Communication in FTDTopicsTermsSlide 4Subtypes of FTDProgressive nonfluent aphasia (PNFA)Slide 7Slide 8Picnic scene pictureSlide 10Semantic dementia (SD)Slide 12Slide 13Logopenic Progressive Aphasia (LPA)Slide 15Slide 16Behavioral variant FTD (bvFTD)Slide 18Slide 19Slide 20Common communication challengesSlide 22Slide 23Example compensatory strategiesSlide 25Slide 26Slide 27Slide 28Slide 29Slide 30Slide 31Slide 32Strategies: Behavioral variantSlide 34Slide 35MGH Progressive Communication Disorders ProgramCommunication in FTDDaisy Sapolsky, MS, CCC-SLPSpeech-Language PathologistMGH Department of Speech, Language and Swallowing Disorders & Reading DisabilitiesMGH Frontotemporal Disorders UnitTopicsSubtypes of FTDCommunication challengesCompensatory strategiesMGH FTD Unit and Progressive Communication Disorders ProgramTerms AphasiaAn acquired communication disorder that impairs a person's ability to process language, but does not affect intelligence.Can have impairment in one or more areas:speakingunderstanding othersreadingwriting/spellinghttp://www.aphasia.org/Terms Primary Progressive Aphasia (Mesulam, 1982)A language disorder (“aphasia”) that worsens over time (“progressive”), and is the most prominent problem the person experiences (“primary”)Subtypes of FTDFrontotemporal Dementia (FTD)Primary Progressive Aphasia (PPA) Behavioral Variant (bvFTD)Progressive Nonfluent Aphasia (PNFA)Semantic Dementia (SD)Logopenic Progressive Aphasia (LPA)Progressive nonfluent aphasia (PNFA)agrammatismnonfluent speech, may be telegraphichesitant, effortful, pauses, hesitations, fillers (e.g., umm)difficulty with verbs and functor words (e.g., the, for, an, to)knowing what you want to say, but can’t think of the word or can’t get the word outcomprehension is (typically) intactthere may be difficulty in comprehension of complex syntactic formsProgressive nonfluent aphasia (PNFA)impaired reading and writingdifficulty with forming grammatically correct sentencesdifficulty with reading complex sentences; comprehension of single words usually intactor, writing may be significantly better than speech in some patients spelling difficultyyes/no confusionpronoun confusionProgressive nonfluent aphasia (PNFA)picture description:“Umm, you know, the umm, the family for uh the picnic...umm...maybe the Cape...you know, the umm, like sailing and fishing and umm the ah, uh, girl is umm, the umm, the sandcastles, and umm the picnic man’s reading a book and umm the lady is uh, wine, and you know, like summertime, summertime.”Picnic scene pictureWestern Aphasia Battery-Revised (Kertesz, A., 2007)Subtypes of FTDFrontotemporal Dementia (FTD)Primary Progressive Aphasia (PPA) Behavioral Variant (Beh)Progressive Nonfluent Aphasia (PNFA)Semantic Dementia (SD)Logopenic Progressive Aphasia (LPA)Semantic dementia (SD)loss of knowledge of the meanings of wordslower frequency/uncommon words most affected“What is a ___?”use of vague/general words (e.g., stuff, thing)speech content has an empty qualitylack of detail, common/vague wordsbut, speech is fluent and grammaticalSemantic dementia (SD)picture description:“There’s a guy and a dog and this, and then there’s a girl and another dog, and something. And, they’re eating. This is the...I should know that because I always do it...I always know that usually.”Subtypes of FTDFrontotemporal Dementia (FTD)Primary Progressive Aphasia (PPA) Behavioral Variant (bvFTD)Progressive Nonfluent Aphasia (PNFA)Semantic Dementia (SD)Logopenic Progressive Aphasia (LPA)Logopenic Progressive Aphasia (LPA)intermittent word-finding hesitationsimpaired namingphonemic paraphasias (saying words or nonwords that share some sounds with the correct word)“octible” for octopus“rackel” for racquet“glow” for globeLogopenic Progressive Aphasia (LPA)picture description:It looks like a family is, has a hou, uh, I think it’s a house or a friend’s place, on the leck lake...Uh, and uh, there’s somebody who’s uh finishing, uh, fishing...Uh some friends are in the boat, in the so, sailboat, sail, sailboat...They uh, the mother is putting some, I’d like to think it’s wing uh wine...Subtypes of FTDFrontotemporal Dementia (FTD)Primary Progressive Aphasia (PPA) Behavioral Variant (bvFTD)Progressive Nonfluent Aphasia (PNFA)Semantic Dementia (SD)Logopenic Progressive Aphasia (LPA)Behavioral variant FTD (bvFTD)As patients may do well in testing, they are often not thought to have a primary speech/language disorder. However, the hallmark changes in behavior and personality directly affect daily communication and functioning, and therefore can result in a communication disorder.Behavioral variant FTD (bvFTD)apathetic variantflat affect, emotional bluntingnot expressing emotion, not understanding or reading someone else’s emotionwithdrawal, loss of interest (apathy)not engaging in conversation or previously enjoyed activitieslack of initiationonly speaks when spoken toBehavioral variant FTD (bvFTD)disinhibited variantsaying inappropriate things or in an inappropriate wayinappropriate increase in talkingpress of speechnot reading social cues that someone is not interested in the conversation or is ready to stop the conversationcompulsive behaviorsTopicsSubtypes of FTDCommunication challengesCompensatory strategiesMGH FTD Unit and Progressive Communication Disorders ProgramCommon communication challengesknowing what you want to say but the words won’t come out → frustrationable to express basic wants and needs, but difficulty with higher-level conversation“I miss the discourse.”feeling rushed and pressured to get your thoughts outmay result in withdrawing from social situationsone patient said she doesn’t want to make people wait for her to come up with wordsCommon communication challengescommunicating the problem to friends and family, people at workcarrying out routines and activitiesdifficulty reading and writing may mean the loss of previously enjoyed and practical activitiesadjusting to new communication style“I used to be a fast talker.”TopicsSubtypes of FTDCommunication challengesCompensatory strategiesMGH FTD Unit and Progressive Communication Disorders ProgramExample compensatory strategieskey words and