Primary Progressive Aphasia

Diagnosis

No test leads to a diagnosis of primary progressive aphasia (PPA). At this time the characteristic findings in the brain for the spectrum of disorders that can cause PPA can only be detected after death through an autopsy. Instead, the disorder is diagnosed by considering which symptoms are present and excluding other conditions that might be causing the signs and symptoms. Because of the complexity of the disorder, there are numerous tests and questions for each patient.

Mental Status and Neuropsychological Assessments

To determine which thinking and memory functions may be affected and to what degree, the patient will be asked questions to measure cognitive functions for attention, learning, recall, language and visuospatial abilities. The tests are compared to the tests of other people of similar age and education.

The patient and people familiar with the patient will be interviewed about the patient's emotional state and day-to-day routines. They will also be asked about possible alcohol or drug abuse, head trauma and other causes for memory loss. Family members or close friends can provide valuable information about how the patient's behavior and personality have changed.

Speech and Language Assessment

Speech pathologists at Mayo Clinic are very experienced in this disorder. The diagnosis of PPA and possible therapies are discussed with the speech pathologist.

Psychiatric Assessments

In addition, the patient may have a psychiatric assessment to uncover possible depression or other mental illness.

Blood Tests

The patient's blood sample will be checked for infections or conditions such as vitamin deficiency, anemia, medication levels, disorders of the thyroid, kidneys or liver, and other factors that can cause memory loss.

Brain Imaging

Tests of internal images of the brain help detect strokes, tumors or other conditions that may have affected the brain, and may show changes to structures in the brain that are associated with memory, such as the hippocampus. Brain imaging techniques offered at Mayo Clinic are:

• Computed tomography (CT scan)
  In this test, an X-ray machine rapidly rotates around the brain while using a series of thin X-ray beams to produce two-dimensional images.
• Magnetic resonance imaging (MRI)
  This test uses powerful magnets and radio waves to produce a detailed, three-dimensional view of the brain.
• Positron emission tomography (PET) or Single-photon emission computerized tomography (SPECT)
  These two fairly new techniques may be needed for clinical-related or research-related study. For both tests, a small amount of radioactive material is injected into the patient and then detectors are placed on the brain to detect emissions. PET provides visual images of metabolic activity in the brain. SPECT is used to measure blood flow to various regions of the brain.

Most patients will be asked to undergo an MRI. In some patients, one of the other types of scans may be performed. The physicians with whom you meet can discuss which tests are most appropriate to establish the correct diagnosis.

Other Tests

Other tests that sometimes provide important diagnostic information include an electroencephalogram (EEG), electromyogram (EMG), urine tests, and tests on the cerebrospinal fluid (CSF) obtained by a lumbar puncture. The physicians discuss with the patient and his/her family which tests are most appropriate to establish the correct diagnosis.