Neuropsychological differentiation of progressive aphasic disorders

Jennifer M Harris, Jennifer A Saxon, Matthew Jones, Julie S Snowden, Jennifer C Thompson, Jennifer M Harris, Jennifer A Saxon, Matthew Jones, Julie S Snowden, Jennifer C Thompson

Abstract

The differentiation of subtypes of primary progressive aphasia (PPA) remains challenging. We aimed to identify optimum neuropsychological measures for characterizing PPA, to examine the relationship between behavioural change and subtypes of PPA and to determine whether characteristic profiles of language, working memory, and behavioural changes occur in PPA. Forty-seven patients with PPA and multi-domain Alzheimer's disease (AD) together with 19 age-matched controls underwent a large battery of working memory and language tests. We found that simple tasks of sentence ordering, narrative production, and buccofacial praxis were particularly useful in differentiating non-fluent/agrammatic variant PPA (nfvPPA) from other PPA subtypes, whereas a test of single word comprehension was useful in detecting semantic dementia (SD). No individual tests were discriminating for logopenic variant PPA (lvPPA) relative to nfvPPA. LvPPA and multidomain AD exhibited similar language profiles. A principal components analysis revealed that characteristic PPA profiles extended beyond the realms of language, in particular, the presence of apraxia in nfvPPA, behavioural changes in SD, and working memory deficits in lvPPA. These findings suggest that not all tests are equally discriminatory for PPA and highlight the importance of a test profile in differentiating PPA. These results also support the view that lvPPA is a focal form of AD and emphasize the difficulties classifying lvPPA.

Keywords: Alzheimer's disease; frontotemporal lobar degeneration; logopenic variant primary progressive aphasia; non-fluent/agrammatic variant primary progressive aphasia; primary progressive aphasia; semantic dementia.

© 2018 The Authors. Journal of Neuropsychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.

Figures

Figure 1
Figure 1
Behavioural change in the cohort. lvPPA, logopenic variant primary progressive aphasia; nfvPPA, non‐fluent/agrammatic variant primary progressive aphasia; SD, semantic dementia; AD, multi‐domain Alzheimer's disease. *p <. 05, **p < .01. [Colour figure can be viewed at wileyonlinelibrary.com]

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