Functional Disabilities and Psychiatric Symptoms in Primary Progressive Aphasia

Abstract

Objective: The aims of this study are to describe the chronology of functional disabilities in primary progressive aphasia (PPA), and to examine associations between psychiatric comorbidities and functional disabilities.

Methods: We conducted a retrospective data analysis using subjects enrolled at Alzheimer's Disease Research Centers between 2005 and 2019. Data were obtained from the National Alzheimer's Coordinating Center database. We included subjects whose primary diagnosis was PPA. Functional status was coded as a binary variable for the following functions: ambulation, transaction skills, verbal communication, meal preparation, and self-care. Behavioral data derived from the Neuropsychiatric Inventory Questionnaire. Descriptive statistics and cox proportional hazard analyses were used to characterize the emergence of disabilities and their association with psychiatric comorbidities.

Results: Data included 91 subjects with a clinical dementia rating scale of zero at baseline. At the initial visit, no individuals had impairments in self-care, while 7% had impairments in transactions, 3% in ambulation, and 2% in meal preparation. Ninety-three percent had language impairments at the onset of the study, and all by visit 4. By visit 5, 41% of patients had impairments in ambulation and in self-care, 49% were impaired in meal preparation and 70% had impairment in transactions. The presence of anxiety, depression, sleep disturbance and psychosis were all significantly associated with an increased risk for multiple functional disabilities.

Conclusion: These findings provide clinicians with guidance for forecasting disabilities and targeting interventions in PPA.

Keywords: Frontotemporal dementia; disability; neuropsychiatric symptoms; primary progressive aphasia.

FIGURE 1.

Association of psychiatric comorbidities and functional disability at visit prior to disability onset.^{† †}Cox proportional hazard ratios adjusted for age, sex, and education. *Statistically significant at p <0.05.