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Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.7 no.1 São Paulo Jan./Mar. 2013 


Primary progressive aphasia: A dementia of the language network

Afasia progressiva primária: uma demência da rede de linguagem

Marsel Mesulam1 

1MD, Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.


Primary progressive aphasia (PPA) is a clinical syndrome diagnosed when three core criteria are met. First, there should be a language impairment (i.e., aphasia) that interferes with the usage or comprehension of words. Second, the neurological work-up should determine that the disease is neurodegenerative, and therefore progressive. Third, the aphasia should arise in relative isolation, without equivalent deficits of comportment or episodic memory. The language impairment can be fluent or non-fluent and may or may not interfere with word comprehension. Memory for recent events is preserved although memory scores obtained in verbally mediated tests may be abnormal. Minor changes in personality and behavior may be present but are not the leading factors that bring the patient to medical attention or that limit daily living activities. This distinctive clinical pattern is most conspicuous in the initial stages of the disease, and reflects a relatively selective atrophy of the language network, usually located in the left hemisphere. There are different clinical variants of PPA, each with a characteristic pattern of atrophy. The underlying neuropathological diseases are heterogeneous and can include Alzheimer's disease as well as frontotemporal lobar degeneration. The clinician's task is to recognize PPA and differentiate it from other neurodegenerative phenotypes, use biomarkers to surmise the nature of the underlying neuropathology, and institute the most fitting multimodal interventions.

Key words: dementia; language; network; frontotemporal; progranulin; tau


A afasia progressiva primária (APP) é uma síndrome clínica diagnosticada quando três critérios centrais são preenchidos. Inicialmente deve haver comprometimento da linguagem (afasia) que interfere com o uso ou a compreensão das palavras. Em segundo lugar, os métodos diagnósticos devem determinar que a doença é neurodegenerativa e, portanto, progressiva. Por último, a afasia deve emergir de forma relativamente isolada, sem alterações equivalentes de comportamento ou memória episódica. O comprometimento da linguagem pode ser de tipo fluente ou não fluente, e pode ou não interferir com a compreensão de palavras. A memória para eventos recentes está preservada, embora escores de memória em testes verbais possam ser anormais. Alterações discretas de personalidade e comportamento podem estar presentes, mas não são os fatores que levam o paciente ao atendimento médico ou que o limitam em suas atividades de vida diária. Este padrão distinto é mais evidente nas fases iniciais da doença e reflete a atrofia relativamente seletiva da rede de linguagem, geralmente localizada no hemisfério cerebral esquerdo. Há diferentes variantes clínicas da APP, cada uma com padrão de atrofia característico. Os substratos neuropatológicos são heterogêneos e podem incluir a doença de Alzheimer e a degeneração lobar frontotemporal. A tarefa do clínico é reconhecer a APP e diferenciá-la de outros fenótipos neurodegenerativos, utilizar biomarcadores para inferir a natureza da neuropatologia subjacente e instituir as intervenções multimodais cabíveis.

Palavras-chave: demência; linguagem; rede; frontotemporal; progranulina; tau

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Received: December 05, 2012; Accepted: February 08, 2013

Marsel Mesulam. Chicago IL 60611, USA. 320 East Superior St, Chicago, IL 60611 - E-mail:

Disclosure: The authors report no conflicts of interest.

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