On Wednesday, the world learned that Hollywood legend Bruce Willis, 67, will be retiring due to his diagnosis of aphasia, a potentially devastating condition that causes a person to lose their communication skills.
Willis' family announced that the illness would cause the “Die Hard” star to “step back from the career that meant so much to him.”
According to the National Institutes of Health, about one million Americans suffer from the disease, and about 180,000 people are diagnosed each year.
It can manifest itself in a variety of ways and is often the result of a head injury, stroke, tumor or other brain damage.
Aphasia can also have devastating consequences. Experts say it leads to depression in over a third of cases, can lead to personality changes and can even alienate friends and family from the affected person.
Other famous examples of aphasia include former Arizona congresswoman Gabby Giffords and Game of Thrones star Emilia Clarke.
“Imagine being dropped off in a country where you don’t speak the language – can’t understand, read, write or speak. It would affect all your interactions – that's what it's like to have aphasia,” Darlene Williamson, president of the Aphasia Association, told .
While it's impossible to say for Willis in particular how drastically the condition has affected him and his behavior, Williamson reports that it can often be devastating for patients.
“The consequences of a speech impediment can change a person’s behavior and outlook on life,” Williamson said.
“Approximately 35 percent of people with aphasia suffer from depression.”
The cause of the disease, which is often a traumatic brain injury or a stroke, can lead to massive personality changes.
'[Aphasia is] Speech difficulties resulting from brain injury. The most common cause is a stroke… but it could also come from any other type of damage,” said Dr. Brenda Rapp, a cognitive scientist at Johns Hopkins University, told .
Certain infections that affect the language centers of the brain can also lead to the formation of aphasia, as well as cognitive decline and deterioration associated with dementia.
This condition can make it very difficult for an actor like Willis to continue his career, as just saying lines can become a challenge.
“It would certainly be difficult,” Williamson said of trying to continue acting while suffering from the illness.
“Aphasia affects language comprehension, speaking, reading and writing.” There are different degrees of severity, which would be another crucial factor. “It may not be impossible, but acting would require extra precautions.”
Dr. Rapp said that despite communication impairments caused by the disease, people suffering from the disease still have the same thoughts and are the same people inside. Although the experience may be alienating, family members should remember that the person has not changed. Pictured: Willis with family and friends after a “roast” event in 2018
There are four common types of aphasia that account for the vast majority of cases: fluent aphasia – often called Wernicke's aphasia; non-fluent – known as Brocas; anomic; and primary progressive aphasia.
Rapp explained that there are different forms of the disorder, as each represents a different type of disruption in the communication process.
Whether it's the ability to translate thoughts into real words, the ability to physically pronounce words, or the ability to interpret and understand the language of others, every part of communication is a complex process, and even minor brain damage can result lead to problems.
Although the illness causes breakdowns in communication, Rapp notes that the person himself is still the same.
Their thoughts, beliefs, and feelings toward their loved ones remain, even though dealing with this condition can be frustrating and alienating for both the aphasia patient and those around them.
Willis' family did not disclose what type of illness Willis had, how severe his case was, or what the root cause of the illness was.
According to the Stroke Association, a United Kingdom-based group, people suffering from Wernicke's aphasia have the ability to string together long sentences of words but often say things in a way that doesn't make sense or even use made-up words.
They also suffer from limited reading and writing skills and may have difficulty understanding clear verbal communication towards them.
An example used by Rapp is that a person might misunderstand the sentence “John kicked the dog.”
Dr. Brenda Rapp, a cognitive scientist at Johns Hopkins University, explains that aphasia is often caused by a stroke and can manifest itself in many different ways
While the average person in this scenario would clearly understand who kicked who, it can be difficult for a person struggling with this type of illness to figure out whether John or the dog was the person who kicked.
Broca's aphasia often causes a person to forget words or put together a correct sequence of words, even if their brain can fully understand what they want to say.
A person suffering from this type of illness often uses simple, short sentences to convey their speech, as they are sometimes unable to properly say what they want to say.
The Stroke Association says these sentences often consist of around four words or less.
A person suffering from Broca's aphasia will also have difficulty writing, but their reading ability will be unaffected.
Someone suffering from anomic aphasia may have difficulty finding the specific verbs and nouns they need to make their point and will speak very vaguely.
This can also affect their writing, where they are simply unable to find the right words they need to express what they want to say.
Primary progressive aphasia affects a person's ability to communicate in virtually every way.
A person suffering from this version of the condition will have difficulty speaking, reading and writing.
Their ability to process and understand someone speaking to them is also impaired.
Doctors can often detect aphasia using an MRI or CT scan, pinpointing the exact part of the brain that is causing the problem.
There is no way to completely resolve or cure the condition, but patients often undergo speech therapy to restore their language skills.
“There’s not much progress.” [with medication for the condition]… the treatment of aphasia is speech therapy,” Rapp said.
She noted that in some cases, a person may undergo electrical stimulation therapy in addition to speech therapy to get the most out of the experience.
Williamson said that “strong family support is a critical factor in living successfully with aphasia.”
However, it is not always permanent and how long it lasts and how severe it is often depends on how severe the brain damage is.
In particular, stroke patients who suffer from aphasia can often regain their speech after just a few weeks.