The Japanese journal of neuropsychology

Full Text of this Article
in Japanese PDF (289K)

ArticleTitle	Comparative symptomatology of aphasia: degenerative aphasia vs vascular aphasia
Language	J
AuthorList	Minoru Matsuda
Affiliation	Department of Geriatrics, Shiga Medical Center
Publication	Japanese Journal of Neuropsychology: 26 (4), 264-271, 2010
Received
Accepted
Abstract	Although classical aphasiology has been based predominantly on the studies of language disturbances in patients with cerebrovascular diseases, recent researchers have devoted much attention to aphasic syndromes resulting from neurodegenerative diseases. In this paper, the former type of aphasia will be termed vascular aphasia, the latter degenerative aphasia. A prototypical form of degenerative aphasia is primary progressive aphasia that was first defined by Mesulam (1982). Aphasic symptoms that can be observed in the course of typical amnestic Alzheimer's disease or other types of dementia are also in the realm of degenerative aphasia. There are not only many similarities but also important differences between degenerative aphasia and vascular aphasia. Progressive non-fluent aphasia (PNFA) is different from Broca's aphasia, and logopenic progressive aphasia (LPA) is distinct from conduction aphasia, especially in the features of expressive verbal output. While patients with Broca's aphasia have an anarthria as a cardinal feature, the speech of patients with PNFA has been reported to be various, ranging from normal articulation to prominent anarthria with motor dysarthria. Production of phonological paraphasias in all modalities of verbal output is a salient feature of conduction aphasia, but in LPA, phonological praphasias are not necessarily present and assumed to be an accessory character. A language disturbance resembling Wernicke's aphasia may be observed in the advanced stage of Alzheimer's disease, but it is not a replica of post-stroke Wernicke's aphasia. Jargon aphasia has rarely been reported in degenerative disease, and to our knowledge there have been no previous reported cases of degenerative aphasia presenting with recurring utterances which have been described in many cases with vascular aphasia. These differences between degenerative and vascular aphasia may be attributed to the differences in temporal profile and in lesion distribution of underlying pathologies. Vascular aphasia usually is brought on sudden-onset and non-progressive stroke with focal lesions, while degenerative aphasia gradually develops and worsens without recovery. Degenerative disease tends to have an anatomical predilection patterns, but the progressive disease process gradually expands resulting in multifocal and diffuse pathology. On the contrary, cerebrovascular disease, in particular, an embolic stroke which is most often associated with aphasia, typically destroys a localized aggregation of neuronal tissue, with other regions completely spared. It is no surprise that different pathological processes yield different patterns for constellation of aphasic symptoms, considering that each aphasic manifestation is not merely a negative symptom but may be the reflection of unbalance between spared functions and damaged ones, or the expression of functional reorganization.
Keywords	degenerative aphasia, progressive aphasia, vascular aphasia, symptomatology, recurring utterances