Links and Excerpts re LvPPA

These Links have been collected by Truthful Loving Kindness (yes, that is my full legal name) for publishing at http://www.truthfulkindness.com , so PLEASE address any questions or comments to that website, regardless of which website shows these words.  *******  The word “Logopenic” comes from the Greek. “Logos” (Strongs #3056) is “communication” or “speech”, and also “reasoning expressed by WORDS”.  + “Penic” = Greek > Modern Latin: “abnormal reduction, decrease in, insufficient, deficiency”.  Becomes “Lack of Words”.

Remember, Links are in colored text.

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FTD is a young-onset type of dementia (40yo-60yo).  Centers in either Frontal or Temporal Lobes of brain.  FTD includes Behavioral variant (BvFTD), Primary Progressive Aphasia (PPA), & a few others.  Logopenic variant (LvPPA) is 1 of 3 sub-types of PPA, first presenting symptoms are language based & targets the more posterior part of the temporal lobe and parietal lobe.  aka Logopenic PPA, Logopenic Alzheimers, Logopenic Aphasia, and Logopenic Dementia.

First LvPPA symptoms are usually “Unable to find right words (especially names), circumlocutions, pauses” … and “Mispronounced or ‘slurred’ speech, jargon, binary reversals, e.g. ‘Yes/No’”… and “Confusion following more complex instructions” and “Usually no specific history; may have difficulty remembering new PIN or telephone numbers”” in Table2 of Feb2018 Springer “Journal of Neurology” at >> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990560/ .

This first excerpt below covers the majority of symptoms for LvPPA (Logopenic variant of PPA), which is the newest-identified sub-type of FTD;  … but does not cover all symptoms.   Additional 2pgs with connections to Anhedonia, Central  Auditory Processing Disorder connection, family history of Dyslexia, Hallucination, & Radiology.  Have not re-found Link with Loss of taste, although there are some for BvFTD.  Attached excerpts are from these Links

https://www.raredementiasupport.org/primary-progressive-aphasia/support-in-later-stages-ppa/ ;

(2013) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808687/ ;

(2018) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990560/ ;

(2021) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861583/ ;

(2021) https://academic.oup.com/brain/article/144/5/1551/6214168 ; & a few others.

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“Rare Dementia Support” began as a nurse-led organization and keeps close primary ties with medical organizations.  Below sections are from Rare Dementia Support at >> https://www.raredementiasupport.org/primary-progressive-aphasia/support-in-later-stages-ppa/  :  LATER stages

“Symptoms that people living with LvPPA might develop are …

 reduced speech and increased hesitation due to problems finding words – and sometimes, use of made-up words or jargon

increased difficulties with reading, spelling and arithmetic

emergence of more problems with memory

increased difficulty with mobility and reduced spatial awareness

increased difficulty using tools and gadgets

increased irritability and anxiety, resulting in social withdrawal  .”

…  and  …

 “Later in the course of PPA, the disease will affect many different parts of the brain beyond the language system. This is true for all the major PPA syndromes and means that similar problems can occur in each subtype, including:

heavily reduced or unintelligible speech

difficulty understanding other people (both with spoken and written information)

increased difficulty making complex decisions (around finances and money, for example)

difficulty with judgment, planning and concentration, affecting activities such as driving

needing assistance with more basic activities like washing, dressing and eating

moving slowly and stiffly, becoming less mobile and developing poor balance

problems with swallowing, diet and nutrition

problems with continence and use of the toilet

changes in behaviour, including loss of social awareness, loss of motivation, agitation and sometimes aggression

A speech and language therapist can help manage some of these symptoms and we have provided information on this on our Living with PPA page. Some of these symptoms are also associated with frontotemporal dementia (FTD) and we have detailed some strategies that can help you with these symptoms on our Living with FTD page. “ …

… The duration of PPA differs from person to person. Although PPA itself is a life-shortening condition, people with PPA will often be affected by another illness, such as pneumonia. This is because PPA affects how the body copes with infection and with other physical problems. Pneumonia is the cause of death in up to two thirds of people with a dementia. …    Above sections are from “Rare Dementia Support” at >> https://www.raredementiasupport.org/primary-progressive-aphasia/support-in-later-stages-ppa/

 

.Additional Excerpts for specifics (arranged by date):

2013Nov re Learning Disability connection; “Among the PPA subtypes, history of learning disability was significantly greater in the logopenic variant (25% dyslexia)” >> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808687/  in Oxford “Brain” journal during Nov2013.

2018Feb re Radiology: Imaging-supported logopenic variant PPA Both:

  1. clinical diagnosis of logopenic variant PPA
  2. predominantly left posterior perisylvian or parietal atrophy on MRI and/or predominant left posterior perisylvian or parietal hypoperfusion or hypometabolism on SPECT or PET … from Feb2018 at https://radiopaedia.org/articles/logopenic-dementia?lang=us  ((open-edit radiology resource, compiled by radiologists and other health professionals from across the globe.)) 

