Behavioral Evolution of Progressive Semantic Aphasia in Comparison with Nonfluent Aphasia

Abstract

Background: Patients with primary progressive aphasia (PPA) usually develop significant behavioral disturbances with progression of the disease. We tested our clinical observation that development of disruptive agitation is more likely in semantic than in nonfluent PPA and examined which clinical variables could be associated with this behavior. Methods: We retrospectively analyzed neuropsychiatric scores and the need for behavioral treatments in semantic PPA (n = 41) and nonfluent PPA (n = 39) cases and compared first (1-3 years since the onset of symptoms) and last (5-13 years since the onset) evaluations. Clinical variables and laterality of temporal atrophy were associated with symptoms in semantic PPA cases. Results: The semantic PPA group developed more frequent (p = 0.03) and intense agitation (p = 0.0008) and had a greater need for antipsychotic drugs (p = 0.001) than the nonfluent PPA group. Presence of agitation was clearly associated with psychotic symptoms (delusions/hallucinations) but was not associated with gender, age at onset, duration of the disease, or laterality of temporal atrophy. In contrast, nonfluent PPA cases were more frequently depressed and treated with antidepressants (p = 0.0007). There were no differences in anxiety, irritability, apathy, perseverations, hyperorality, or abnormal motor behavior. Conclusions: Semantic PPA in advanced disease is frequently associated with agitation and psychotic symptoms with fewer mood symptoms, while nonfluent PPA maintains a high prevalence of depression. This implies different treatment and care and support needs for each group.

Therapy and clinical trials in frontotemporal dementia: past, present, and future

“…), have been described in nfvPPA (Gómez‐Tortosa et al . ) and as a possible clinical presentation of CBD (Murray et al . ; Ling et al .…”

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Primary progressive aphasia: conceptual evolution and challenges

“…Of clinical importance, unlike other variants, almost all cases with sv-PPA develop some degree of behavioral symptoms such as agitation and delusions that can become disruptive and require pharmacological intervention. 100 This fact prompts clinicians to monitor patients on a regular basis to allow early identification of nonlinguistic changes and advising of caregivers on mitigation of disruptive behaviors and prognosis.…”

Primer Progressive Aphasia with Psychiatric Symptoms

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