sex-related phenotypic diversity should thus be taken into account when determining an individual’s probability of ASD” (Ecker et al., 2017).  It remains unclear whether a thinner cortex is a direct cause of autism, or simply a symptom of the disorder and thus the normal variations in thickness between male and female brains should be considered.

Looking forward, Ecker hopes to expand on her research to include investigating the potential functional changes the varying thicknesses have on male and female brains to determine if they can be connected to ASD. Ecker also hopes to track the variations in cortex measurements over the lifespans, to see if the male and female differences remain from infancy throughout adolescence or whether they arise later in life.

The release of the study highlights the need for continued research in an effort to determine the cause of ASD. With 1 in 68 children diagnosed today, autism is one of the fastest-growing developmental disorders in the United States with 1 in 42 boys being diagnosed with ASD, a statistic that is the central basis of this new study. Determining why more males are affected by autism than females is an important aspect of autism diagnosis, which may lead to groundbreaking findings on the main cause of the disorder.


Ecker, C., Andrews, D. S., & Gudbrandsen, C. M. (2017). Association Between the Probability of Autism Spectrum Disorder and Normative Sex-Related Phenotypic    Diversity in Brain Structure. JAMA Psychiatry. Retrieved February 12, 2017, from

Park, A. (2017, February 8). Why Autism Affects Boys More than Girls. Retrieved February 12, 2017, from


Through another’s eyes: Capgras Syndrome

Through Another’s Eyes is a video series that explores how different individuals perceive the world. Capgras Syndrome is very rare, but it reminds us how much our brains do behind the scenes, and is a helpful reminder to be patient with others.


For more about Capgras Syndrome:

When a ‘Duplicate’ Family Moves In by Carol W. Berman, M.D. in The New York Times

Seeing Imposters: When Loved Ones Suddenly Aren’t by Jad Abumrad and Robert Krulwich on Radiolab