Some Dementias Affect Speech and Language First & Foremost

Trouble talking or understanding speech? Maybe it’s Primary Progressive Aphasia.

Posted May 27, 2019

After memory, language problems are the most common complaint that individuals and their families tell us about in our clinic. Here is a recent example:

“With my wife, the problem started with words. She couldn’t find the words she was looking for. So, my kids and I began to jump in and finish her sentences for her. We didn’t think much of it—I mean, I’ve got trouble coming up with people’s names myself. But then she started not knowing what the words mean. We were talking with our granddaughter about going to the zoo, and she says she’s excited to see the giraffes. My wife looks at me and asks, “What’s a giraffe?” Then in October we’re getting ready to go buy a pumpkin and she says, “Pumpkin? What’s a pumpkin?” I mean, she’s lived New England all her life—grew up with Halloween. That’s when I started to get scared. We knew something was wrong. Now she really doesn’t have any language left. But the funny thing is, somehow we can still communicate. With her face and gestures and the movements she makes, I’m able to figure out what she wants—most of the time, anyways—and she always knows when to give me a hug."

Difficulty finding the names of people, places, and other proper nouns is frequently seen in normal aging. When there is trouble finding ordinary words or difficulty with other parts of speech and language, however, it could be a sign of dementia. Although speech and language problems are most often seen in common disorders of thinking and memory such as Alzheimer’s disease and vascular dementia, there are some individuals who present first and foremost with speech and language problems. These individuals have primary progressive aphasia.

Primary progressive aphasia has three common variants. In the logopenic (word-finding) variant, the difficulty is mainly finding and pronouncing words, with comprehension and grammar being normal. In the semantic (word-meaning) variant there is difficulty naming objects, comprehending single words, and even understanding what objects are used for. In the non-fluent/agrammatic variant there is effortful, halting speech with errors, distortions, and impaired grammar; comprehension is normal for simple sentences but may be impaired for complicated ones.

Common features of primary progressive aphasia

General Features

  • Difficulty with language is the most prominent feature, particularly at the start of the disorder
  • Language problems impair daily living activities

Logopenic (word-finding) variant

  • Difficulty retrieving single words in ordinary speech and when naming items
  • Pronunciation errors are common
  • Difficulty repeating phrases and sentences is common
  • Comprehension is normal
  • Use of grammar is normal

Semantic (word-meaning) variant

  • Naming objects is impaired
  • Comprehension is impaired—even of single words
  • Comprehension is often impaired for what some objects are—not just their names
  • Difficulty reading and writing is common

Non-fluent/agrammatic variant

  • Speech takes great effort and is halting, with speech errors and distortions.
  • Grammar is impaired
  • Comprehension of complex sentences may be impaired

Key Question:

Q: Your loved one has trouble finding words. Does that mean they have primary progressive aphasia?

A: Not necessarily. Although it is possible they have primary progressive aphasia, because word-finding difficulties occur so frequently it could be part of a more common disorder such Alzheimer’s disease or vascular dementia.

© Andrew E. Budson, MD, 2019, all rights reserved.

References

Budson AE, O’Connor MK. Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It, New York: Oxford University Press, 2017.

Budson AE, Solomon PR. Memory Loss, Alzheimer’s Disease, & Dementia: A Practical Guide for Clinicians, 2nd Edition, Philadelphia: Elsevier Inc., 2016.