2018Feb re Limb Apraxia: Below is from “Logopenic canonical syndrome” … The clinical picture in lvPPA is usually dominated by word-finding difficulty and conversational lapses, for which the syndrome is named (Greek, ‘lack of words’; Table 3, Supplementary sound file 4). Early on, ‘tip-of-the-tongue’ hesitations are often prominent. Some patients develop a rather mannered style of conversation, likened by one spouse to a ‘Jane Austen character’. Interrupted sentences that tend to trail off may give the impression of agrammatism though without the frank syntactic dislocations of nfvPPA [18]. Speech sound or spelling errors are frequently described. The patient may struggle to understand more complex sentences and to hold verbal information in mind. While language is (by definition) the leading and dominant issue, there is frequently a history of associated extra-linguistic difficulties extending to the realms of memory (e.g., forgetfulness, repetitiveness or route-finding problems), praxis (e.g., use of work equipment, tools or household gadgets) or visuo-spatial awareness (e.g., inability to judge distances accurately, find exits or locate items in plain sight) [6566]. … and … Other dominant (and often, bi-hemispheric) posterior cortical signs such as limb apraxia and visual apperceptive agnosia can frequently be elicited in lvPPA. … .These sections are from “Logopenic canonical syndrome” >>  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990560/ in Feb2018 Springer “Journal of Neurology”

2021Feb re Auditory Disorder, Dyslexia, & LBD connection; “Evidence suggests a clear rationale for a personalised approach: language functions are highly dependent on life trajectory, and intriguing links have been identified between PPA and dyslexia [27].”  … and … “lvPPA has been associated with dementia with Lewy bodies[43] and TDP-43 (type A) [41]; and an lvPPA-like phenotype has been consistently identified in people with mutations in the progranulin gene [4445]. Emerging evidence suggests that specific language network vulnerabilities caused by genetic, developmental, and/or lifestyle factors may determine why some people develop a PPA phenotype in the context of a specific proteinopathy [274647]. Age at onset may also influence phenotypic expression [48].  … and …  “Patients with lvPPA also show pronounced difficulties understanding degraded speech [52••], which may reflect a more general deficit in terms of parsing the auditory environment (‘auditory scene analysis’)”. … and …  ““Language and auditory functions are closely interrelated [68], meaning that auditory measures may represent useful probes of integrity of the relevant networks in PPA [69]. Indeed, language output deficits in all three major PPA syndromes are likely to be significantly influenced by disordered complex sound processing and understanding: an emerging picture in PPA is of fundamental deficits in central auditory perception [7071]..”  … and … “ Logopenic variant PPA is associated with deficient processing of phonemes [29••, 78••]. One parsimonious explanation for the phonemic errors made in speech output in lvPPA is that these relate to a general impairment in phonemic representation, though the association between phonemic input and output errors is yet to be explored experimentally.  … this has not been tested experimentally but accords with findings in typical Alzheimer’s disease and posterior cortical atrophy (a visuospatial form of Alzheimer’s disease) suggesting that damage to posteromedial cortices may underpin these deficits across the AD spectrum [7980].  … and …   Atypical presentations in the PPA/FTD spectrum manifesting as very early problems with auditory processing have also been identified, including progressive pure phonagnosia [4681], progressive word deafness [8284], and generalised auditory agnosia [85]. Taken together, these recent findings suggest that the PPA might be characterised as pervasive ‘communication’ disorders that go beyond language. Tests of auditory processing could have considerable advantages over tests measuring language functions: they are relatively easy to measure and administer, and less linguistically/culture-bound than language tests, making them attractive as outcome measurements in future clinical trials.”  Above excerpts from >> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861583/  in “Current Neurology and NeuroScience Reports” Feb2021.

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Apr2021 re Taste; “FTD is associated with complex changes in neural networks of gustatory processing” in “Neurocase” journal of Apr2021 >> https://pubmed.ncbi.nlm.nih.gov/33789074/ ;

2021May re Anhedonia and FTD (May2021 study has BvFTD, nfvPPA & SvPPA,types of FTD, but no ppl w/LvPPA are included in study, maybe because LvPPA was the most recently identified sub-type of FTD)  “demonstrate profound anhedonia in FTD syndromes” >>  https://academic.oup.com/brain/article/144/5/1551/6214168 ;

2020Fall re self-awareness : “People with PPA experience progressive language loss, but often retain memory, personality, reasoning, and insight into their condition until the advanced stages (Mesulam, 2001; Banks SJ, Weintraub S. 2009).” In “Partners in FTD Care” Fall 2020 at https://www.theaftd.org/ppa-and-depression/ .

Hallucination as Symptom of PPA at >> https://rarediseases.info.nih.gov/diseases/8541/primary-progressive-aphasia?fbclid=IwAR35K_CGv9ynpDzyxV7Rg96vqch7rykEQMcMH_kVYo9ttb388Tz1IlH_vOM ;

Very nice explanation of whether LvPPA fits as category in FTD or category in Alz (because need autopsy to confirm pathology among 3 known causes) >> https://www.theaftd.org/ask-an-expert-is-logopenic-ppa-an-ftd-disorder-or-alzheimers-disease/ .

Genetics of FTD and PPA at >> https://www.ftdtalk.org/what-is-ftd/genetics/#1581232614640-f40d1332-af19

Some good ideas at >> https://www.theaftd.org/what-to-do-about-managing-logopenic-variant-ppa/ ..

Swallow suggestions at >> https://www.brainsupportnetwork.org/swallowing-eating-speech-therapist-talk/ ;

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***  (((Husband’s comment is that he is amazed that I am able to gather these applicable Links, yet unable to understand his comments on what I have compiled.)))

… and you might want to check out the Links gathered for Dementia Symptoms and Strategies (alphabetized) at https://truthfulkindness.com/about/d-info/links-sx-strategies/.

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PPA Variants (page currently in “draft” stage)

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