Primary progressive aphasia (PPA) affects language expression and comprehension. But the condition, linked to neurodegenerative disease, can also go hand in hand with swallowing difficulties.
Aphasia refers to impairment in areas of verbal and written expression and understanding. It’s a disorder that occurs when there’s damage to areas of the brain responsible for language processing.
Stroke, traumatic brain injury, brain tumors, and progressive neurological conditions can all cause aphasia.
Primary progressive aphasia (PPA) is a specific type of aphasia that involves challenges with writing, speaking, and language comprehension.
It’s considered one of two subtypes of frontotemporal dementia, second to behavioral variant frontotemporal dementia (bvFTD), which features prominent behavioral and personality changes.
Swallowing difficulty, known as dysphagia, is possible in PPA.
Your frontotemporal region of the brain, which consists of the frontal and temporal lobes, is responsible for more than just language processing. It also controls behavior, memory, learning, and motor functions. As frontotemporal dementia advances, other symptoms like dysphagia can develop.
According to a 2018 review, swallowing difficulties and unusual eating behaviors are common in neurological conditions affecting the frontotemporal region of the brain.
There are several variants of PPA:
- Semantic variant PPA (SvPPA): Often described as difficulty “finding the right word,” svPPA primarily involves an inability to recall the meaning of words, use the correct word, or understand what others are saying.
- Nonfluent/Agrammatic variant PPA (NvPPA): This variant is characterized by a loss of muscle control necessary to produce speech. It can appear as omitting words while speaking, slow or difficult speech, and sometimes the complete inability to talk.
- Logopenic variant PPA (LvPPA): LvPPA involves word hunting. It typically doesn’t affect your ability to recall meanings or form speech, but it can result in slow or hesitant communication as you search for the words you want to use.
NvPPA is often associated with dysphagia due to underlying progressive loss of muscle control.
According to a small
In the research, experts found swallowing difficulties were most common and varied among people living with SvPPA. Challenges included drooling food or saliva, swallowing multiple times, choking, and delayed swallowing.
While the study offered insight into swallowing impairment among PPA variants, only 16 people were involved in the research. Larger studies are still needed to better understand the prevalence of swallowing challenges among people living with PPA.
Living with PPA may affect your eating patterns and behavior.
When you’re experiencing swallowing challenges, your comfort around mealtimes can change. You may gravitate toward softer foods, seek smaller portions, or become reluctant to eat at all.
It may be difficult for you to express what you like or dislike in your food choices or to communicate if you’re in pain or not feeling well enough to eat.
According to the same 2016 study, eating behavior disturbances were most commonly seen among people living with LvPPA and correlated with communication challenges.
Currently, there’s no cure for PPA, and swallowing difficulty will vary by person and on the progression of frontotemporal dementia.
Swallowing difficulty in PPA can be managed in the same ways as dysphagia from other conditions, such as:
- switching to easy-to-swallow foods
- adding thickening agents to liquids
- adjusting head and neck posture/position
- muscle strengthening and coordination exercises
What makes swallowing easier for you may differ from someone living with PPA. Some people may see improvement when eating in specific positions, while others may swallow easier by avoiding too-hot or too-cold food options.
If swallowing challenges make eating too difficult, there are other ways to provide your body with the nourishment it needs. Your doctor can discuss using a feeding device, like an enteral feeding tube, that delivers nutrients directly into your digestive tract.
Primary progressive aphasia (PPA) is a subtype of frontotemporal dementia. It’s caused by neurodegeneration in the areas of the brain responsible for language processing.
Depending on which PPA variant you’re living with, symptoms can range from hesitant speech and difficulty forming words to challenges in recalling word meanings.
Swallowing difficulties are possible in all variants of PPA. Changes to food textures, rehabilitative exercises, and posture adjustments may help manage symptoms. If you cannot take in nutrition by mouth, your doctor can recommend a substitute for a feeding system.