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Semin Speech Lang 2020; 41(03): 249-256
DOI: 10.1055/s-0040-1710062
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ethical and Practical Challenges of the Communication and Behavioral Manifestations of Primary Progressive Aphasia

Donna C. Tippett
1   Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
2   Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
3   Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Argye E. Hillis
1   Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
2   Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland
4   Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland
› Author Affiliations
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Publication History

Publication Date:
25 June 2020 (online)

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Abstract

The communication and behavioral manifestations of primary progressive aphasia (PPA) present ethical and practical challenges for individuals with this clinical syndrome as well as for individuals who are involved closely in their care. In this article, cases representing all three PPA variants (logopenic variant, nonfluent agrammatic, semantic variant) are presented to illustrate commonly encountered situations in which self-determination is at risk in decisions about housing, driving, social interactions, finances, and treatment interventions. Potential approaches, including patient/family education, implementation of safeguards, redirection to meaningful activities, and protections against vulnerability in treatment decisions, are described to preserve autonomy in patients with this neurodegenerative clinical syndrome.

Keywords

primary progressive aphasia - logopenic variant PPA - nonfluent agrammatic PPA - semantic variant PPA
 

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