Abstract
Primary progressive aphasia (PPA) is a form of dementia caused by frontotemporal lobar degeneration. Unlike aphasia due to stroke, in which the association between particular aphasia profiles and insight has been well characterized, this relationship has not been investigated in PPA. Reduced insight is seen in other neurological conditions, but tends to involve right hemisphere damage, whereas PPA is predominantly a left hemisphere disorder. The aim of the current study was to examine whether fluent aphasia with less meaningful speech output, associated with diminished insight in stroke, is also characteristic of PPA patients with reduced insight. Fourteen PPA patients were studied. Results indicated that reduced information content in speech and poor performance on a nonlanguage test, the Pyramids and Palm Trees test, predicted reduced insight. This study has implications for the anatomical network involved in insight and clinical implications in terms of selecting interventions appropriate for individual patients with PPA.
Keywords: dementia, primary progressive aphasia, insight, awareness, frontotemporal dementia
Full Text
The Full Text of this article is available as a PDF (73.7 KB).
Contributor Information
Sarah Jane Banks, Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, sarah.banks@mail.mcgill.ca .
Sandra Weintraub, Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
References
- Mesulam MM Slowly progressive aphasia without generalized dementia. Ann Neurol. 1982;11:592-598. [DOI] [PubMed] [Google Scholar]
- Mesulam MM Primary progressive aphasia-differentiation from Alzheimer's disease. Ann Neurol. 1987;22: 533-534. [DOI] [PubMed] [Google Scholar]
- Mesulam MM Primary progressive aphasia-a language-based dementia. N Engl J Med. 2003;349:1535-1542. [DOI] [PubMed] [Google Scholar]
- Neary D., Snowden JS, Gustafson L., et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology. 1998;51:1546-1554. [DOI] [PubMed] [Google Scholar]
- Marczinski CA , Davidson W., Kertesz A. A longitudinal study of behavior in frontotemporal dementia and primary progressive aphasia. Cogn Behav Neurol . 2004;17: 185-190. [PubMed] [Google Scholar]
- Howorth P., Saper J. The dimensions of insight in people with dementia. Aging Ment Health. 2003;7:113-122. [DOI] [PubMed] [Google Scholar]
- Gorno-Tempini ML, Dronkers NF, Rankin KP, et al. Cognition and anatomy in three variants of primary progressive aphasia. Ann Neurol. 2004;55:335-346. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Weinstein EA , Cole M., Mitchell MS, Lyerly OG Anosognosia and aphasia. Arch Neurol. 1964;10: 376-386. [DOI] [PubMed] [Google Scholar]
- Lebrun Y. Anosognosia in aphasics. Cortex. 1987;23: 251-263. [DOI] [PubMed] [Google Scholar]
- Kertesz A., McMonagle P., Blair M., Davidson W., Munoz DG The evolution and pathology of frontotemporal dementia. Brain . 2005;128(pt 9):1996-2005. [DOI] [PubMed] [Google Scholar]
- Knopman DS, Petersen RC, Edland SD, Cha RH, Rocca WA The incidence of frontotemporal lobar degeneration in Rochester, Minnesota, 1990 through 1994. Neurology. 2004;62:506-508. [DOI] [PubMed] [Google Scholar]
- Eslinger PJ , Dennis K., Moore P., Antani S., Hauck R., Grossman M. Metacognitive deficits in frontotemporal dementia . J Neurol Neurosurg Psychiatry. 2005;76:1630-1635. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mesulam MM, Grossman M., Hillis A., Kertesz A., Weintraub S. The core and halo of primary progressive aphasia and semantic dementia. Ann Neurol. 2003; 54(suppl 5): S11-S14. [DOI] [PubMed] [Google Scholar]
- Cutting J. Study of anosognosia. J Neurol Neurosurg Psychiatry. 1978;41:548-555. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gerstmann J. Problems of imperception of disease and impaired body territories with organic lesions. Arch Neurol Psychiatry . 1942;48:890-913. [Google Scholar]
- Venneri A., Shanks MF Belief and awareness: reflections on a case of persistent anosognosia. Neuropsychologia. 2004;42:230-238. [DOI] [PubMed] [Google Scholar]
