PPA

Question 1

PPA

Answer 1

Language is the main impairment at the early stage
- E.g. word finding difficulties, paraphasias, effortful speech, grammatical or comprehension difficulties, semantic knowledge

• (non-language) cognitive impairments and behavioural changes in later stages

3 variants:

1. non-fluent/agrammatic variant (naPPA)
2. semantic variant (svPPA)
3. logopenic variant (lvPPA)
   - lvPPA sometimes regarded as variant of AD - some authors include lvPPA under FTD, other authors distinguish only semantic and non-fluent
   variants

Question 2

Diagnostic criteria

Answer 2

Insidious onset with gradual decline in language

Language difficulties main complaint and main reason for difficulties daily functioning (e.g. activities requiring communication)

Explained by neurodegenerative process, not other medical condition (e.g. stroke, tumour)

Differs from other language impairments bc it is characterised by gradual cognitive decline that
affects activities of daily living

Question 3

Criteria svPPA

Answer 3

20% of FTD cases

Semantic variant PPA when:
- impaired object naming and single-word comprehension are both present
- 3 of the following
1. Impaired object knowledge
2. Spared repetition
3. spared grammer and motor aspects
4. surface dyslexia/dysgraphia

Progressed stage; failed recognition extended to other modalities (faces, objects)

Neuropathology:
- Early stage: atrophy anterior temporal lobes
- With progression: degeneration posterior temporal lobe, posterior inferior frontal lobe or both

Overlap degeneration bvFTD – overlap behavioural changes

Question 4

Criteria naPPA

Answer 4

25% of FTD cases

non-fluent agrammatic PPA when;
- either agrammation in language production or halting speech w errors (apraxia)
- 2 of the following
1. Impaired comprehension
2. Spared single-word comprehension
3. spared object knowledge

Progressed stages; impaired complex syntax comprehension

Impairment speech production: slow, effortful, non-fluent speech, pauses between and within utterances, agrammatism, comprehension intact

Neuroimaging: atrophy or hypoperfusion left posterior and frontal lobe and insular cortex

Question 5

Criteria lvPPA

Answer 5

Logopenic variant PPA when;’
- Impaired single-word retrieval in spontaneous speech and repetition of phrases must be present
- 3 of the following
1. Phonological errors
2. spared single-word comprehension
3. spared motor speech
4. Absence of aggramatism

Progressed stage: more language functions affected

Spontaneous speech slow with pauses. Phonological paraphasias. No articulation difficulties or comprehension problems

Neuroimaging: atrophy posterior temporal and parietal regions, mainly left

Question 6

Cognitive impairments

Answer 6

In a meta-analysis including all types of PPA, they found;

Episodic memory is
- Worse than HC for all variants
- lvFTD < nfFTD & svFTD

Working memory is
- Worse than HC for all variants
- lvFTD < nfFTD & svFTD