Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-18T07:01:00.497Z Has data issue: false hasContentIssue false
  • English
  • Français

Primary progressive aphasia presenting as possible conversion disorder

Published online by Cambridge University Press:  13 June 2014

Foluso Ademola ,
Jennifer Brophy ,
John Oguntade  and
Denis Murphy
Foluso Ademola
Affiliation:
Adelaide andMeath Hospital Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin 24, Ireland
Jennifer Brophy
Affiliation:
HSE Dublin South West/AMNCH, Tallaght, Dublin 24, Ireland
John Oguntade
Affiliation:
Naas General Hospital, Naas, Co Kildare
Denis Murphy
Affiliation:
Adelaide andMeath Hospital Incorporatingthe National Children's Hospital, Tallaght, Dublin 24, Ireland
Get access Rights & Permissions [Opens in a new window]

Abstract

We describe a case of primary progressive aphasia (PPA) in a 62 year old right handed Irish woman who had progressive speech and language difficulty over a period of six years. She continued to work for a remarkable length of time and lived independently managing all her activities of daily living. The case posed a diagnostic challenge because initial presentation was suggestive of a conversion disorder. She also displayed signs and symptoms which overlapped with a fronto-temporal dementia and possibly early Alzheimer's disease. In our discussion, we explore the possible reasons for this overlap and the implication for psychiatrists. The need for adequate and sensitive investigations and a multi-disciplinary approach cannot be overemphasised as PPA cases are easily missed depending on the stage at which the patient presents.

