Diagnosis & Treatment
DIAGNOSIS
A thorough evaluation of PPA includes the following:
History: First, a careful history is taken to establish that a condition of dementia exists. This often requires that family
members or friends be questioned about the patient’s behavior because sometimes the patient is unaware of the
symptoms (as in the case of memory loss or personality changes) or may be unable to describe them due to aphasia.
Neurological Examination: A neurological examination is done to determine if there are signs of dementia on a
simple screening of mental functions (the mental status examination) and also if there are signs of motor or sensory
symptoms that indicate other types of neurological disorders might be causing the dementia. The neurologist will also
order tests (e.g., blood tests, spinal tap, brain imaging studies) to further investigate the cause of the symptoms.
Neuropsychological Examination: A neuropsychological examination provides a more detailed evaluation of
mental functioning. This is especially important in the very early stages of illness when a routine screening evaluation
may not detect the problems the patient is experiencing. This requires several hours and consists of paper-and-pencil
or computer-administered tests of mental abilities, including attention and concentration, language, learning and
memory, visual perception, reasoning and mood. The results can indicate if there are abnormalities of thinking and
behavior and also their degree--mild, moderate or severe. It is often difficult to demonstrate that individuals with PPA
have intact memory since we usually test memory by telling a person some information and then asking them to
repeat it later on. In an individual with PPA, it may be impossible to repeat back the information because of the
aphasia. Therefore, it is important that testing is done properly to make sure that there is not a true loss of memory.
Speech and Language Evaluation: Since a decline in language abilities is the primary symptom of PPA, it is
important to determine which components of language use are most affected, how severely affected they are, and
what can be done to improve communication. A Speech-Language Pathologist evaluates different aspects of
language in detail and can make recommendations for strategies to improve communication. Family members should
be included in the treatment sessions to educate them about how to facilitate communication.
Psychosocial Evaluation: PPA affects not only the individual who is suffering from this disorder, but also all people
who are close to the patient. The disorder has an impact on relationships, the ability to continue working, the ability to
perform many routine duties, and the ability to communicate even the simplest of needs. Although there are many
resources available for individuals with memory loss, there are relatively fewer appropriate resources for individuals
with PPA, their relatives and friends. Evaluation with a social worker who is familiar with PPA can address these
issues and provide suggestions for dealing with day-to-day frustrations and problems.
Brain Imaging Studies: The evaluation for dementia also includes a brain imaging study. This is done in the form of
a computed axial tomography scan (CAT scan) or a magnetic resonance imaging scan (MRI scan). Both of these
methods provide a picture of the brain so that any structural abnormalities, such as a stroke, tumor or hydrocephalus-
-all of which can give rise to dementia-like symptoms, can be detected. In the case of degenerative brain disease, the