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Case 21 - Difficulty with Language: When Is It Not Aphasia?

from Part 5 - Difficult-to-Characterize Cognitive/Behavioral Disorders

Published online by Cambridge University Press:  03 November 2020

Keith Josephs
Affiliation:
Mayo Clinic Alzheimer’s Disease Research Center
Federico Rodriguez-Porcel
Affiliation:
Medical University of South Carolina
Rhonna Shatz
Affiliation:
University of Cincinnati
Daniel Weintraub
Affiliation:
University of Pennsylvania
Alberto Espay
Affiliation:
University of Cincinnati
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Summary

A 70-year-old man had worsening speech over 18 months, with increased effort required to enunciate words. His wife described him as speaking with a monotone voice, and the overall rate of speech was slow. He paused frequently between and in the middle of words, especially during long and complex sentences. He denied problems with finding words, forming sentences, or comprehending spoken or written language. His writing mirrored the slowness in speaking, but there were no abnormalities in its appearance or spelling. On exam, his speech exhibited increased intersegment duration between words, as well as aprosodia. No sound distortions were noticed, except for one false start. Subtle agrammatism was detected early in the interview, though grammar appeared normal during the remainder of the examination (Video 21.1). The rest of his language evaluation and neurological exam was unremarkable. An MRI of the brain demonstrated asymmetric atrophy, predominantly affecting the left premotor cortex.

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Publisher: Cambridge University Press
Print publication year: 2020

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References

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Josephs, K. A. et al. 2012. Characterizing a neurodegenerative syndrome: primary progressive apraxia of speech. Brain 135(Pt 5) 15221536.CrossRefGoogle ScholarPubMed
Josephs, K. A. et al. 2006. Clinicopathological and imaging correlates of progressive aphasia and apraxia of speech. Brain 129(Pt 6) 13851398.Google Scholar
Jung, Y., Duffy, J. R. and Josephs, K. A. 2013. Primary progressive aphasia and apraxia of speech. Semin Neurol 33(4) 342347.Google Scholar
Levelt, W. J., Roelofs, A. and Meyer, A. S. 1999. A theory of lexical access in speech production. Behav Brain Sci 22(1) 138; discussion 3875.Google Scholar
Strand, E. A., Duffy, J. R., Clark, H. M. and Josephs, K. 2014. The apraxia of speech rating scale: a tool for diagnosis and description of apraxia of speech. J Commun Disord 51 4350.CrossRefGoogle Scholar

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