DISSOLUTION OF SPOKEN LANGUAGE IN PRIMARY PROGRESSIVE APHASIA

The dissolution of speech and language was investigated over a 4 year period in a male with an 8 year history of isolated speech and languag e deterioration exhibiting a non-fluent profile of primary progressive aphasia (PPA). The course of his communication impairment began with apraxia of speech and difficulty accessing word form (e.g. as evidence d by frequent 'tip-of-the-tongue' errors that typically contained corr ect production of word onsets or first syllables but not whole words). Ultimately all aspects of oral language use deteriorated until the in dividual became non-vocal. His ability to communicate through non-verb al modalities remained intact. Results of repeated administrations of standardized tests and analyses of connected speech obtained over 2 ye ars were compared. The ability of various assessment probes to substan tiate clinical impressions of noticeable declines in expressive langua ge use was examined. It was concluded that the most sensitive indices of spoken language dissolution are likely to be measures derived from connected speech. Unlike level-specific subtests (i.e. subtests that a re designed to probe relatively isolated stages of processing such as word retrieval apart from syntactic formulation), the requisite simult aneity of processing across levels during connected speech taxes the a phasic's entire language processing system. Three principles guided th e approach to management: (i) anticipatory implementation of treatment goals; (ii) therapy is dyad oriented; and (iii) therapy is directed a t the level of the disability, defined as the limitations to perform s pecific functions within a natural context The cornerstone of this app roach, labelled proactive management, lies in the concept that the goa ls are formulated and implemented in anticipation of future declines s o that the patient with PPA is prepared to maximize communication effe ctiveness at every stage despite the relentless progression of the dis ease.