Speech and language therapy in primary progressive aphasia: a critical review of current practice

ABSTRACT

Introduction

Primary progressive aphasia (PPA) is a complex language-led dementia syndrome whereby disproportionate deterioration of speech and language occurs subsequent to neurodegenerative disease in the early to mid-stages of the condition. As no effective pharmacotherapies are currently available, speech and language therapies are the optimum treatment to maximize communication for as long as possible.

Areas covered

The authors present an overview of current speech-language therapy practices in PPA, highlighting recent research on effective treatments.

Expert opinion

The challenges in this complex field of practice are described. We highlight the challenge of improving access to speech-language therapy by advocating for increased referral rates. The authors also suggest effective incorporation of innovative technologies in treatment and an enhanced evidence base for the utility of lexical retrieval treatment in improving everyday communication as challenges for the future. Finally, increased provision of PPA-specific education and support for individuals and their families is required.

KEYWORDS:

• Primary progressive aphasia
• neurodegeneration
• aphasia
• communication
• speech therapy
• speech-language therapy
• clinical care

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article Highlights

• The primary progressive aphasias (PPA) is a complex group of clinical dementia syndromes characterized by prominent deterioration of language with relative preservation of other cognitive abilities in the early to mid-stages of disease progression.

• PPA is a rapidly expanding and emerging field of practice for speech-language therapists.

• Rather than restitution of language ability, as is the case in stroke rehabilitation, the goal of speech and language therapy in PPA is to maximize effective communication for as long as possible.

• Numerous effective behavioral interventions are available to the speech language therapist for integration into an individualized holistic care plan, in collaboration with the individual with PPA and their close others.

• Treatment and all aspects of care need to be continuously modified to meet the changing needs of the individual and their close others with disease progression.

• As pharmacological interventions to slow or halt language deterioration continue to be unavailable, there is an imperative for expansion of evidenced-based behavioral interventions for people with PPA.

• The ongoing challenge for speech-language therapists is to develop effective, evidence-based, innovative, responsive treatments and methods of treatment delivery.

• We argue that speech and language therapy in PPA is beneficial for the vast majority of individuals living with PPA, thus referral to a speech-language therapist should be among the highest priorities in their care.

Notes

1. The Australian Bureau of Statistics defines baby boomers as those born between 1946 and 1964.

2. Although some authors, e.g. [9,119,120], refer to the fluent language variant of frontotemporal dementia as Semantic Dementia, the term semantic variant PPA (svPPA) will be used throughout this paper.

3. The peak dementia organization in Australia states that younger onset dementia is the term given when dementia is diagnosed in people under the age of 65 (retrieved from www.dementia.org.au on 22 August 2020).

4. The term ‘remnants’ initially appeared in the stroke aphasia literature and is used to describe ‘actual objects, or photographs of events or items of personal significance, (which) may be a more useful means of representing conversational topics for individuals with global aphasia than generic pictographic symbols’ (Ho et al., 2005, page 218 [79]).

5. It is estimated that the number of smart phone users, worldwide, exceeded three billion on 20 August 2020 (retrieved from statista.com on 15 October 2020).

6. The emerging term ‘high touch care’ describes a high-intensity care model that ‘encourages frequent and direct person-to-person interaction between patients and their health-care providers to optimize the value of care’ (Ghany et al., 2018, page 300) [107].

Additional information

Funding

During the drafting the original of this manuscript, C Taylor-Rubin was supported by the Australian Government Research Training Scheme MQRES 2014197.