Abstract
‘Primary progressive aphasia’ (PPA) refers to core linguistic disorders caused by neurodegenerative disease. Three main PPA variants are recognized: nonfluent/agrammatic, semantic and logopenic. Correctly classifying patients during life according to the underlying histopathology will become increasingly important as cause-specific treatments become available. This article reviews clinical and histopathological studies of PPA, with particular reference to updated PPA classifications. Currently, one-to-one relationships do not exist within PPA subtypes. The semantic variant has the best correspondence between the clinical syndrome and the underlying pathological cause and the logopenic variant the worst correspondence. The use of future biomarkers should facilitate accurate clinicopathological correlation of patients during life.
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Pick A. Über die Beziehungen der senilen Hirnatrophie zur Aphasie. Prager Med Wochenschr. 1892;17:165–7.
Pick A. Zur Symptomatologie der linksseitigen Schlafenlappenatrophie. Monatsschr Psychiatr Neurol. 1904;16:378–88.
Sérieux P. Sur un cas de surdite verbale pure. Rev Med Paris. 1893;13:733–50.
Mesulam M. Primary progressive aphasia—differentiation from Alzheimer's disease. Ann Neurol. 1987;22(4):533–4.
Mesulam M. Slowly progressive aphasia without generalized dementia. Ann Neurol. 1982;11(6):592–8.
Neary D, Snowden J, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology. 1998;51(6):1546–54.
Thompson SA, Patterson K, Hodges JR. Left/right asymmetry of atrophy in semantic dementia: behavioral-cognitive implications. Neurology. 2003;61(9):1196–203.
Snowden J, Thompson JC, Neary D. Knowledge of famous faces and names in semantic dementia. Brain. 2004;127(4):860–72.
Mesulam M, Wicklund A, Johnson N, et al. Alzheimer and frontotemporal pathology in subsets of primary progressive aphasia. Ann Neurol. 2008;63(6):709–19.
Greene JD, Patterson K, Xuereb J, et al. Alzheimer disease and nonfluent progressive aphasia. Arch Neurol. 1996;53(10):1072–8.
Knibb JA, Xuereb JH, Patterson K, et al. Clinical and pathological characterization of progressive aphasia. Ann Neurol. 2006;59(1):156–65.
Rogalski E, Mesulam M. An update on primary progressive aphasia. Curr Neurol Neurosci Rep. 2007;7(5):388–92.
Josephs KA, Whitwell JL, Duffy JR, et al. Progressive aphasia secondary to Alzheimer disease vs FTLD pathology. Neurology. 2008;70(1):25–34.
Alladi S, Xuereb J, Bak T, et al. Focal cortical presentations of Alzheimer's disease. Brain. 2007;130(10):2636–45.
Galton CJ, Patterson K, Xuereb JH, et al. Atypical and typical presentations of Alzheimer's disease: a clinical, neuropsychological, neuroimaging and pathological study of 13 cases. Brain. 2000;123(3):484–98.
Kertesz A, McMonagle P, Blair M, et al. The evolution and pathology of frontotemporal dementia. Brain. 2005;128(9):1996–2005.
Gorno-Tempini ML, Hillis AE, Weintraub S, et al. Classification of primary progressive aphasia and its variants. Neurology. 2011;76(11)):1006–14. This article describes the most up to date classification system for PPA and is of particular significance because no assumptions are made regarding the relationship between aphasia subtype and pathological disease.
Mesulam M. Primary progressive aphasia — a language-based dementia. N Engl J Med. 2003;349(16):1535–42.
Mesulam M. Primary progressive aphasia pathology. Ann Neurol. 2008;63(1):124–5.
Kirshner HS, Tanridag O, Thurman L, et al. Progressive aphasia without dementia: two cases with focal spongiform degeneration. Ann Neurol. 1987;22(4):527–32.
Mackenzie IR, Baborie A, Pickering-Brown S, et al. Heterogeneity of ubiquitin pathology in frontotemporal lobar degeneration: classification and relation to clinical phenotype. Acta Neuropathol. 2006;112(5):539–49.
