Dear Nurse,

My husband has primary progressive aphasia and has difficulty speaking. What sort of things can I be doing to help him communicate?

It is important to talk about the different types of primary progressive aphasia, or PPA, that your loved one may have. This will help you to choose directed interventions to improve communication. There are three types of PPA outlined below (see Table 1).

The first type of PPA is semantic variant PPA, or svPPA. The key feature of svPPA is impaired comprehension. Individuals with svPPA have difficulty understanding words and naming objects, but can make speech sounds without difficulty. Early on, these individuals may not understand single words or objects: for example, they may not recall the word “remote” or what it is used for. Later, they may have more difficulty understanding whole sentences and complex instructions. You can use several techniques to improve comprehension for these individuals. First, it is important to make sure that your loved one can both see you and hear you. Ensure that they have their hearing aids in and turned on if appropriate. Make sure they are wearing their glasses so they can see your mouth and gestures. Try to communicate in brightly lit spaces and face your loved one directly and at the same level. Speak slowly and calmly. Use short, simple phrases, and give one simple direction at a time. Speak redundantly and use multiple modes of communication. For example, talk about plans for dinner in the kitchen, while pointing at the kitchen table and gesturing to the food options.

The second type of PPA is non-fluent variant PPA or nfPPA. The key feature of nfPPA is difficulty with speech production or expression. These individuals have slow and effortful speech. It may seem hard for them to get the words out, as if their mouth isn’t doing what they want. Sometimes they may say words that don’t make sense or sound incorrect.

The third type of PPA is logopenic PPA, or lvPPA. Individuals with lvPPA, like nfPPA, also have impaired speech expression, but this is because they have a hard time finding the word that they want to say, as if it’s on the tip of their tongue. You may notice that individuals with lvPPA may frequently pause to think of a word or try to talk around or describe the word that they cannot think of.

Effective communication with individuals with lvPPA and nfPPA is very similar. It may be beneficial to use written communication or communication boards (see Figure 1) to empower these individuals to communicate non-verbally. It is important to allow time for these individuals to find or form the word they are trying to say while at the same time timing your support to relieve their stress. This is a personal choice for you and your loved one. Consider first allowing time for word retrieval or production and then watching for your love one’s response. Once you notice signs of anxiety or stress about not producing the words, offer some options or use other tools like the communication boards to augment their speech. There are also several applications available for smart phones and other devices that can be useful. Some examples include: Scene and Heard, Small Talk Aphasia, Talk Path, AllTalk, Tactus Language TherAPPy, Pictello, Medlert 911, Constant Therapy, Proloquo2Go, and Tapgram. You may need to experiment with a few to find out which one works best for you.


Table 1: Types of PPA, Key Features, and Interventions.

PPA Type Acronym Key Feature Description Interventions
Semantic Variant PPA svPPA Impaired comprehension Unable to understand single words and later complex sentences Correct for sensory deficits, speak slowly and calmly, use short simple sentence, be redundant, use multiple modes of communication
Non-Fluent PPA nfPPA Impaired expression Slow, effortful speech Allow for time, use alternative communication, time your support
Logopenic Variant PPA lvPPA Impaired expression Difficulty recalling words Allow for time, use alternative communication, time your support

Figure 1: Sample Communication Board. 

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