Word-finding difficulties suggest PPA
Dear Dr. Roach: About a year ago, my 77-year-old wife started to have some trouble speaking, and in some cases remembering or forming words. It’s not so bad that you don’t understand her and it’s not constant. But it’s there just the same. The family thought she may have had a TIA, but saw no other symptoms. She’s seen a neurologist. The diagnosis is she is suffering from PPA (primary progressive aphasia).
There is a lot of information on this condition on the internet. But how does one get through all of this to see what is most successful and/or current? Will her fight involve medication, therapy, something else or all of them? Can you tell us what the latest and most successful direction may be?
D.C.
Answer: Primary progressive aphasia is a type of dementia, in the group of frontotemporal dementias, named for the part of the brain most affected. These diseases include what used to be called Pick’s disease. The underlying cause seems to be deposits of abnormal proteins in the brain. This is similar to Alzheimer’s disease, though the proteins are different. Word-finding difficulties are the hallmark early symptom of PPA.
Unfortunately, there are no currently approved medication treatments for PPA that can slow down or stop the progression of the disease. Treatment is aimed at relieving symptoms and ensuring the safety of the person affected by PPA. Driving, for example, can become dangerous early on in the course of PPA.
Speech therapy is an important part of treatment in the early stages of the disease, and swallowing evaluation becomes important as the disease progresses, since people with more advanced disease are prone to aspiration — breathing food particles into the lung can cause lung infection.
Although there are currently no approved treatments available, extensive work is being done, especially with medications that may block the tau proteins, which accumulate in the brain. In the meantime, compassionate care will help both you and your wife. Medications can help with some of the behavioral changes. I recommend getting more information from the National Aphasia Association at aphasia.org.