What is alexia?

Alexia is an acquired reading disorder affecting previously literate adults. Reading comprehension is significantly impaired due to brain injury, damage, or trauma, most commonly a stroke or tumour, affecting the left hemisphere of the brain, which is responsible for language in most of the population. Alexia affects the ability to read and comprehend written words, and the severity may differ. It may also be associated with other deficits including:

• Agraphia - difficulty writing 
• Aphasia - difficulty with speech 
• Acalculia - difficulty with mathematic ability, such as calculations¹

This is in contrast to dyslexia, which is a learning difficulty present from childhood that affects reading, writing and spelling without acquired brain injury.¹ This article will outline some of the strategies available to help you cope with everyday reading difficulties.

Types of alexia 

Alexia can be divided into subtypes based on where the damage is located in the brain or the linguistic challenges an individual experiences. The two main subtypes are: 

Alexia without agraphia

Also known as ‘pure alexia’, individuals with this type of alexia lose their ability to read, but are still able to write and speak fluently. You may have difficulty recognising written words and may only be able to read one letter at a time. It is often accompanied by visual blindness on one side.^2,3

Alexia with agraphia 

The individual develops both an inability to read and write. 

Alexia may also be categorised by the way language is affected:

Linguistic subtypes

Surface alexia 

Individuals with this type of alexia rely on the pronunciation of words to understand their meaning and may be unable to identify if it is a real word unless it is pronounced.

Phonological alexia

Individuals with this type of alexia have trouble sounding out words when they read, may mistake words for similar words and have difficulty spelling.

Deep alexia 

Individuals with deep alexia have trouble reading both regular words (which sound the way they are spelt) and irregular words, as well as understanding complex sentences and metaphorical language. When speaking they may omit functional words (such as ‘and’, ‘over’ and ‘the’).

Causes of alexia 

Some of the most common causes of alexia include:

• Brain damage 
• Stroke 
• Dementia 
• Traumatic brain injury 
• Alzheimer's disease (age-related memory loss, confusion, etc.)¹

Daily challenges caused by reading difficulties

Reading difficulties caused by alexia may affect everyday tasks including:

• Academic work
• Employment difficulties
• Inability to drive: difficulty reading signs
• Difficulty reading letters: including bank statements, hospital appointments, newspaper
• Difficulty following written instructions

Reading difficulties associated with alexia may cause you to feel frustrated. These feelings may impact your self-esteem and motivation to improve reading. Alexia may also cause difficulties with writing and speech comprehension, which may impact communication and social relationships. It is important to remember you are not alone.

Treatment and coping strategies

Although there is no cure for alexia, there are several therapies available to support you to strengthen reading difficulties, including:

• Re-reading therapy - involves repeatedly reading the same passage of text aloud at home, which helps to improve reading time and comprehension⁴
• Tactile-kinaesthetic training- tactile methods including tracing letters with hand, or tracing the shape of letters onto skin^1,5
• Audio-visual reading training- involves reading aloud, flashcards and naming⁶
• Online behavioural therapy - online reading therapy has been proven to improve reading speed and can be accessed here

Other coping strategies include: 

• Reading words letter by letter
• Spelling aloud as you read
• Use signs, visual images and symbols to identify objects and communicate your needs. 
• Audio-support tools- audiobooks can be accessed at the library or on apps such as Audible. Speechify can also help to read text aloud
• Ask a friend or family member to help read letters, and explain to others that you need support. They may be able to use alternate means of communication, such as more visual techniques

Further help with communication and reading difficulties can be found here.

FAQs 

What is alexia and how is it treated?

It is an acquired neurological disorder that affects a person's ability to read. Treatment for alexia includes speech therapy, vision therapy and treatment for underlying conditions. 

Is pure alexia a reading disorder?

Pure alexia is a distinct reading disorder that is characterised by difficulties recognising whole words. An individual is still able to write fluently, but is unable to read their own handwriting. 

What is an example of alexia?

Individuals with alexia may spell out words such as ‘blow’ as ‘b-l-o-w’. They may also mistake words for similar-sounding words such as ‘beat’ as ‘heat’, or have difficulty pronouncing irregular words that sound different to their appearance, such pronouncing ‘tough’ as ‘tug’. Individuals may also miss functional words such as ‘the’ or ‘and’. 

How does not being able to read affect your life?

Being unable to read causes a higher risk of struggling academically or at work. It can leave an individual feeling frustrating and isolated. 

What is the difference between literal and verbal alexia? 

Liberal alexia is when a patient is unable to name letters. Verbal alexia is when an individual recognizes the words but has difficulty in reading them. 

How to help someone struggling with phonological awareness?

Some techniques may help, including:

• Voice out the sounds while reading them aloud
• Break apart the words into component sounds 
• Focus on rhyming words

Summary 

Alexia is an acquired neurological disorder affecting reading comprehension as a result of brain pathology, most commonly stroke or tumour. The two main types of alexia are alexia with agraphia and alexia without agraphia. Alexia typically affects previously literate adults. This can lead to difficulties with everyday tasks. Support to cope with reading difficulties includes a range of reading therapies, audio tools and support from others.