Agraphia: Types, Symptoms, Causes, and Treatments

Agraphia is a kind of an impairment or loss in ability to write in people (Most often in case of adults) who could write and/or spell prior to the brain damage, either all of a sudden or progressive. If you want to know more about Agraphia, you definitely need to read below.

What is Agraphia?

For writing, one needs to be able to execute and to integrate many separate skills. Your brain should be able to process language. It can be said in other words that one must be able to convert their thoughts into words.

For writing, you should be able to choose the right letters to spell the words that you want to write, you should be able to plan how to draw the graphic symbols that we call letters, and be able to physically copy them with your hand. Again, while copying the letters, you must be able to see what exactly you are writing now and must plan what you will be writing next.

Agraphia is a condition that occurs when any area of the brain that is involved in the process of writing, gets damaged or injured. Agraphia might be defined as a loss or an impairment of a person’s ability to produce written language, which occurs as a result of brain dysfunction.

Since both, spoken as well as the written language are produced by intricately connected neural networks in your brain, if you have agraphia, you will most probably also have other language impairments. (1) Usually patients of agraphia suffer from difficulty speaking or reading correctly.

Types And Symptoms Of Agraphia

Now, what exactly Agraphia looks like varies according to the area of the brain that has been damaged. We can broadly categorize agraphia in to two primary categories, namely the Central Agraphia and the Peripheral Agraphia.

This can be again subdivided in to various sub categories, according to which part of the process of writing has been impaired. Let’s look at the types and their symptoms of agraphia.

Central Agraphia:

This category of agraphia refers to a loss of writing in a person that stems from dysfunction in their language, visual, or in their motor centers of their brain.

Depending on where exactly the injury is, patients of central agraphia might not be able to write understandable words. In fact their writing might have frequent errors in spellings, or the syntax might be quite problematic.

Forms Of Central Agraphia

Deep Agraphia: An injury to your left parietal lobe of your brain at times damages the ability to remember how actually to spell words. This skill is known to be the Orthographic memory. When a person suffers from deep agraphia, they not only struggle at remembering the spelling of a word, but they might even have a difficult time in remembering how exactly to “sound out” the word. This skill is what we call Phonological ability. Deep agraphia is also characterized by semantic errors, or confusing words whose meanings are quite related, for example, writing sailor in place of sea.

Lexical Agraphia Lexical agraphia is a disorder that involves the loss of the ability to spell words that are actually not spelled phonetically. Patients of lexical agraphia can no longer spell irregular words. These are the words that use the lexical spelling system, and not the phonetic spelling system.

Phonological Agraphia One more type of central agraphia is the phonological agraphia. This is the inverse of lexical agraphia. In such a disorder, the ability to sound out a word is being damaged. In order to spell out a word properly, a person with phonological agraphia has to depend on memorized spellings. We must let you know that individuals with this disorder have less trouble in writing words that have concrete meanings, such as table or fish, while they might have a difficulty in writing abstract concepts like, honor and faith.

Alexia With Agraphia Alexia with agraphia is a disorder that causes the victim to lose the ability to read and to write. They might be able to sound out a word, but can no longer access the part of their orthographic memory, or where the individual letters of the words are stored. Words having uncommon spellings are mostly more problematic than the words that actually follow simpler patterns of spellings.

Gerstmann Syndrome This syndrome is comprised of symptoms like finger agnosia or the inability to recognize fingers, agraphia, lef-right confusion, and acalculia or the loss of one’s ability to perform simple number operations, such as addition or subtraction. This Gerstmann syndrome occurs when there is a damage to the left angular gyrus, which is generally because of a stroke. However, this syndrome has been also associated with widespread brain damage because of specific conditions like lupus, carbon monoxide poisoning, alcoholism, and excessive exposure to lead. (2)

Peripheral Agraphia

Peripheral agraphia is the agraphia that refers to a loss of writing abilities. It is caused by a damage to the brain. However, it can mistakenly appear to be linked with visual perception or motor function. This condition involves the loss of cognitive ability for selecting and connecting letters to form words.

Apraxic Agraphia

At times apraxic agraphia is also called as ‘Pure” agraphia. This is the condition where there is a loss of writing ability while you can still speak and read.

Such a disorder sometimes occurs when there is a lesion or a hemorrhage in your frontal lobe, temporal lobe, or the parietal lobe of your brain or in the thalamus. (3)

It is believed by researchers that this type of agraphia results in lose access to the areas of your brain that actually allow you to plan the specific movements that you need to make so as to draw the letters or the shape of the letters.

Reiterative Agraphia

This type of agraphia is also called as Repetitive agraphia. Such a writing impairment in people causes them to repeat letters, words, or even parts of words while they write.

