Anomia is a mild, fluent form of aphasia in which the individual fails to recall words and cannot express the words they want to say. Anomia is a disorder of expressive language. The most common disorder in aphasia is anomia. Some loss of naming is present in all aphasias. People with aphasia who show anomia can sometimes describe an object in detail, using hand gestures to describe how the object is used, but they cannot find the appropriate word to name it. Anomia is a type of aphasia characterized by problems retrieving words, names, and numbers. Speech is fluent and receptive language is intact in people with anomia. Patients sometimes use verbosity to avoid a name they cannot recall or to express a word they cannot remember. Sometimes patients can retrieve a name when given cues or clues. In addition, patients can speak with correct grammar, but the main problem is finding the appropriate word to identify a person or object. Sometimes patients may know what an object does, but cannot name it. For example, if a patient is shown an orange and asked what it is called, the person may be fully aware that it can be peeled and eaten, and that these actions can be described in words or actions – yet the patient cannot recall the word “orange” as the name for the object. Sometimes, when a person with this problem is multilingual, they may become confused about their own language while trying to find the right word. There are three main types of anomia or loss of anomia: Anomia can be hereditary or result from damage to different parts of the parietal or temporal lobe of the brain as a result of an accident, stroke or brain tumor. Although the exact causes are not known, several researchers have found contributing factors to anomia. It is known that people with damage to the left hemisphere of the brain are more likely to develop anomia. Broca’s area, the brain’s speech production center, has been linked to problems with speech execution, with functional magnetic resonance imaging now commonly used to study anomia patients. Other experts believe that lesions to Wernicke's area, the speech-comprehension area of the brain, are linked to anomia because patients cannot understand the words they hear. Although many experts believe that lesions to Broca's area or Wernicke's area are the primary causes of anomia, current studies show that lesions to the left parietal lobe are the primary focus of anomia. A study was conducted using a word repetition test as well as functional magnetic resonance imaging to see the highest level of activity and the location of the lesion in brain tissue. Fredrickson and others suggested that lesions to Broca's area or Wernicke's area were not the sole source of anomia in these patients. Thus, the original model of anomia, which assumed that the lesion occurred in the surface gray matter of the brain, was shown to be incorrect, and the lesion was found to occur in the white matter deep within the brain in the left hemisphere. More specifically, the damage was to a part of a nerve pathway called the arcuate fasciculus, whose mechanism is unknown, although it is known to connect the back of the brain to the front and vice versa. New data suggest that although the main function of the arcuate fasciculus is not to connect Broca’s area and Wernicke’s area, lesions in the pathway cause speech problems because the areas of speech comprehension and speech production are connected to the pathway. Some studies have found that in right-handed people, the language center is located in the left hemisphere in 99 percent of cases, so naming aphasia occurs almost exclusively in left-handed people. In left-handed people, the language center is located in the left hemisphere in about 60 percent of cases, so naming aphasia can occur in right-handed people. The best way to determine whether naming aphasia has occurred is to use oral tests in combination with imaging. Using two tests seems to be most effective, because either test alone can give false positives. For example, the oral test is used to see if there is a speech disorder, whether the problem is in speech comprehension or speech production. Alzheimer’s patients have speech problems associated with dementia or primary progressive aphasia, which can include loss of naming. Imaging testing, often using MRI, is ideal for visualizing the lesion or monitoring brain deterioration. However, imaging alone cannot diagnose anomia because the lesions may not be deep enough to affect the white matter or the arcuate fasciculus. However, it is very difficult to associate anomia with a specific brain injury site. Therefore, a combination of speech tests and imaging has the highest sensitivity and specificity. It is important to perform a hearing test first if the patient cannot clearly hear the words or sentences required in the speech repetition test. In speech tests, the person is asked to repeat a sentence with common words. If the person cannot recognize the words but can describe them, there is a high probability that he or she has anomia. However, to be completely sure, the test is performed while the patient undergoes fMRI and the exact locations of the lesions and the areas activated by speech are identified. There are simpler and cheaper options, so speech repetition tests with lesion location are the main method for diagnosing anomia. There is no cure for anomia. However, there are some habits that can help improve word-finding skills. Although anomia patients may have difficulty retrieving many types of words such as common nouns, proper nouns, verbs, etc. Several studies have shown that word or name therapy has shown promising results in rehabilitation research. The therapy involves visual aids, such as pictures, and the patient is asked to identify the object or activity. However, if this is not possible, the same picture is shown to the patient surrounded by words related to the object or activity. Positive reinforcement is provided throughout the process. Word-finding abilities are shown to increase during therapy, however, word recognition declines after two weeks of rehabilitation. Thus, rehabilitation needs to be ongoing for word-finding abilities to improve. Studies have shown that verbs are more difficult to retrieve or repeat, even with rehabilitation. Other approaches to treating anomia include naming therapy by circumlocution, in which the patient uses circumlocution to help them name rather than being asked to name the item in the picture. The results suggest that patients do better at naming objects appropriately during therapy because naming therapy by circumlocution strengthens the weak link between meanings and speech sounds in patients with anomia. Anomia can often be challenging or demanding for family and friends of patients. One way to overcome this is through computer-based therapy, which is particularly effective when used in conjunction with clinical therapy. Lehmann et al. provided computer-assisted therapy sessions for patients with anomia, in addition to traditional word list therapy sessions. Some patients received levodopa, which is known to help relieve symptoms, while others received a placebo. The researchers found that the drug had no significant effect on improvement with the list therapy, but all patients improved after the computer-assisted therapy sessions, and they concluded that this form of therapy was effective in increasing naming abilities in patients with anomia. In addition, one study looked at the effects of transcranial direct current stimulation on the temporoparietal cortex, a brain region associated with language. Electrical stimulation was shown to enhance language training outcomes in patients with chronic aphasia. Many different populations suffer from anomia. For example, deaf patients who have had a stroke may exhibit errors in meaning or words, much like patients with anomia. The researchers have dubbed this subtype sign anomia. Multilingual patients typically have a greater degree of anomia in only one of their languages. However, there is conflicting evidence about which language is most affected, the first or second language. Research on children with anomia has indicated that children who receive treatment are often able to return to normal language abilities, aided by neuroplasticity. However, research on children with anomia due to head injury shows that even many years after the injury, some deficits in word retrieval can still be observed. These residual symptoms can cause academic difficulties later on. The condition can be extremely frustrating for both those with and without anomia. Although an anomia sufferer may know the specific word, he or she may be unable to retrieve it, making it extremely difficult for everyone in the conversation. Positive reinforcement is helpful. Although there is not much literature on anomia, there are several nonfiction books about living with aphasia. One such book is The Man Who Lost His Language by Sheila Hill. It is the story of Sheila Hill’s husband, John Hill, a scientist who suffered from sedation and lost the ability to form speech. In her book, Sheila Hill explains the symptoms and mechanisms behind aphasia and speech formation, and adds emotional elements about dealing with someone with aphasia and how to be patient with speech and communication.