Early detection of primary progressive aphasia through speech and hearing tests

The difficulty in finding words or the habit of replacing them with others that are similar semantic – such as the knife and the cutter – or phonological – as the knife and spouse – are usually the first symptoms of a type of dementia known as primary progressive aphasia (PPA). Another sign is a subtle difficulty in making suggestions, evidenced by oral and nominal errors that have never been made before, or inverting the order of words, for example. Writing errors (dyslexia) and reading difficulties (dyslexia) may also occur, so that writing and reading are being done more and more difficult tasks, as well as expressing ideas and thoughts.

Primary progressive aphasia is a rare and difficult diagnosis of neurodegenerative disease that begins with linguistic problems that affect communication and evolves into more serious cognitive changes that may 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 other than language and communication problems.

Now, a study supported by FAPESP and published in the magazine PLOS ONE It has shown that this condition can be detected early using a set of speech and hearing tests known as Montreal-Touli Language Evaluation Battery (MTL-BR).

The likelihood of early and more accurate diagnosis is a great deal of news because the previous treatment begins, the slower the progression of the disease. The earlier rehabilitation, the greater the possibility that the patient will be able to maintain communication, speech, reading and writing skills for a longer period. But of course we are not talking about a complete diagnosis, only a part of the evaluation that can allow us to identify patients who need more follow -up and attention. “

Karin Zazo Ortiz, Professor in the Department of Therapy and Hearing at the Federal University of Sao Paulo (UNIFESP) in Brazil and corresponding author of the article

In the study, the researchers evaluated 87 people, including 29 diagnosed with primary progressive aphasia and 58 healthy people who fit for age and educational level.

“We compared the performance of the participants with and without the syndrome to a large number of duties involving different linguistic processes. As a result, we have observed significant differences in certain tasks and at this stage of the project we were able to identify the most relevant tests between the 22 work that constitutes the MTL-brushes.”

Since this is a very complete and complete battery, the researcher says that locating basic tests can help to simplify the evaluation, making preliminary detection faster and more accessible.

According to the results, the tasks in which patients with primary progressive aphasia performed worse in MTL-BR were: directed interview, from oral understanding of the proposals, oral narrative speech, written understanding of proposals, dictation, dictation, oral text, arithmetic dictation, comprehension of written text and numerical calculation (mental and written).

Ortiz explains that the test battery was chosen as a subject of study because it provides a broad evaluation of oral (speech) and written understanding and production, as well as the only validated test in Brazil for acquired linguistic disorders of neurological origin.

The research is now entering a new phase, which aims to identify the most important linguistic duties to identify any variant of the syndrome.

Variations

The partial or overall loss of the ability to understand and express spoken or written language came to the fore in 2022 when Hollywood actor Bruce Willis was diagnosed with aphasia, which later developed into frontal dementia. In the same year, the Brazilian cartoonist Angeli announced that he had abandoned his work due to the syndrome.

Primary progressive aphasia is a different condition from aphasia, which can result as a result of strokes, brain tumors and traumatic brain injuries. PPA belongs to the group of diseases known as dementia. It affects the front of the brain and is considered even more aggressive than Alzheimer’s disease.

However, PPA is difficult to diagnose, mainly because the initial symptoms can be very similar to those of other dementia syndromes – although linguistic weakening is much greater than other cognitive areas. Another factor that complicates is the heterogeneity of cases. “Despite the importance of language in the differential diagnosis of neurodegenerative diseases, there is still a lack of language evaluation tools for all types of dementia, including primary progressive aphasia,” he says.

To further complicate the diagnosis, there are four PPA subtypes. One is an obvious or agricultural primary progressive aphasia, which is characterized by changes in the syntactic structure of proposals, difficulty understanding complex sentences and may be accompanied by inaction, in which the patient makes speech errors due to engine deficits.

Another variant is semantic primary progressive aphasia, which is characterized by difficulty in understanding words due to semantic damage, abnormalities and difficulty reading and writing irregular words. Accounting primary progressive aphasia is considered more similar to Alzheimer’s dementia and in these cases the patient has difficulty understanding the long content and committing exchanges and omissions in speech.

There is also a mixed or non -classified PPA, characterized by linguistic changes in which a particular linguistic profile cannot be detected because either patients do not have the characteristics provided for one of the variations or have characteristics of many variants, making it difficult to diagnose one of them.

“And in this sense our study contributes to the diagnosis, as it allows for early recognition of changes in language, underlining the differences between primary progressive aphasia and other dementia syndromes,” Ortiz says.