A look at aphasia and dementia: Recognizing symptoms, exploring treatments, and delving deeper
Primary progressive aphasia (PPA) and Alzheimer's disease (AD) are two distinct neurological conditions that affect the brain and impact an individual's communication and daily activities.
PPA, a subtype of frontotemporal dementia, is characterised by a gradual decline in speech and language abilities due to neurodegeneration in language-related brain areas. Unlike AD, PPA primarily affects the ability to find words, form sentences, understand language, and conduct conversations, while memory and other cognitive functions are initially preserved.
On the other hand, AD typically begins with short-term memory impairment, followed by progressive deficits in thinking, reasoning, judgment, and eventually language. Communication becomes impaired later as memory and cognitive decline worsen.
In PPA, the primary symptoms are language-related, with difficulty recalling words, forming grammatical sentences, understanding word meanings, or stopping mid-sentence while searching for words. There are three main types of PPA: the semantic variant, which impairs word meaning and vocabulary loss; the nonfluent variant, which causes difficulty producing speech and grammar; and the logopenic variant, which results in word-finding pauses during speech.
In contrast, language problems in AD arise secondary to broader cognitive decline. Although patients may have word-finding trouble early on, memory loss dominates.
PPA predominantly affects communication, leading to progressive difficulty in speaking and understanding language, which severely hinders social interaction and daily functioning related to communication. Other cognitive areas are initially less affected but may decline over time. AD, however, affects memory and executive functions early, resulting in impaired ability to plan, judge, reason, and remember daily tasks. This causes loss of independence for daily living activities, with communication decline following.
PPA often begins earlier, typically in the 50s to early 60s, and progresses with a major impact on language skills before other cognitive domains decline substantially. AD is usually diagnosed after age 65 and progresses more slowly at first, with memory issues predominating in early stages and language deficits appearing later.
Behavioral changes such as apathy, socially inappropriate actions, and obsessive behaviors are common early in frontotemporal dementias including PPA variants, but less so initially in AD. Memory usually remains relatively intact early in PPA, contrasting with early memory loss in AD.
Researchers believe the unusual buildup of proteins inside the brain cells may be a cause of PPA. The semantic variant might be caused by a build of proteins called TDP-43, the nonfluent agrammatic variant by a buildup of tau protein, and the logopenic variant by a build of up the amyloid protein.
Both conditions progressively reduce independence but differ in their initial symptoms, affected functions, and disease trajectory. Aphasia, which affects a person's ability to understand, read, write, and speak words, can occur due to a stroke or acute brain damage, but PPA may develop due to the slow degeneration of the brain from some types of dementia, such as Alzheimer's.
Dementia, a range of neurological degenerative disorders that affect the brain, has several potential risk factors, including age, family history, genetics, and head injuries. Alzheimer's disease causes an unusual buildup of two proteins, called amyloid plaques and neurofibrillary tangles, in the brain, which can lead to primary progressive aphasia. Alzheimer's is the most common form of dementia in the United States.
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