Partners in FTD Care, Fall 2020
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People with PPA experience progressive language loss, but often retain memory, personality, reasoning, and insight into their condition until the advanced stages (Mesulam, 2001; Banks SJ, Weintraub S. 2009). Engaging socially and participating in language-focused activities becomes more challenging because of their difficulties with word-finding. Combined with the awareness of their condition, those living with PPA often feel withdrawn, isolated, and excluded. Indeed, studies have shown that people with PPA are at a greater risk of experiencing depression (Medina and Weintraub, 2007).

In one study of persons diagnosed with PPA, a significant portion evaluated for depression scored in the clinically depressed range. More specifically, this study found that the number of depressive symptoms correlated with the severity of language impairments. The most common depressive symptoms included social withdrawal, lack of mental and physical energy, agitation, restlessness, sad mood and a pessimistic outlook. The study also found that people with previous depression were more vulnerable to a recurrence of symptoms because of their diagnosis (Medina and Weintraub, 2007).

Another study that compared neuropsychiatric features of PPA with cognitively normal controls suggested that PPA is associated with depression, apathy, agitation, anxiety, appetite change, and irritation. Depression symptoms are either an emotional reaction to language impairment or a noncognitive manifestation of the neurodegenerative process, the study speculated (Fatemi, 2011).

Knowing that reduced language function and a preserved understanding of their condition can leave people with PPA vulnerable for depression, the medical community must remain thoughtful and persistent in evaluating persons diagnosed for changes in mood. Attention should be given to emotional needs that are more difficult to express due to language loss. Early detection of depressive symptoms is important to ensure the most adequate treatment.

Until we have effective treatments for PPA, healthcare professionals should focus on helping those affected maintain their best quality of life. Treating depression to help improve one’s mood can impact quality of life for both people with PPA and their families. Talk therapy may help, but its utility as a treatment is increasingly limited as one’s PPA progresses, so non-verbal therapies such as music, art, dance and mindfulness can be considered as alternative mood interventions. Encouraging families to speak with their neurologist about their loved one’s changes in mood will ensure they find the best treatment options available.

References:

• Banks SJ, Weintraub S. Generalized and symptom-specific insight in behavioral-variant frontotemporal dementia and primary progressive aphasia. J Neuropsychiatry Clin Neurosci. 2009; 21:299–306.
• Fatemi et al. Neuropsychiatric aspects of primary progressive aphasia. J Neuropsychiatry Clin Neurosci. 2011; 23:2.
• Medina J, Weintraub S. Depression in primary progressive aphasia. J Geriatr Psychiatry Neurol. 2007; 20:153–160.
• Mesulam MM. Primary Progressive Aphasia. Annals of Neurology. 2001; 49 (4):425-32.

See also:

• When the Conversation Stops: Logopenic Variant Primary Progressive Aphasia
• Ask an Expert: Is Logopenic PPA an FTD Disorder or Alzheimer’s Disease?
• PPA Subtyping: Helping or Hindering the Understanding of PPA?
• From a Caregiver’s Perspective: Music Therapy and Language Retention
• From a Caregiver’s Perspective: The Importance of Speech and Language Therapy in PPA
• What to Do About… Managing Logopenic Variant PPA
• Download the full issue (pdf)