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Her history of heavy alcoholism could mean she has "wet brain" dementia (specific to alcoholics).
https://americanaddictioncenters.org/alcohol/risks-effects-dangers/wernicke-korsakoff-syndrome
How old was she when her aphasia started? What reason for the aphasia was ever given by her doctor?
Or have they done an MRI with contrast ?
My sister’s dementia wasn’t detected on CT images but it was on the MRI with contrast last year . She’s 69 now but was having symptoms for a a couple of years before diagnosed. It did get worse after her back surgery last year . Anesthesia caused a step down .
How is Mom's hearing? Full hearing tests done? Auditory processing, not just hearing?
Is there any susupicion of a lifelong neurodiversity issue eg ADHD or Autism?
This may sound completely wacky.. but people with auditory hallucinations (aka hearing voices) can present as very distracted. The sounds they hear makes it very hard to hear others, to concentrate or remember things later. Any suspicion of something strange like that going on?
You talk about expressive aphasia and scans, so I assume your mom has a neurologist. Has she seen this neurologist in a while? Maybe the ongoing pattern over time would give some clues (even if they weren’t sure what was going on at the beginning).
There is a variation of frontotemporal dementia (non-Alzheimer’s) known as primary progressive aphasia. There are different types, most of which seem to start with difficulty expressing, but some of which progress to difficulty understanding. I can’t say if imaging is good at picking them up.
Here’s the Mayo Clinic info:
https://www.mayoclinic.org/diseases-conditions/primary-progressive-aphasia/symptoms-causes/syc-20350499
That’s going too far of course here – suggesting a diagnosis category just from a one paragraph description on the Internet! Absurd. The point is that there are lots of subtle patterns that only a neurologist could pick up. This is just an example.
So I guess what I’m really suggesting that for neurologic things the diagnosis is all in the details – so seeing the neurologist again, if it’s been a while—for update, or a new one might be your best bet.
Then you add years of alcohol abuse on top of that and the damage that that does to your body and brain, and then expressive aphasia on top of that and you're pretty much guaranteed cognitive decline.
Her doctors shouldknow that.
Plus people with expressive aphasia "are likely to have difficulty with cognitive processes such as attention, short-term memory, decalrative memory and executive functioning."
So your mom has a lot going against her right now. I would make sure that she has all of her legal ducks in a row, like POA's, Will, MOST or POLST forms and the like before her mind gets much worse.