Treatment for Lexical Retrieval in Primary Progressive Aphasia

: http://si p://pubs.as In recent years there has been an increase in research describing the behavioral characteristics and underlying pathology of primary progressive aphasia (PPA). One of the earliest and most prominent features of PPA, particularly for the logopenic and semantic variants, is anomia, and this is often the symptom that prompts individuals with PPA to seek treatment. However, speech-language pathologists who encounter individuals with PPA on their clinical caseloads often have questions about how best to manage progressive language decline in these patients. A small body of literature suggests that treatment for anomia in PPA is indeed warranted, and that item-specific improvement can be expected for a majority of individuals receiving treatment. Although generalization and maintenance of treatment gains are variable in the face of progressive decline, there are some emerging themes as to treatment approaches and patient characteristics that may promote more generalized and relatively durable treatment outcomes. Ultimately, treatment that engages residual semantic, phonologic and orthographic skills, using both strategic training and stimulation, may be appropriate for PPA patients with mild-moderate anomia. Primary Progressive Aphasia (PPA) is characterized by progressive decline in speechlanguage abilities, with a relative absence of impairment to other cognitive domains during initial stages of the syndrome (Mesulam, 1982, 2001). Three variants of PPA are widely accepted in the literature, each characterized by distinct patterns of behavior and cortical atrophy (Gorno-Tempini et al., 2011). The nonfluent/agrammatic variant is associated with agrammatism in language production, impaired syntax comprehension and slow, halting speech, often with features of speech apraxia. Semantic PPA is characterized by loss of object knowledge, significant anomia, and fluent but relatively empty speech; and logopenic PPA is characterized by lexical retrieval deficits and impaired repetition, but relatively intact comprehension of single words and syntax. While the exact incidence and prevalence of PPA are not known, Mesulam (2001) estimated that as many as 20% of all individuals with dementia have PPA. Recent data from The Aging, Demographics, and Memory Study (Plassman et al., 2007) suggest that over 3 million people in the United States aged 71 and older have dementia from varying etiologies. While this does not account for dementia onset in individuals under the age of 71, based on Mesulam’s estimate, as many as 600,000 individuals in the United States may be experiencing symptoms of primary progressive language loss. Although patients with PPA are thought to be under-referred to speech-language pathology practices (Taylor, Kingma, Croot, & Nickles, 2009), the Aphasia Research Project at the University of Arizona has seen an increase in referrals for individuals with PPA over the past decade, and anecdotal reports from speech-language pathologists (SLPs) in our community and around the