ANTICIPATING PROBLEMS LATER ON
The particular symptoms that a person has at the start of their illness are caused by damage to the part of the brain that mainly controls that function. As the disease develops, it spreads to other brain areas, meaning that more functions are affected, and more symptoms emerge. Some of the additional symptoms that people with different forms of PPA might develop are listed below.
Progressive nonfluent aphasia (PNFA). Symptoms that can emerge during the course of PNFA include:
- Increasing difficulty understanding language, less able to take initiative, difficulty using tools and gadgets, and a decline in organisational skills and memory
- Difficulty with swallowing and/or symptoms similar to Parkinson’s disease such as slowing or clumsiness of movements, falls, shuffling or freezing when walking and/or tremor
Semantic dementia (SD). Symptoms that can emerge during the course of SD include:
- Increasing difficulty recognising familiar people or everyday items, by sight or by sound
- Changes in personality, such as becoming more inflexible about time and routines, more obsessional or disinhibited in public
- Inability to recognise or react appropriately to other people’s emotions
- Development of a sweet tooth, changes in appetite, ‘food fads’ or decline in table manners
- Development of intense new interests, for example in music or puzzles
- Changes in sensitivity to pain, temperature and bodily sensations, alterations of hearing
Logopenic aphasia (LPA). Symptoms that can emerge during the course of LPA include:
- Reduced speech and increasing hesitation due to problems finding words – and sometimes, use of made-up words or jargon
- Increasing difficulties with reading and spelling
- Emergence of more problems with memory
- Increasing difficulty navigating and reduced spatial awareness
- Increasing difficulty using tools and gadgets
- Increased irritability and anxiety, resulting in social withdrawal
All forms of PPA. Later in the course of PPA, the disease will impact on parts of the brain beyond the language system. This is true for all the major PPA syndromes, and means that similar problems can occur in each type, potentially including:
- Very sparse or unintelligible speech
- Difficulty understanding other people – both with spoken and written information
- Increasing difficulty making more complex decisions, for example around finances and money
- Difficulty with judgment, planning and concentration, affecting activities such as driving
- Needing assistance with more basic activities like washing, dressing and eating
- Moving slowly and stiffly, loss of dexterity and poor balance
- Problems with swallowing, diet and nutrition
- Problems with continence and use of the toilet
- Changes in behaviour, including loss of social awareness, loss of motivation, agitation and sometimes aggression
Trying to forecast when particular symptoms may develop or what a person with PPA may be able to do (or may find challenging) at a particular stage of the illness remains very difficult. We do know these things can vary significantly from person to person. From the onset of symptoms, many people with PPA will live for over ten years.
The onset of other neurological problems – such as difficulties with movement or swallowing – tends to be associated with reduced independence and a need for increasing support, but again, this varies widely from person to person.
Although it is not yet possible to predict the outlook of a particular person with PPA in any detail, there are some important general issues that can and should be planned for. These include regular review of driving safety and arranging power of attorney.