Keywords

Primary progressive aphasia (PPA)Progressive non-fluent aphasia (PNFA)Conversion disorderDementia
Type
Case reports
Information
Irish Journal of Psychological Medicine , Volume 25 , Issue 4 , December 2008 , pp. 145 - 148
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Addenbrook's Cognitive Examination- ACE-R. Final Revised Version A 2005.Google Scholar
2.Neary, D, Snowden, JS, Gustafson, Let al.Frontolobar degeneration: a consensus on clinical diagnostic criteria. Neurology 1998; 51: 1546–54.CrossRefGoogle ScholarPubMed
3.Adlam, A, Patterson, K, Rogers, TTet al.Semantic dementia and fluent primary progressive aphasia: two sides of the same coin. Brain 2006; 129: 3066–80.CrossRefGoogle ScholarPubMed
4.Mesulam, MM. Primary progressive aphasia. Ann Neurol 2001 Apr; 49(4): 425–32. Review.CrossRefGoogle ScholarPubMed
5.Bayles, K, Tomoeda, C. The Arizona Battery for Communication Disorders of Dementia. PRO-ED, Austin, Texas, 1993.Google Scholar
6.Kertesz, A. The Western Aphasia Battery. The Psychological Corporation. San Antonio, Texas, 1982.Google Scholar
7.Le Rhun, E, Richard, F, Pasquier, F. Natural history of primary progressive aphasia. Neurology 2005 Sep 27; 65(6): 887–91.CrossRefGoogle ScholarPubMed
8.Kertesz, A, Hudson, L, MacKenzie, IRA, Munoz, DG. The pathology and nosology of primary progressive aphasia. Arch Neurology 1994; 44: 2065–72.CrossRefGoogle ScholarPubMed
9.Radanovic, M, Senaha, ML, Mansur, LLet al.Primary progressive aphasia: analysis of 16 cases. Arq Neuropsiquiatr 2001 Sep; 59(3-A): 512–20.CrossRefGoogle Scholar
10.Pick, A. ?ber die Beziehungen der senilen Hirnatrophie zur Aphasie. Prager Medizinische WocheNSchrift 1892; 17: 165–167.Google Scholar
11.Mesulam, MM. Slowly progressive Aphasia without generalised dementia. Ann Neurol 1982; 11: 592–598.CrossRefGoogle ScholarPubMed
12.Sinnatamby, R, Antoun, NA, Freer, CEet al.Neuroradiological findings in primary progressive aphasia: CT MRI and cerebral perfusion SPECT. Neuroradiology 1996 Apr; 38(3): 232–8.CrossRefGoogle ScholarPubMed
13.Turner, RS, Kenyon, LC, Trojanowski, JQ, Gonatas, N, Grossman, M. Clinical neuroimaging, and pathologic features of progressive nonfluent aphasia. Ann Neurol 1996 Feb; 39(2): 166–73. Review.CrossRefGoogle ScholarPubMed
14.Mesulam, MM. Primary progressive aphasia – differentiation from Alzheimer's disease. Ann Neurol 1987 Oct; 22(4): 533–4. Review.CrossRefGoogle ScholarPubMed
15.Mendez, MF, Clark, DG, Shapira, JS, Cummings, JL. Speech and language in progressive nonfluent aphasia compared with early Alzheimer's disease. Neurology 2003 Oct 28; 61 (8): 1108–13.CrossRefGoogle ScholarPubMed
16.Grossman, M. Critical Review: Frontotemporal dementia: a review. J Int Neuropsychologial Soc 2002; 8: 566–83.CrossRefGoogle Scholar
17.Amici, S, Gorno-Tempini, ML, Ogar, JMet al.An overview on Primary Progressive Aphasia and its variants. Behav Neurol 2006; 17(2): 77–87. Review.CrossRefGoogle ScholarPubMed
18.Philbrick, KL, Rummans, TA, Duffy, JRet al.Primary progressive aphasia. An uncommon masquerader of psychiatric disorders. Psychosomatics 1994 Mar-Apr; 35(2): 138–41.CrossRefGoogle ScholarPubMed
19.Gelder, MG, Mayou, R, Cowen, P. Shorter Oxford Textbook of Psychiatry. 4th Ed. Oxford University Press, 2001.Google Scholar
20.American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Ed, Text Revision. Washington DC, American Psychiatric Association, 2000.Google Scholar
21.The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. World Health Organisation 1992.Google Scholar
22.David, D, Moreaud, O, Charnallet, A. [Primary progressive aphasia: clinical aspects] Psychol Neuropsychiatr Vieil 2006 Sep; 4(3): 189–200. Review. FrenchGoogle ScholarPubMed
23.Cummings, JL, Benson, DF, Hill, MA, Read, S. Aphasia in dementia of the Alzheimer type. Neurology 1985; 35: 394–397.CrossRefGoogle ScholarPubMed
24.Serrno, C, Martelli, M, Harris, P, et al.Primary Progressive Aphasia: its clinical variability: an analysis of 15 cases. Rev Neurol 2005 Nov 1-15; 41 (9): 527–33. Spanish.Google Scholar
25.Wicklund, AH, Johnson, N, Rademaker, Aet al.Profiles of decline in activities of daily living in non-Alzheimer dementia. Alzheimer Dis Assoc Disord. 2007 Jan-Mar; 21 (1): 813.CrossRefGoogle ScholarPubMed
26.Snowden, JS, Neary, D, Mann, DMet al.Progressive language disorder due to lobar atrophy. Ann Neurol 1992 Feb; 31(2): 174–83.CrossRefGoogle ScholarPubMed
27.Duffy, JR, Peterson, RC. Primary Progressive Aphasia. Aphasiology 1992; 6: 1–15.CrossRefGoogle Scholar
28.Grossman, M, Mickanin, J, Onishi, Ket al.Progressive non-fluent Aphasia: Language, cognitive, and PET measures contrasted with probable Alzheimer's disease. J Cogn Neurosci 1996; 8: 135–54.CrossRefGoogle Scholar
29.Chawluk, JB, Mesulam, MM, Hurtig, Het al.Slowly progressive aphasia without generalised dementia: studies with positron emission tomography. Ann Neurol 1986 Jan; 19(1): 68–74.CrossRefGoogle ScholarPubMed
30.Kempler, D, Metter, EJ, Riege, WHet al.Slowly progressive aphasia: three cases with language, memory, CT and PET data. J Neurol Neurosurg Psychiatry 1990 Nov; 53( 11): 987–93.CrossRefGoogle ScholarPubMed
31.Graff-Radford, NR, Damasio, AR, Hyman, BTet al.Progressive aphasia in a patient with Pick's disease: a neuropsychological, radiologic, and anatomic study. Neurology 1990 Apr; 40(4): 620–6.CrossRefGoogle Scholar
32.Soriani-Lefèvre, MH, Hannequin, D, Bakchine, Set al.Evidence of bilateral temporal lobe involvement in primary progressive aphasia: a SPECT study. J Nucl Med 2003 Jul; 44(7): 1013–22.Google ScholarPubMed
33.Mesulam, MM. Primary progressive aphasia: a language-based dementia. N Engl J Med 2003 Oct 16; 349(16): 1535–42. Review.CrossRefGoogle ScholarPubMed