Sampathu DM, Neumann M, Kwong LK, et al. Pathological heterogeneity of frontotemporal lobar degeneration with ubiquitin-positive inclusions delineated by ubiquitin immunohistochemistry and novel monoclonal antibodies. Am J Pathol. 2006;169(4):1343–52.
Mackenzie IR, Neumann M, Baborie A, et al. A harmonized classification system for FTLD-TDP pathology. Acta Neuropathol. 2011;122(1):111–3.
Mesulam MM, Weintraub S, Rogalski EJ, et al. Asymmetry and heterogeneity of Alzheimer's and frontotemporal pathology in primary progressive aphasia. Brain. 2014;137(4):1176–92. This article closely examines pathological postmortem diagnosis and the topographical distribution of pathological changes in a series of PPA patients.
Braak H, Braak E. Neuropathological stageing of Alzheimer-related changes. Acta Neuropathol. 1991;82(4):239–59.
Neary D, Snowden J, Mann DM, et al. Alzheimer's disease: a correlative study. J Neurol Neurosurg Psychiatry. 1986;49(3):229–37.
Arriagada PV, Marzloff K, Hyman BT. Distribution of Alzheimer-type pathologic changes in nondemented elderly individuals matches the pattern in Alzheimer's disease. Neurology. 1992;42(9):1681–8.
Hof PR, Vogt BA, Bouras C, et al. Atypical form of Alzheimer's disease with prominent posterior cortical atrophy: a review of lesion distribution and circuit disconnection in cortical visual pathways. Vis Res. 1997;37(24):3609–25.
Johnson JK, Head E, Kim R, et al. Clinical and pathological evidence for a frontal variant of Alzheimer disease. Arch Neurol. 1999;56(10):1233–9.
Guillozet AL, Weintraub S, Mash DC, et al. Neurofibrillary tangles, amyloid, and memory in aging and mild cognitive impairment. Arch Neurol. 2003;60(5):729–36.
Whitwell JL, Josephs KA, Murray ME, et al. MRI correlates of neurofibrillary tangle pathology at autopsy: a voxel-based morphometry study. Neurology. 2008;71(10):743–9.
Whitwell JL, Dickson DW, Murray ME, et al. Neuroimaging correlates of pathologically defined subtypes of Alzheimer's disease: a case-control study. Lancet Neurol. 2012;11(10):868–77.
Gefen T, Gasho K, Rademaker A, et al. Clinically concordant variations of Alzheimer pathology in aphasic versus amnestic dementia. Brain. 2012;135(5):1554–65.
Josephs KA, Dickson DW, Murray ME, et al. Quantitative neurofibrillary tangle density and brain volumetric MRI analyses in Alzheimer's disease presenting as logopenic progressive aphasia. Brain Lang. 2013;127(2):127–34.
Adlam AL, Patterson K, Rogers TT, et al. Semantic dementia and fluent primary progressive aphasia: two sides of the same coin? Brain. 2006;129(11):3066–80.
Mummery CJ, Patterson K, Price CJ, et al. A voxel-based morphometry study of semantic dementia: relationship between temporal lobe atrophy and semantic memory. Ann Neurol. 2000;47(1):36–45.
Gorno-Tempini ML, Dronkers NF, Rankin KP, et al. Cognition and anatomy in three variants of primary progressive aphasia. Ann Neurol. 2004;55(3):335–46.
Rosen HJ, Kramer JH, Gorno-Tempini ML, et al. Patterns of cerebral atrophy in primary progressive aphasia. Am J Geriatr Psychiatry. 2002;10(1):89–97.
Galton CJ, Patterson K, Graham K, et al. Differing patterns of temporal atrophy in Alzheimer's disease and semantic dementia. Neurology. 2001;57(2):216–25.
Chan D, Fox NC, Scahill RI, et al. Patterns of temporal lobe atrophy in semantic dementia and Alzheimer's disease. Ann Neurol. 2001;49(4):433–42.