- Fordyce DJ, Roueche JR Changes in perspectives of disability among patients, staff and relatives during rehabilitation of brain injury. Rehabil Psychol. 1986;312: 217-229. [Google Scholar]
- Morley JB, Cox FN Cortical blindness with anosognosia subsequent simultaneous agnosia and persistent gross recent memory defect. Proc Aust Assoc Neurol. 1974;11: 41-47. [PubMed] [Google Scholar]
- Redlich FC, Dorsey JF Denial of blindness by patient with cerebral disease. Arch Neurol Psychiatry. 1945;53:407-417. [Google Scholar]
- Bisiach E., Vallar G., Perani D., Papagno C., Berti A. Unawareness of disease following lesions of the right hemisphere: anosognosia for hemiplegia and anosognosia for hemianopia. Neuropsychologia . 1986;24:471-482. [DOI] [PubMed] [Google Scholar]
- Pia L., Neppi-Modona M., Ricci R., Berti A. The anatomy of anosognosia for hemiplegia: a meta-analysis. Cortex. 2004;40:367-377. [DOI] [PubMed] [Google Scholar]
- Prigatano GP Disturbances of self-awareness of deficit after traumatic brain injury. In: Schacter DL, Prigatano GP, eds. Awareness of Deficit After Brain Injury . New York, NY: Oxford University Press; 1991:111-126. [Google Scholar]
- Mesulam MM Principles of Behavioral and Cognitive Neurology. New York, NY: Oxford University Press; 2000. . [Google Scholar]
- Salmon E., Perani D., Herholz K., et al. Neural correlates of anosognosia for cognitive impairment in Alzheimer's disease. Hum Brain Mapp. 2006;27:588-597. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Vogel C. Cognitive and functional neuroimaging correlate for anosognosia in mild cognitive impairment and Alzheimer's disease. Int J Geriatr Psychiatry . 2005;20: 238-246. [DOI] [PubMed] [Google Scholar]
- Mendez MF, Shapira JS Loss of insight and functional neuroimaging in frontotemporal dementia. J Neuropsychiatry Clin Neurosci. 2005;17:413-416. [DOI] [PubMed] [Google Scholar]
- Ricci PT, Zelkowicz BJ, Nebes RD, Meltzer CC, Mintun MA, Becker JT Functional neuroanatomy of semantic memory: recognition of semantic associations . Neuroimage. 1999;9:88-96. [DOI] [PubMed] [Google Scholar]
- Morris JC, Weintraub S., Chui HC, et al. The Uniform Data Set (UDS): clinical and cognitive variables and descriptive data from Alzheimer Disease Centers. Alzheimer Dis Assoc Disord. 2006;20:210-216. [DOI] [PubMed] [Google Scholar]
- Ott BR, Fogel BS Measurement of depression in dementia: self vs. clinician rating. Int J Geriatr Psychiatry. 1992;7:899-904. [Google Scholar]
- Kertesz A., Davidson W., Fox H. Frontal behavioral inventory: diagnostic criteria for frontal lobe dementia . Can J Neurol Sci. 1997;24:29-36. [DOI] [PubMed] [Google Scholar]
- Kertesz A. The Western Aphasia Battery. New York, NY: Grune and Stratton; 1982. [Google Scholar]
- Howard D., Patterson K. The Pyramids and Palm Trees Test: A Test of Semantic Access from Words and Pictures. London, UK: Harcourt Assessment; ; 1992. [Google Scholar]
- Kaplan E., Goodglass H., Weintraub S. Boston Naming Test. Experimental Edition. Boston, MA: Aphasia Research Center, Boston University; 1976. [Google Scholar]
- Alajouanine T., Lhermitte F. The phonemic and semantic components of jargonaphasia . Int J Neurol. 1964;4: 277-286. [PubMed] [Google Scholar]
- Rubens AB, Garrett MF Anosognosia of linguistic deficits in patients with neurological deficits . In: Prigatano GP, Schacter DL, eds. Awareness of Deficit After Brain Injury . New York, NY: Oxford University Press; 1991:40-52. [Google Scholar]
- Cohn R., Neuman MA Jargon aphasia. J Nerv Ment Dis. 1958;127:381-399. [DOI] [PubMed] [Google Scholar]
- Thompson CK, Johnson N. Language intervention in dementia. In: Attix DK, Welsh-Bohmer KA, eds. Geriatric Neuropsychology. New York, NY: Guilford; 2006:315-332. [Google Scholar]
- Green SB How many subjects foes it take to do a regression analysis? Multivariate Behav Res. 1991;26: 499-510. [DOI] [PubMed] [Google Scholar]
- Banks S., Weintraub S. Neuropsychiatric symptoms in behavioral variant frontotemporal dementia and primary progressive aphasia. J Geriatr Psychiatry Neurol. 2008; 26:133-141. [DOI] [PMC free article] [PubMed] [Google Scholar]