RECOGNISING PPA


It is important to bear in mind that individual experiences of PPA can vary greatly from one person to the next. Symptoms may vary from individual to individual owing to a variety of factors including age, general health, and the specific type of PPA. Not everyone will experience the same symptoms or progress at the same rate.

Here, we have attempted to outline some of the early symptoms that people with each of the three major types of PPA may notice. 

Progressive nonfluent aphasia (PNFA). Early symptoms of PNFA include:

  • Difficulty producing and/or pronouncing words - although the person knows what they want to say, speech is non-fluent, hesitant or effortful, and speech is often distorted. This is due to a problem coordinating the movements of speech, sometimes called ‘speech apraxia’. The person may say the opposite of what they mean (e.g., saying ‘No’ when they mean, ‘Yes’)
  • Difficulty organising words - sentences may break down with omissions of words or other errors in the structure (grammar) of the sentence, though this is often much less affected than pronunciation.
  • Difficulty understanding more complex messages - though understanding of others is usually much better than the production of speech.

Together these factors make speech difficult to understand and communication more difficult. Although written expression is often much better than speech to start with, this usually becomes affected as well, in time. This situation is often extremely frustrating, for patients and caregivers alike.

Semantic dementia (SD). Early symptoms of SD include:

  • Not knowing the word to use - often substituting a less precise word or a general term such as ‘thing’ instead of the specific word, with a ‘roundabout’ (though fluent) way of speaking
  • Difficulty understanding words - loss of vocabulary and knowledge of word meanings, spoken and written. The person may ask the meaning of particular words that were well known to them. This is due to erosion of the brain’s ‘semantic’ (meaning) memory system, hence the name ‘semantic dementia’.

Sometimes non-language problems (such as inability to recognise familiar people) may be prominent early in the illness or may even be the leading symptom.

Logopenic aphasia (LPA). Early symptoms of LPA include:

  • Difficulty finding the right word – the person’s conversational speech often contains long pauses or trails off, as they search for the word they need. The Greek term for ‘lack of words’ (‘logopenia’) gives the condition its name.
  • Producing the wrong words – these may contain the wrong sounds or substitute the wrong word entirely.
  • Difficulty understanding more complex messages and holding information in mind.
  • Some difficulties with memory and other functions, such as spatial awareness, arithmetic and use of tools and gadgets (though mild compared with the language problem)