Primary Progressive Aphasia (PPA)

Aphasia is a language condition that starts when something damages the parts of your brain that help you write, read, speak, listen and understand. Strokes or traumatic brain injuries (TBIs) can cause aphasia. But temporary aphasia can also happen from conditions like migraine headaches.

When aphasia is caused by a neurodegenerative disease like Alzheimer’s disease or frontotemporal dementia, we call it primary progressive aphasia because it “progresses” or gets worse over time. Neurodegenerative diseases cause brain tissue to shrink (atrophy), and that can affect your ability to communicate.

There are three subtypes of PPA:

• Logopenic progressive aphasia makes it hard to find the right words or understand what other people are saying.
• Progressive non-fluent aphasia can make it hard to get the words out. Speech can be halting instead of fluent. And when the words do come, the sentences often have incorrect grammar.
• Semantic dementia can make it hard to name objects or understand what words mean.

Any of these can start as minor speech problems but can progress to problems with judgment and thinking. So, if you’re finding it harder to hold conversations or remember words, it’s time to see a healthcare provider experienced in treating PPA.

What to expect at your first visit

The first thing we’ll do is take some time to get to know you. We’ll listen to your concerns and answer any questions you may have. We’ll ask about what changes you’ve noticed in your ability to talk and communicate. We’ll also talk about your health history and your family’s history to see if you have an increased risk for PPA.

Then we may do a few tests.

Cognitive and neurological tests

You may have cognitive tests to see how well your brain processes information. We look at things like language, memory, problem-solving, learning and more. Your provider makes sure you know what to expect from cognitive tests and neuropsychological assessments.

Imaging tests

CT scans (computed tomography scans), MRIs (magnetic resonance imaging) and PET scans (positron emission tomography) take detailed pictures of your brain so we have a clear idea of what’s going on inside. And they can help us rule out conditions like stroke, bleeding, too much fluid or tumors. All these things can affect how you think and process language.

Meet Our Primary Progressive Aphasia Team

Cleveland Clinic believes in teamwork to make sure you get the best care. You’ll have the knowledge and support of skilled providers from different specialties on your PPA team. These experts work together to plan your care and keep a close eye on your progress. Your team may include:

• Neurologists.
• Geriatricians.
• Psychiatrists
• Neuropsychologists.
• Nurse practitioners.
• Physician assistants.
• Speech therapists.

When we build your care plan, we focus on slowing PPA’s progression. We want to manage the condition so you can keep communicating and living independently for as long as possible. You may have:

Speech therapy

Our team may recommend speech therapy to help you keep your language skills for as long as possible. We can also work with you to find new ways to communicate, like sign language. If you want, we’ll involve your loved ones in some therapy sessions, so they can learn the best ways to communicate with you.

Cognitive therapy

We may also recommend cognitive therapy with our neuropsychology team. You’ll do activities aimed at keeping your thinking skills active. These could be games with your therapist or in a group setting. We work to make it as engaging and enjoyable as possible.

Medications

You may start taking medications to help manage the changes that can come with PPA. These can include drugs to help reduce anxiety or depression. And if we learn Alzheimer’s disease causes your PPA, you may also take medications for managing that condition.

Living With Primary Progressive Aphasia (PPA)

As you learn how to live with PPA, it’s important to follow your care team’s recommendations. Take your medications as prescribed. Go to therapy sessions. And remember that regular check-ups with your providers are important. They let our team keep an eye on your condition and adjust your care plan as needed. As your condition progresses, we can help you find new ways to communicate. And we can put you and your family in touch with support groups — online or in person.

Taking the Next Step

Learning you’re slowly losing your language skills isn’t an easy thing to hear. But you don’t have to handle PPA on your own. Our experienced team is here to help you find ways to keep your brain as healthy as possible — for as long as possible. We provide a support system for you and your family. We want you to feel confident about your care as we guide you every step of the way.