Progressive nonfluent aphasia
The main clinical features are progressive difficulties with speech production. There can be problems in different parts of the speech production system, hence patients can present with articulatory breakdown, phonemic breakdown (difficulties with sounds) and other problems. However, it is rare for patients to have just one of these problems and most people will present with more than one problem. Features include:
- Hesitant, effortful speech
- Speech 'apraxia'
- Stutter (including return of a childhood stutter)
- Phonemic paraphasia (sound errors in speech e.g. 'gat' for 'cat')
- Agrammatism (using the wrong tense or word order)
As the disease develops, speech quantity decreases and many patients will become mute.
Cognitive domains other than language are rarely affected early on. However, as the disease progresses other domains can be affected. Problems with writing, reading and speech comprehension can occur as can behavioural features similar to frontotemporal dementia.
There is some confusion in the terminology used by different neurologists. Mesulam's original description in 1982 of progressive language problems caused by neurodegenerative disease (which he called Primary Progressive Aphasia (PPA)  included patients with progressive non-fluent (PNFA), Semantic Dementia(SD), and Logopenic progressive aphasia (LPA).
Imaging studies have shown differing results which probably represents the heterogeneity of language problems than can occur in PNFA. However, classically atrophy of left perisylvian areas is seen. Comprehensive meta-analyses on MRI and FDG-PET studies identified alterations in the whole left frontotemporal network for phonological and syntactical processing as the most consistent finding. Based on these imaging methods, progressive nonfluent aphasia can be regionally dissociated from the other subtypes of frontotemporal lobar degeneration, frontotemporal dementia and semantic dementia.
There is no curative treatment for this condition. Supportive management is helpful.
- Alzheimer's disease
- Corticobasal degeneration
- Frontotemporal dementia
- Frontotemporal lobar degeneration
- Logopenic progressive aphasia
- Pick's disease
- Semantic dementia
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- FTD information and videos from the UCSF Memory and Aging Center
- FTD Info from the Mayo Clinic
- The Association for Frontotemporal Dementias