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Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.1 no.2 São Paulo Apr./June 2007

http://dx.doi.org/10.1590/s1980-57642008dn10200014 

Original Articles

Verbal and non-verbal semantic impairment: From fluent primary progressive aphasia to semantic dementia

Comprometimento semântico verbal e não-verbal: da afasia progressiva primária para demência semântica

Mirna Lie Hosogi Senaha 1  

Paulo Caramelli 2  

Claudia Sellitto Porto 3  

Ricardo Nitrini 4  

1PhD. Member of Behavioral and Cognitive Neurology Unit of the Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil.

2MD, PhD. Associate Professor, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

3PhD. Member of Behavioral and Cognitive Neurology Unit of the Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil.

4MD, PhD. Associate Professor, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil.

Abstract

Selective disturbances of semantic memory have attracted the interest of many investigators and the question of the existence of single or multiple semantic systems remains a very controversial theme in the literature. Objectives: To discuss the question of multiple semantic systems based on a longitudinal study of a patient who presented semantic dementia from fluent primary progressive aphasia.

Methods:

A 66 year-old woman with selective impairment of semantic memory was examined on two occasions, undergoing neuropsychological and language evaluations, the results of which were compared to those of three paired control individuals.

Results:

In the first evaluation, physical examination was normal and the score on the Mini-Mental State Examination was 26. Language evaluation revealed fluent speech, anomia, disturbance in word comprehension, preservation of the syntactic and phonological aspects of the language, besides surface dyslexia and dysgraphia. Autobiographical and episodic memories were relatively preserved. In semantic memory tests, the following dissociation was found: disturbance of verbal semantic memory with preservation of non-verbal semantic memory. Magnetic resonance of the brain revealed marked atrophy of the left anterior temporal lobe. After 14 months, the difficulties in verbal semantic memory had become more severe and the semantic disturbance, limited initially to the linguistic sphere, had worsened to involve non-verbal domains.

Conclusions:

Given the dissociation found in the first examination, we believe there is sufficient clinical evidence to refute the existence of a unitary semantic system.

Key words: semantic dementia; semantic memory; temporal lobe; progressive primary aphasia; semantic system.

Resumo

Distúrbios seletivos da memória semântica têm atraído o interesse de muitos pesquisadores e a questão da existência de sistema semântico único ou múltiplo permanece como um tema muito controvertido na literatura.

Objetivos:

Discutir a questão de sistemas semânticos múltiplos por meio de um estudo longitudinal de uma paciente com afasia progressiva primária fluente que evoluiu para um quadro de demência semântica.

Métodos:

Uma mulher de 66 anos com comprometimento seletivo da memória semântica foi avaliada em dois momentos por meio de testes neuropsicológicos e fonoaudiológicos e os resultados foram comparados aos de três indivíduos controles pareados.

Resultados:

Na primeira avaliação, o exame físico estava normal e a paciente obteve 26 pontos no Mini-exame do estado mental. Na avaliação da linguagem foram constatadas: produção oral fluente, anomia, comprometimento da compreensão de palavras, preservação dos aspectos sintáticos e fonológicos da linguagem e dislexia e disgrafia de superfície. As memórias autobiográfica e episódica encontravam-se relativamente preservadas. Em testes de memória semântica, a seguinte dissociação foi constatada: distúrbio da memória semântica verbal com preservação da memória semântica não-verbal. Os exames de ressonância magnética cerebral revelaram atrofia acentuada do lobo temporal anterior do hemisfério cerebral esquerdo. Após 14 meses, as dificuldades da memória semântica verbal tornaram-se mais intensas e o distúrbio semântico, inicialmente restrito, à esfera verbal passou a domínios não-verbais.

Conclusões:

Dada a dissociação encontrada na primeira avaliação, acreditamos que temos evidências clínicas contra a existência de um único sistema semântico.

Palavras-chave: demência semântica; memória semântica; lobo temporal; afasia progressiva primária; sistema semântico.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

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Dra. Mirna Lie Hosogi Senaha - Rua Montesquieu 371 / 62 - 04116-190 São Paulo SP - Brazil. E-mail: senaha@uol.com.br

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