Word-Finding Difficulty: Causes, When to Worry and What Helps

01Basics

What is word-finding difficulty?

Word-finding difficulty means knowing what you want to say but not being able to bring the right word to mind. Dorset HealthCare, an NHS trust, explains it with an image: imagine the brain stores words in filing cabinets, arranged by how they sound and in categories; with word-finding difficulties, it is as if the files have been muddled.

It is one of the possible symptoms of aphasia, a condition that, according to the NHS, makes it hard to speak, read, write and understand others. But not every forgotten word means aphasia or dementia. The rest of this guide explains how to tell the situations apart.

02How it shows

How word-finding problems show up

In aphasia, the NHS lists symptoms such as:

• not being able to say the right words, speaking very slowly or with long pauses
• speaking in very short or incomplete sentences
• repeating, mixing up or missing out words
• making up words or sounds
• not being able to understand what other people are saying, particularly if you cannot see them
• difficulty reading or writing

Aphasia affects people in different ways. Someone may only have trouble finding words, or may also struggle to understand, read or write.

03Onset

Sudden, gradual or occasional: why the pattern matters

• Sudden: difficulty finding words that appears suddenly, with or without other symptoms, can be a sign of stroke and needs an emergency call.
• Gradual and worsening: the NIA says that in Alzheimer’s disease, besides memory problems, many people notice a decline in other skills, including trouble finding words, and that these can be early signs. A change that slowly gets worse and makes everyday tasks harder deserves a medical check.
• Occasional: the NIA explains that forgetfulness can be a normal part of aging, while serious memory problems make everyday tasks such as driving, cooking or shopping hard. If you are worried, talk to a health care provider.

Noting when the difficulty started, whether it came on suddenly or slowly, how often it happens and whether it affects daily life will help whoever assesses you.

04Causes

Possible causes

Aphasia is caused by damage to the parts of the brain that deal with language. The NHS lists these common causes:

• stroke, the most common cause of aphasia
• severe head injury
• a brain tumor, or bleeding or an infection in the brain
• conditions that damage the brain over time, such as dementia, or alcohol- or drug-related brain damage

Anyone can get aphasia, but it is more common after 65, because the risk of stroke and dementia is higher in older people. The sources used here do not cover other, everyday reasons for occasional tip-of-the-tongue moments, so if you are unsure, a health professional is the right person to ask.

05Not a self-diagnosis

Aphasia, dementia or normal forgetting?

It is not possible to tell the cause of word-finding difficulty from a list of symptoms. The NIA notes that trouble finding words can be an early sign of Alzheimer’s disease, but it presents it as one of several possible signs, together with memory problems, difficulty judging where objects are and problems with reasoning. A single symptom does not indicate a stage of dementia.

Quick online word or memory tests cannot diagnose dementia either. The NIA says scientists are studying biological markers to detect early signs of Alzheimer’s, but more research is needed before they can be used broadly and routinely. If you are worried, the first step is to talk to a doctor.

07Assessment and therapy

Assessment and speech and language therapy

The NHS explains that aphasia is treated with speech and language therapy. A speech and language therapist assesses the symptoms and works to improve speaking, reading and writing and to find other ways to communicate. Depending on the symptoms, therapy can include matching words to pictures, sorting words into categories, repeating words or rhyming tasks, communicating without words, and using technology such as voice-activated phones or photos of things that are hard to name. It can be individual or in a group, face to face or online, and usually involves family and friends.

After a stroke, head injury or brain tumor, most people improve with treatment, especially in the first few months, and some recover fully. When the cause gets worse over time, such as dementia, treatment may focus on other ways of communicating. In our speech therapy practice in Bilbao we assess adults with word-finding difficulties and work on communication strategies, alongside their medical assessment (consultations are in Spanish).

08Strategies

Strategies when a word will not come, and how others can help

Dorset HealthCare suggests using every form of communication available: gesture, facial expression, writing, key words, or pointing to letters. Spelling out the first few letters on an alphabet board can help the listener. Activities to practice include talking around the word (describing it), naming items in a category, completing phrases, working with sounds and syllables, writing shopping lists, sorting words into categories and finding opposites. Showing an awareness card can let others know you need a little more time.

For family and friends, the NHS notes that therapy usually involves the people around the person, and points to tips for “aphasia friendlier” communication. Giving the person time, not finishing every sentence for them unless they want you to, and welcoming gestures or writing are ways to keep the conversation going without taking it over. Aphasia can also cause frustration, anxiety, low mood and isolation; talking therapies and support groups can help.

09Sources

Where the sources differ

Scope. The NHS and Dorset HealthCare focus on aphasia, where word-finding difficulty is caused by brain damage. The NIA covers word-finding difficulty only as one possible early sign of Alzheimer’s disease and distinguishes it from normal forgetfulness. None of the three covers every cause of occasional word-finding lapses.

Outlook. The NHS says there is no cure for aphasia but most people improve with treatment, and some recover fully. The NIA says there is no cure for Alzheimer’s, although medicines may help manage symptoms or potentially slow progression. The outlook depends entirely on the cause.

10Summary

In summary

Word-finding difficulty can be an occasional lapse, a sign of aphasia after a stroke or brain injury, or one of several early signs of a condition such as Alzheimer’s disease. The way it starts and changes over time is the most useful clue.

Sudden difficulty finding or saying words is an emergency. Gradual change that affects daily life needs a medical check, not a self-test. Speech and language therapy helps people with aphasia, and gestures, writing, describing the word and patient listeners make conversation easier.