Early detection of primary progressive aphasia through speech and hearing tests

Difficulties to find words or the habit of replacing them with others who are semantically similar – such as knife and cutter – or phonological – such as knife and woman – are usually the first symptoms of a type of dementia known as primary progressive aphasia (PPA). Another sign is a subtle difficulty to form sentences, according to verbal and nominal agreement errors that have never been made before, or, for example, reversing the word order. Writing errors (dysgraphia) and reading problems (dyslexia) can also take place, so that writing and reading become increasingly difficult tasks become, just like expressing ideas and thoughts.

Primary progressive aphasia is a rare and difficult to diagnose neurodegenerative disease that starts with language problems that influence communication and continue to serious cognitive changes that can resemble Alzheimer’s disease or other types of dementia. The neurological diagnosis of this dementia syndrome requires a complete analysis that includes other cognitive functions in addition to language and communication problems.

Now a study supported by FAPESP and published in the magazine Plos One has shown that this condition can be detected early using a series of speech and hearing tests that are known as the Montreal-Toulouse Language Assessment Battery (MTL-BR).

The possibility of early and more accurate diagnosis is great news because the earlier treatment has started, the slower the progression of the disease. The sooner the rehabilitation, the greater the chance that the patient can maintain his communication, speaking, reading and writing skills for longer. But of course we are not talking about a complete diagnosis, only part of the assessment with which we can identify patients who need more monitoring and attention. “

Karin Zazo Ortiz, Professor at the Department of Speech and Hearing Therapy at the Federal University of São Paulo (Unifesp) in Brazil and accompanying author of the article

In the study, the researchers evaluated 87 people, including 29 diagnosed with primary progressive aphasia and 58 healthy people who were linked to age and education level.

“We compared the performance of participants with and without the syndrome with a large number of tasks with different language processes. As a result, we have observed clear differences in some tasks, and at this stage of the work we were able to identify the most relevant tests between the MTL-BR battery,” Ortiz says.

Because this is a very extensive and complete battery, the researcher says that identifying the most important tests can simplify the assessment, making provisional detection faster and more accessible.

According to the results, the tasks in which patients with primary progressive aphasia were the worst on the MTL-BR: Poem interview, oral understanding of sentences, oral narrative discourse, written understanding of sentences, dictation, repetition of sentences, semantic verbal fluenteheid, name of the head text, recognition of bodies, recognition of bodies, recognition of bodies, recognition of bodies of names, recognition of bodies, recognition of bodies, recognition of bodies, recognition of bodies of names, recognition of bodies of names, recognition of bodies, recognition of bodies, recognition of bodies, recognition of bodies, recognition of bodies, recognition of bodies, recognition of bodies, Dictation, understanding of written text and numerical calculation (mental and written).

Ortiz explains that the battery of tests was chosen as the research object because it offers a broad assessment of oral (speech) and written understanding and production, as well as the only validated test in Brazil for acquired language disorders of neurological origin.

The research is now in a new phase, which aims to identify the most important language tasks for identifying any variant of the syndrome.

Variants

The partial or total loss of the ability to understand and express spoken or written language was in the spotlight in 2022 when Hollywood actor Bruce Willis was diagnosed with aphasia, who later developed to head -up dementia. In the same year, the Brazilian cartoonist Angeli announced that he was stopping his job because of the syndrome.

Primary progressive aphasia is a different situation than aphasia, which can arise as a result of strokes, brain tumors and traumatic brain injury. PPA belongs to the group of diseases known as dementia. It influences the frontotemporal part of the brain and is considered even more aggressive than Alzheimer’s disease.

Nevertheless, PPA is difficult to diagnose, especially since the initial symptoms can be very similar to those of other dementia syndromes – although language disorders is much greater in relation to other cognitive domains. Another complicating factor is the heterogeneity of the cases. “Despite the importance of language in the differential diagnosis of neurodegenerative diseases, there is still a lack of language rating tools for all types of dementia, including primary progressive aphasia,” he says.

To further complicate the diagnosis, there are four subtypes PPA. One is non-flowing or agramatic primary progressive aphasia, which is characterized by changes in the syntactic structure of sentences, difficult to understand complex sentences and can be accompanied by Aapraxia of speech, where the patient makes speech errors due to motor planning deficits.

Another variant is semantic primary progressive aphasia, which is characterized by difficulty understanding words because of semantic disorders, anomia and difficulty reading and writing irregular words. Logopenic primary progressive aphasia is considered more comparable to the dementia of Alzheimer’s and in these cases the patient has difficulty understanding long content and commits exchanges and omissions of sounds in speech.

There is also mixed or non -classifiable PPA, characterized by language changes in which a specific language profile cannot be identified because patients do not have the characteristics that are predicted for one of the variants whether they have characteristics of different of the variants, making it difficult to specifically diagnose one of them.

“And in this sense it is that our study contributes to the diagnosis, because it makes early identification of changes in language, whereby the differences between primary progressive aphasia and other dementia syndromes are emphasized,” says Ortiz.