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Primary progressive aphasia

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Main article: Aphasia
Primary progressive aphasia
SpecialtyNeurology Edit this on Wikidata

Primary progressive aphasia (PPA) is a type of neurological syndrome in which language capabilities slowly and progressively become impaired while other mental functions remain intact. [1] It was first described as a distinct syndrome by M.-Marsel Mesulam in 1982.[2] Primary Progressive Aphasias have a clinical and pathological overlap with the Frontotemporal Lobar Degeneration (FTLD) spectrum of disorders and Alzheimer's disease.

Classification

Three classifications of primary progressive aphasia have been described.[3][4][5] In the classical Mesulam criteria for primary progressive aphasia, there are 2 variants: a non-fluent type Progressive Nonfluent Aphasia (PNFA) and a fluent type Semantic Dementia (SD).[6][7] A third variant of primary progressive aphasia, Logopenic Progressive Aphasia (LPA)[8] is an atypical form of Alzheimer's disease.

Diagnostic criteria

The following diagnosis criteria were defined by Mesulam [9]

  • Gradual impairment of object naming, syntax and word-processing
  • Premorbid language function is usually intact
  • Acalculia: inability to perform simple mathematical calculations
  1. ^ "Primary Progressive Aphasia - National Aphasia Association". National Aphasia Association. Retrieved 2015-11-12.
  2. ^ Mesulam M (1982). "Slowly progressive aphasia without generalized dementia". Annals of Neurology. 11 (6): 592–8. doi:10.1002/ana.410110607. PMID 7114808.
  3. ^ Gorno-Tempini ML, Hillis AE, Weintraub S, et al. (March 2011). "Classification of primary progressive aphasia and its variants". Neurology. 76 (11): 1006–14. doi:10.1212/WNL.0b013e31821103e6. PMC 3059138. PMID 21325651.
  4. ^ Bonner MF, Ash S, Grossman M (November 2010). "The new classification of primary progressive aphasia into semantic, logopenic, or nonfluent/agrammatic variants". Curr Neurol Neurosci Rep. 10 (6): 484–90. doi:10.1007/s11910-010-0140-4. PMC 2963791. PMID 20809401.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  5. ^ Harciarek M, Kertesz A (September 2011). "Primary progressive aphasias and their contribution to the contemporary knowledge about the brain-language relationship". Neuropsychol Rev. 21 (3): 271–87. doi:10.1007/s11065-011-9175-9. PMC 3158975. PMID 21809067.
  6. ^ Mesulam MM (April 2001). "Primary progressive aphasia". Annals of Neurology. 49 (4): 425–32. doi:10.1002/ana.91. PMID 11310619.
  7. ^ Adlam AL, Patterson K, Rogers TT, et al. (Nov 2006). "Semantic dementia and fluent primary progressive aphasia: two sides of the same coin?". Brain. 129 (Pt 11): 3066–80. doi:10.1093/brain/awl285. PMID 17071925.
  8. ^ Gorno-Tempini ML, Dronkers NF, Rankin KP, et al. (Mar 2004). "Cognition and anatomy in three variants of primary progressive aphasia". Annals of Neurology. 55 (3): 335–46. doi:10.1002/ana.10825. PMC 2362399. PMID 14991811.
  9. ^ Mesulam MM: Primary progressive aphasia—a language-based dementia. N Engl J Med 2003, 349:1535–1542
  • Ideomotor Apraxia: loss of the ability to execute or carry out learned purposeful movements

Risk Factors

There are no known environmental risk factors for the progressive aphasias. However, one observational, retrospective study suggested that vasectomy could be a risk factor for PPA in men.[1] These results have yet to be replicated or demonstrated by prospective studies.

PPA is not considered a hereditary disease. However, relatives of a person with any form of frontotemporal lobar degeneration, including PPA, are at slightly greater risk of developing PPA or another form of the condition.[2]

Treatment

There is no approved treatment. But speech therapy can assist an individual with strategies to overcome difficulties. ″There are three very broad categories of therapy interventions for aphasia: restorative therapy approaches, compensatory therapy approaches, and social therapy approaches.[3] Rapid and sustained improvement in speech and dementia in a patient with primary progressive aphasia utilizing off-label perispinal etanercept, an anti-TNF treatment strategy also used for Alzheimer's, has been reported.[4] A video depicting the patient's improvement was published in conjunction with the print article. These findings have not been independently replicated and remain controversial.

See also

References

  1. ^ Weintraub S, Fahey C, Johnson N, et al. (December 2006). "Vasectomy in men with primary progressive aphasia". Cogn Behav Neurol 19 (4): 190–3. doi:10.1097/01.wnn.0000213923.48632.ab. PMID 17159614.
  2. ^ Goldman JS, Farmer JM, Wood EM, et al. (Dec 2005). "Comparison of family histories in FTLD subtypes and related tauopathies". Neurology. 65 (11): 1817–9. doi:10.1212/01.wnl.0000187068.92184.63. PMID 16344531.
  3. ^ Manasco, H. (2014). The Aphasias. In Introduction to Neurogenic Communication Disorders (Vol. 1, p. 91). Burlington, MA: Jones & Bartlett Learning.
  4. ^ Tobinick E (2008). "Perispinal etanercept produces rapid improvement in primary progressive aphasia: identification of a novel, rapidly reversible TNF-mediated pathophysiologic mechanism". Medscape Journal of Medicine. 10 (6): 135. PMC 2491668. PMID 18679537.

Further reading

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