Harris JM, Gall C, Thompson JC, et al. Classification and pathology of primary progressive aphasia. Neurology. 2013;81(21)):1832–9. This article examines the relationship between pathological postmortem diagnosis and clinical classification of progressive aphasia using the most recent classification recommendations.
Rohrer JD, Lashley T, Schott JM, et al. Clinical and neuroanatomical signatures of tissue pathology in frontotemporal lobar degeneration. Brain. 2011;134(9):2565–81.
Hodges JR, Mitchell J, Dawson K, et al. Semantic dementia: demography, familial factors and survival in a consecutive series of 100 cases. Brain. 2010;133(1):300–6.
Grossman M. Primary progressive aphasia: clinicopathological correlations. Nat Rev Neurol. 2010;6(2):88–97.
Hodges JR, Davies RR, Xuereb JH, et al. Clinicopathological correlates in frontotemporal dementia. Ann Neurol. 2004;56(3):399–406.
Stevens M, van Duijn CM, Kamphorst W, et al. Familial aggregation in frontotemporal dementia. Neurology. 1998;50(6):1541–5.
Josephs KA, Hodges JR, Snowden JS, et al. Neuropathological background of phenotypical variability in frontotemporal dementia. Acta Neuropathol. 2011;122(2):137–53.
Tyrrell PJ, Kartsounis LD, Frackowiak RS, et al. Progressive loss of speech output and orofacial dyspraxia associated with frontal lobe hypometabolism. J Neurol Neurosurg Psychiatry. 1991;54(4):351–7.
Josephs KA, Duffy JR, Strand EA, et al. Clinicopathological and imaging correlates of progressive aphasia and apraxia of speech. Brain. 2006;129(6):1385–98.
Snowden J, Thompson JC, Stopford CL, et al. The clinical diagnosis of early-onset dementias: diagnostic accuracy and clinicopathological relationships. Brain. 2011;134(9):2478–92.
Snowden J, Neary D, Mann DM, et al. Progressive language disorder due to lobar atrophy. Ann Neurol. 1992;31(2):174–83.
Grossman M, Mickanin J, Onishi K, et al. Progressive nonfluent aphasia: language, cognitive, and PET measures contrasted with probable Alzheimer's disease. J Cogn Neurosci. 1996;8(2):135–54.
Caselli RJ, Jack Jr CR. Asymmetric cortical degeneration syndromes. A proposed clinical classification. Arch Neurol. 1992;49(7):770–80.
Delecluse F, Andersen AR, Waldemar G, et al. Cerebral blood flow in progressive aphasia without dementia. Case report, using 133xenon inhalation, technetium 99 m hexamethylpropyleneamine oxime and single photon emission computerized tomography. Brain. 1990;113(5):1395–404.
Caso F, Mandelli ML, Henry M, et al. In vivo signatures of nonfluent/agrammatic primary progressive aphasia caused by FTLD pathology. Neurology. 2014;82(3):239–47.
Nestor PJ, Graham NL, Fryer TD, et al. Progressive non-fluent aphasia is associated with hypometabolism centred on the left anterior insula. Brain. 2003;126(11):2406–18.
Kobylecki C, Thompson JC, Jones M, et al. Sporadic Creutzfeldt-Jakob disease presenting as progressive nonfluent aphasia with speech apraxia. Alzheimer Dis Assoc Disord. 2013;27(4):384–6.
Josephs KA, Duffy JR, Strand EA, et al. Characterizing a neurodegenerative syndrome: primary progressive apraxia of speech. Brain. 2012;135(5):1522–36.
Mesulam M, Johnson N, Krefft TA, et al. Progranulin mutations in primary progressive aphasia: the PPA1 and PPA3 families. Arch Neurol. 2007;64(1):43–7.
Leverenz JB, Yu CE, Montine TJ, et al. A novel progranulin mutation associated with variable clinical presentation and tau, TDP43 and alpha-synuclein pathology. Brain. 2007;130(5):1360–74.
