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Trying to tell a tale

Discourse impairments in progressive aphasia and frontotemporal dementia

From the Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA.

Address correspondence and reprint requests to Dr. Sharon Ash, Department of Neurology–3 West Gates, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104-4283; e-mail: ash{at}babel.ling.upenn.edu

Objective: To assess discourse in patients with frontotemporal dementia (FTD).

Methods: The authors asked patients with progressive nonfluent aphasia (PNFA), patients with semantic dementia (SemD), and nonaphasic patients with a disorder of social comportment and executive functioning (SOC/EXEC) to narrate the story of a wordless children's picture book.

Results: The authors found significant discourse impairments in all three groups of patients. Moreover, there were qualitatively important differences between the groups. Patients with PNFA had the sparsest output, producing narratives with the fewest words per minute. Patients with SemD had difficulty retrieving words needed to tell their narratives. Though not aphasic, patients with SOC/EXEC had profound difficulty organizing their narratives, and they could not effectively express the point of the story. This deficit correlated with poor performance on a measure of executive resources requiring an organized mental search. In addition, a correlation of narrative organization with cortical atrophy in patients with SOC/EXEC was significant in right frontal and anterior temporal brain regions.

Conclusions: Impaired day-to-day communication in nonaphasic frontotemporal dementia patients with a disorder of social comportment and executive functioning is due in part to a striking deficit in discourse organization associated with right frontotemporal disease. Difficulty with discourse in progressive aphasia is due largely to the language impairments of these patients.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the May 9 issue to find the title link for this article.

Supported in part by NIH grants AG17586, AG15116, and NS44266.

Disclosure: The authors report no conflicts of interest.

Portions of this work were presented at the Academy of Aphasia, Chicago, IL (October 17 through 19, 2004), and at the American Academy of Neurology, Miami, FL (April 9 through 16, 2005).

Received October 7, 2005. Accepted in final form January 19, 2006.

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