4.7 Article

Graded, multidimensional intra- and intergroup variations in primary progressive aphasia and post-stroke aphasia

Journal

BRAIN
Volume 143, Issue -, Pages 3121-3135

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/brain/awaa245

Keywords

aphasia; stroke; neurodegeneration; classification

Funding

  1. Rosetrees Trust [A1699]
  2. European Research Council [GAP: 670428 - BRAIN2MIND_NEUROCOMP]
  3. Medical Research Council [MC_UU_00005/18]

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Language impairments caused by stroke (post-stroke aphasia, PSA) and neurodegeneration (primary progressive aphasia, PPA) have overlapping symptomatology, nomenclature and are classically divided into categorical subtypes. Surprisingly, PPA and PSA have rarely been directly compared in detail. Rather, previous studies have compared certain subtypes (e.g. semantic variants) or have focused on a specific cognitive/linguistic task (e.g. reading). This study assessed a large range of linguistic and cognitive tasks across the full spectra of PSA and PPA. We applied varimax-rotated principal component analysis to explore the underlying structure of the variance in the assessment scores. Similar phonological, semantic and fluency-related components were found for PSA and PPA. A combined principal component analysis across the two aetiologies revealed graded intra- and intergroup variations on all four extracted components. Classification analysis was used to test, formally, whether there were any categorical boundaries for any subtypes of PPA or PSA. Semantic dementia formed a true diagnostic category (i.e. within group homogeneity and distinct between-group differences), whereas there was considerable overlap and graded variations within and between other subtypes of PPA and PSA. These results suggest that (i) a multidimensional rather than categorical classification system may be a better conceptualization of aphasia from both causes; and (ii) despite the very different types of pathology, these broad classes of aphasia have considerable features in common.

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