Snowden J, Pickering-Brown SM, Mackenzie IR, et al. Progranulin gene mutations associated with frontotemporal dementia and progressive non-fluent aphasia. Brain. 2006;129(11):3091–102.
Snowden JS, Pickering-Brown SM, Du Plessis D, et al. Progressive anomia revisited: focal degeneration associated with progranulin gene mutation. Neurocase. 2007;13(5):366–77.
Beck J, Rohrer JD, Campbell T, et al. A distinct clinical, neuropsychological and radiological phenotype is associated with progranulin gene mutations in a large UK series. Brain. 2008;131(3):706–20.
Le Ber I, Camuzat A, Hannequin D, et al. Phenotype variability in progranulin mutation carriers: a clinical, neuropsychological, imaging and genetic study. Brain. 2008;131(3):732–46.
Rohrer JD, Warren JD, Barnes J, et al. Mapping the progression of progranulin-associated frontotemporal lobar degeneration. Nat Clin Pract Neurol. 2008;4(8):455–60.
Kelley BJ, Haidar W, Boeve BF, et al. Prominent phenotypic variability associated with mutations in progranulin. Neurobiol Aging. 2009;30(5):739–51.
Mahoney CJ, Beck J, Rohrer JD, et al. Frontotemporal dementia with the C9ORF72 hexanucleotide repeat expansion: clinical, neuroanatomical and neuropathological features. Brain. 2012;135(3):736–50.
Snowden JS, Rollinson S, Thompson JC, et al. Distinct clinical and pathological characteristics of frontotemporal dementia associated with C9ORF72 mutations. Brain. 2012;135(3):693–708.
Hodges JR, Patterson K. Nonfluent progressive aphasia and semantic dementia: a comparative neuropsychological study. J Int Neuropsychol Soc. 1996;2(6):511–24.
Gorno-Tempini ML, Brambati SM, Ginex V, et al. The logopenic/phonological variant of primary progressive aphasia. Neurology. 2008;71(16):1227–34.
Mesulam M, Wieneke C, Rogalski E, et al. Quantitative template for subtyping primary progressive aphasia. Arch Neurol. 2009;66(12):1545–51.
Henry ML, Gorno-Tempini ML. The logopenic variant of primary progressive aphasia. Curr Opin Neurol. 2010;23(6):633–7.
Rabinovici GD, Miller BL. Frontotemporal lobar degeneration: epidemiology, pathophysiology, diagnosis and management. CNS Drugs. 2010;24(5):375–98.
Teichmann M, Kas A, Boutet C, et al. Deciphering logopenic primary progressive aphasia: a clinical, imaging and biomarker investigation. Brain. 2013;136(11):3474–88.
Hu WT, McMillan C, Libon D, et al. Multimodal predictors for Alzheimer disease in nonfluent primary progressive aphasia. Neurology. 2010;75(7):595–602.
Leyton CE, Villemagne VL, Savage S, et al. Subtypes of progressive aphasia: application of the international consensus criteria and validation using β-amyloid imaging. Brain. 2011;134(10):3030–43.
Rabinovici GD, Jagust WJ, Furst AJ, et al. Aβ amyloid and glucose metabolism in three variants of primary progressive aphasia. Ann Neurol. 2008;64(4):388–401.
Rabinovici GD, Rosen HJ, Alkalay A, et al. Amyloid vs FDG-PET in the differential diagnosis of AD and FTLD. Neurology. 2011;77(23):2034–42.
Itabashi S, Arai H, Higuchi S, et al. APOE epsilon 4 allele in Alzheimer's and non-Alzheimer's dementias. Lancet. 1996;348(9032):960–1.
Saunders AM, Strittmatter WJ, Schmechel D, et al. Association of apolipoprotein E allele epsilon 4 with late-onset familial and sporadic Alzheimer's disease. Neurology. 1993;43(8):1467–72.
Rogalski E, Cobia D, Harrison TM, et al. Progression of language decline and cortical atrophy in subtypes of primary progressive aphasia. Neurology. 2011;76(21):1804–10.
