Causes and risk factors
PPA is caused due to injury or damage to the left hemisphere of brain which is responsible for language and comprehension. This injury can be due to trauma, stroke, tumour, infection, or due to ageing that is senile dementia, Alzheimer’s disease, chronic neurological disorders like migraine, epilepsy, cerebrovascular accidents like TIA.
Clinical presentation
PPA begins gradually, initially with difficulty in thinking of common words when talking or writing. The ability to understand what others are saying starts declining. There is difficulty in calculations, slow or halting speech, decreased use of language, abnormal sentence formation, replacement of words, mispronunciation of words, difficulties finding exact word, As the illness progresses mental abilities start declining. It progresses to the extent where verbal communication becomes impossible. It is associated with other mental disabilities. Diseases like dementia, Alzheimer’s commonly present with symptoms of PPA. Types of PPA include semantic variant, nonfluent/agrammatic variant, logopenic variant PPA. Semantic variant PPA, there is difficulty in understanding words. The person has difficulty in naming objects. He is unable to find the right word while speaking or writing. He forgets simple words such as , forgets the proper noun word like ‘chicken’ and uses the common word ‘bird’ for it. It is common feature of Frontotemporal dementia. In non fluent type, the person knows what he wants to say but is unable to convey. There are language difficulties such as errors in grammar, slow hesitant speech, impaired comprehension of complex sentences. They form short sentences, omit small words while speaking. In logopenic type, there is difficulty in finding words. They take long pauses to find the right word. Speech production skills are intact. The patients talk slowly.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Difficulty in speaking, comprehending, writing, reading after stroke or head injury can suspect of PPA. CT scan, MRI is done for further evaluation to see whether there is any space occupying lesion or shrinkage of brain areas.
Treatment
Speech and language therapy is useful in cases of PPA. Psychotherapy may be required. It involves cognitive behavioural therapy, and relaxation techniques. Medications like anti psychotics, anti depressants, anti anxiety drugs, mood stabilizers help in management of the disease. Electroconvulsive therapy [ECT] may be required in PPA. Individual and family counselling will also help in managing PPA patients.
Other Modes of treatment
The other modes of treatment can also be effective in treating PPA. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating PPA.
