PPA Diagnosis
How is PPA diagnosed? What are the guidelines for diagnosis recommended
and used by most medical research centers?
1. History:
First, a careful history is taken to establish that a condition
of dementia, as defined above, exists. This often requires that
family members or friends be questioned about the patient’s
behavior because sometimes the patient is unaware of the symptoms
(as in the case of memory loss or personality changes) or may be
unable to describe them due to aphasia.
2. Neurological Examination:
A neurological examination is done to determine if there are signs
of dementia on a simple screening of mental functions (the mental
status examination) and also if there are signs of motor or sensory
symptoms that indicate other types of neurological disorders might
be causing the dementia. The neurologist will also order tests,
such as a magnetic resonance imaging (MRI) scan, to make sure that
the symptoms are not due to factors such as stroke or tumor.
3. Neuropsychological Examination:
A neuropsychological examination provides a more detailed evaluation
of mental functioning. This is especially important in the very
early stages of illness when a routine screening evaluation may
not detect the problems the patient is experiencing. This requires
several hours and consists of paper-and-pencil or computer-administered
tests of mental abilities, including attention and concentration,
language, learning and memory, visual perception, reasoning and
mood. The results can indicate if there are abnormalities of thinking
and behavior and also their degree--mild, moderate or severe. It
is often difficult to demonstrate that individuals with PPA have
intact memory since we usually test memory by telling a person some
information and then asking them to repeat it later on. In an individual
with PPA, it may be impossible to repeat back the information because
of the aphasia. Therefore, it is important that testing is done
properly to make sure that there is not a true loss of memory. To
date, neuropsychological evaluation is the only way to objectively
identify a dementia. Currently, there are no blood tests or other
physiological tests that are specific for dementia. This is especially
important when symptoms are in the very early stages or mild.
4. Speech and Language Evaluation:
Since a decline in language abilities is the primary symptom of
PPA, it is important to determine which components of language use
are most affected, how severely affected they are, and what can
be done to improve communication. A Speech-Language Pathologist
evaluates different aspects of language in detail and can make recommendations
for strategies to improve communication. Family members should be
included in the treatment sessions to educate them about how to
facilitate communication.
5. Psychosocial Evaluation:
PPA affects not only the individual who is suffering from this
disorder, but also all people who are close to the patient. The
disorder has an impact on relationships, the ability to continue
working, the ability to perform many routine duties, and the ability
to communicate even the simplest of needs. Although there are many
resources available for individuals with memory loss, there are
relatively fewer appropriate resources for individuals with PPA,
their relatives and friends. Evaluation with a social worker who
is familiar with PPA can address these issues and provide suggestions
for dealing with day-to-day frustrations and problems.
6. Brain Imaging Studies:
The evaluation for dementia also includes a brain imaging study.
This is done in the form of a computed axial tomography scan (CAT
scan) or a magnetic resonance imaging scan (MRI scan). Both of these
methods provide a picture of the brain so that any structural abnormalities,
such as a stroke, tumor or hydrocephalus--all of which can give
rise to dementia-like symptoms, can be detected. In the case of
degenerative brain disease, the CAT scan and MRI scan may show “atrophy,”
which suggests a “shrinkage” of the brain tissue, or,
especially in early stages, they may not show anything. See Figure
2 below. In fact, the report often comes back “normal.”
But this only means that there is no evidence for a tumor or stroke.
It cannot tell us anything about the microscopic degenerative changes
that have occurred.
7. Psychiatric Evaluation:
Sometimes there will also be a need for a psychiatric evaluation.
This may be the case when it is not clear if the changes in behavior
are due to depression or another psychiatric disturbance. Also,
some individuals, especially those with PPA, may become saddened
by their condition and may require treatment for depression.
Figure 2:
The picture on the left shows one level of the brain in an individual
without dementia. The X-like shape contains fluid that feeds the
brain. Both sides are similar in appearance. On the right is the
same view in the brain of someone with PPA. The darkened spaces
on the right side of the figure represent atrophy in the language
areas.
Related Information
Introduction to PPA
Treatment
For Family and Friends
Brain Donation
Resources
Visit our Volunteer
For A Study page. If you would like to participate in a research
study and/or clinical trial, please contact us at 312-695-2343 or
by e-mail at CNADC-Admin@northwestern.edu
|