Visuospatial Agraphia

While a person has got visuospatial agraphia, they might be unable to keep their handwriting horizontal. These people might group parts of a word incorrectly, (say for example instead of writing “I am somebody” they would write Iam somebo dy”) Or they might confine their writing to only one quadrant of the page.

In certain cases, individuals with this type of agraphia omit several letters from words or they add strokes to some specific letters while they write them.

It must be listed that such a type of agraphia has been associated with damage of the right hemisphere of the affected person’s brain.

Musical Agraphia

Rarely, musical agraphia might occur in person when a person who knew how to write music once, loses that ability. This is because of a brain injury.

In one case that was reported in 2000, a piano teacher who underwent brain surgery lost her ability to write, both words and also music. (4) Though her ability to write words along with sentences was restored eventually, her ability to write melodies and rhythms did not actually recover.

Dysexecutive Agraphia

Dysexecutive agraphia is a type of agraphia that has got features of aphasia or the inability to use language in speech and also features of apraxic agraphia. This condition is associated with Parkinson’s disease or a damage of the frontal lobe of the affected person’s brain.

Since this condition is associated with writing issue related to planning, focusing, and organizing, which are all considered as executive tasks; such a kind of writing disorder is at times known as Dysexecutive Agraphia.

Causes Of Agraphia

An injury or illness that affects the areas of your brain that are involved in the process of writing, could cause agraphia. Language skills are present in various areas of the dominant side of your brain, in the parietal, temporal, and frontal lobes. The language centers found in the brain have neural connections between each other and this actually facilitates language. Any damage occurring in the language centers or in the connections between them can result in agraphia.

Some of the common causes of agraphia are listed below

    • Traumatic Brain Injury

According to the CDC or the Centers for Disease has described that a traumatic brain injury could be explained as a bump, a blow, or any jolt to the head that disrupts the brain’s functioning. (6)

Any such brain injury that affects the language areas of your brain, whether it arises from a fall in the washroom, or a concussion on the soccer pitch, or a car accident, can cause a temporary or a permanent agraphia.

    • Stroke

When there is an interruption in the supply of blood to the language areas of the brain because of a stroke, you might lose the ability to write. It is found by the researchers that language disorders are really a frequent result of stroke. (7)

    • Dementia

Dementia is another condition that can cause agraphia. In fact it can be mentioned that agraphia that gets steadily worse in some people, is believed to be one of the earliest signs of dementia. (8)

With lots of types of dementia, including the Alzheimer’s disease, people not just lose the ability to communicate properly in writing, but they might even develop problems with their reading and also their speech as they progress with their condition.

This generally occurs because of the atrophy or shrinking of the language areas in the brain.

    • Less Common Lesion

A lesion is an area of any abnormal tissue or any damage within your brain. These lesions can really disrupt the normal functioning of the area where they appear.

Agraphia could occur if a lesion occurs in an area of your brain that helps in writing.

Treatments For Agraphia

Now, let’s talk about the treatments for the condition of agraphia. In severe cases of agraphia, where there is an injury to the brain and that is permanent, it might be impossible to completely restore someone’s previous level of skill in writing.

However, there is some research that shows that when rehabilitation includes a lot of different language strategies, recovery results are quite better than when only a single strategy is being used. (9)

A study from 2013 has found that writing skills improved in people who had alexia along with agraphia when they had undergone multiple treatment sessions where they read the same text over and over until they could actually be able to read whole words instead of single letter by letter. (10)

This strategy of reading was combined with interactive spelling exercises where participants could make use of a spelling device so as to help them spot and to correct their spelling errors.

Rehabilitation therapists might also make use of a combination of some sight word drills, anagrams, and mnemonic devices, so as to help people re-learn.

They might even use spelling and sentence-writing exercises along with oral reading and spelling practice so as to address deficits in multiple areas simultaneously.

There are other researchers who have had some kind of success using drills in strengthening the connections between word sounds or the phonemes and awareness of the letters that actually represent sounds or the graphemes. (11)

All these methods might help people with some sort of coping strategies, so they can function better even their damage to the brain is not reversible.

Conclusion

So, by now we are known pretty much about agraphia. It is the condition that is caused by stroke, traumatic brain injury, and several health conditions like brain lesions, dementia, or epilepsy. In this condition there is a loss of the ability to communicate in writing. Many times patients of agraphia also experience disturbances in their ability to speak or to read.

Though some types of damage to the brains are not reversible, people might be able to regain some of their abilities to write by working with their therapists so as to re-learn how to plan, write and to spell with a greater accuracy even with their existing condition.

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