Written Narrative Analysis in Primary Progressive Aphasia

Abstract

Primary Progressive Aphasia (PPA) is a slow-onset language disorder associated with cortical atrophy affecting critical language regions of the brain. There are three recognized variants of PPA, and they have been characterized on the basis of spoken language comprehension and production, as well as the location of cortical atrophy. Although written language is also impaired in PPA, the research in this area is limited, especially at the text level. The aim of this paper was to characterize the written narrative language samples of three individuals, each diagnosed with a different variant of PPA. Because PPA differentially degrades underlying cognitive processes fundamental to language performance (i.e., semantics, phonology, syntax, and orthography), we predicted that written language profiles would vary accordingly. Damage to phonological processing would be associated with a decline in the grammatical accuracy of sentences. Written narratives were compared to spoken narratives, and samples were analyzed for each variant at two points in time, to understand the progression of decline of written language. We found that written narratives had fewer words, but greater proportion of content. Overall, written narratives degraded phonological skills were, in fact, associated with the production of sentences that were not well-formed. These data support further investigation of narrative writing skills over time in individuals with PPA.