Rogalski EJ, Rademaker A, Harrison TM, et al. ApoE E4 is a susceptibility factor in amnestic but not aphasic dementias. Alzheimer Dis Assoc Disord. 2011;25(2):159–63.
Mesulam M, Wieneke C, Thompson C, et al. Quantitative classification of primary progressive aphasia at early and mild impairment stages. Brain. 2012;135(5):1537–53.
Wicklund MR, Duffy JR, Strand EA, et al. Quantitative application of the primary progressive aphasia consensus criteria. Neurology. 2014;82(13):1119–26.
Sajjadi SA, Patterson K, Arnold RJ, et al. Primary progressive aphasia: a tale of two syndromes and the rest. Neurology. 2012;78(21):1670–7.
Rohrer JD, Crutch SJ, Warrington EK, et al. Progranulin-associated primary progressive aphasia: a distinct phenotype? Neuropsychologia. 2010;48(1):288–97.
Pickering-Brown SM, Rollinson S, Du Plessis D, et al. Frequency and clinical characteristics of progranulin mutation carriers in the Manchester frontotemporal lobar degeneration cohort: comparison with patients with MAPT and no known mutations. Brain. 2008;131(3):721–31.
Josephs KA, Duffy JR, Strand EA, et al. Progranulin-associated PiB-negative logopenic primary progressive aphasia. J Neurol. 2014;261(3):604–14.
Sajjadi SA, Patterson K, Nestor PJ. Logopenic, mixed, or Alzheimer-related aphasia? Neurology. 2014;82(13):1127–31.
Mesulam MM, Weintraub S. Is it time to revisit the classification guidelines for primary progressive aphasia? Neurology. 2014;82(13):1108–9.
Xiong L, Xuereb JH, Spillantini MG, et al. Clinical comparison of progressive aphasia associated with Alzheimer versus FTD-spectrum pathology. J Neurol Neurosurg Psychiatry. 2011;82(3):254–60.
Deramecourt V, Lebert F, Debachy B, et al. Prediction of pathology in primary progressive language and speech disorders. Neurology. 2010;74(1):42–9.
Doran M, Xuereb J, Hodges JR. Rapidly progressive aphasia with bulbar motor neurone disease: a clinical and neuropsychological study. Behav Neurol. 1995;8:169–80.
Caselli RJ, Windebank AJ, Petersen RC, et al. Rapidly progressive aphasic dementia and motor neuron disease. Ann Neurol. 1993;33(2):200–7.
Tsuchiya K, Ozawa E, Fukushima J, et al. Rapidly progressive aphasia and motor neuron disease: a clinical, radiological, and pathological study of an autopsy case with circumscribed lobar atrophy. Acta Neuropathol. 2000;99(1):81–7.
Davies RR, Hodges JR, Kril JJ, et al. The pathological basis of semantic dementia. Brain. 2005;128(9):1984–95.
Kim SH, Seo SW, Go SM, et al. Semantic dementia combined with motor neuron disease. J Clin Neurosci. 2009;16(12):1683–5.
Yokota O, Tsuchiya K, Itoh Y, et al. Frontotemporal lobar degeneration with ubiquitin pathology: an autopsy case presenting with semantic dementia and upper motor neuron signs with a clinical course of 19 years. Acta Neuropathol. 2006;112(6):739–49.
Josephs KA, Petersen RC, Knopman DS, et al. Clinicopathologic analysis of frontotemporal and corticobasal degenerations and PSP. Neurology. 2006;66(1):41–8.
Yokota O, Tsuchiya K, Arai T, et al. Clinicopathological characterization of Pick's disease versus frontotemporal lobar degeneration with ubiquitin/TDP-43-positive inclusions. Acta Neuropathol. 2009;117(4):429–44.
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Harris, J.M., Jones, M. Pathology in Primary Progressive Aphasia Syndromes. Curr Neurol Neurosci Rep 14, 466 (2014). https://doi.org/10.1007/s11910-014-0466-4
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DOI: https://doi.org/10.1007/s11910-014-0466-4