Ppa progressive primary aphasia

[PikminOC]

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I have a patient that the neurologist referred to me. She says the dx is ppa.
Patient is very agitated and violent at home. 75 plus years old.

I think he also has dementia. Numerous falls at home.

She referred pt to me due to agitation. He is already in seroquel.

Any help is appreciated.

 

[deathmerchant]

how much seroquel is he on?. and is he on any other meds like Dopa/benzos etc.? obviously if its an acute change, Im assuming u have checked for TMEs/head injury etc

 

[RenegadeSynapse]

I have a patient that the neurologist referred to me. She says the dx is ppa.
Patient is very agitated and violent at home. 75 plus years old.

I think he also has dementia. Numerous falls at home.

She referred pt to me due to agitation. He is already in seroquel.

Any help is appreciated.

Did they further specify what PPA variant? There are three variants: semantic, nonfluent/agrammatic, and logopenic. semantic and nonfluent are frontotemporal lobar degenerations and logopenic is usually an Alzheimer's variant.

If I'm hazarding a guess, it would be semantic variant PPA (svPPA) which was previously (and probably still is sometimes) as temporal variant FTD. Left-predominant atrophy leads to more loss of language semantic knowledge but right-predominant leads to early loss of emotions concept knowledge and they can be very unpleasant to their family members (not understanding that someone is angry leads to poor ability to suboptimal comportment).

http://www.ncbi.nlm.nih.gov/pubmed/23997827

This is a good review from the MGH FTD unit.

 

[PikminOC]

Did they further specify what PPA variant? There are three variants: semantic, nonfluent/agrammatic, and logopenic. semantic and nonfluent are frontotemporal lobar degenerations and logopenic is usually an Alzheimer's variant.

If I'm hazarding a guess, it would be semantic variant PPA (svPPA) which was previously (and probably still is sometimes) as temporal variant FTD. Left-predominant atrophy leads to more loss of language semantic knowledge but right-predominant leads to early loss of emotions concept knowledge and they can be very unpleasant to their family members (not understanding that someone is angry leads to poor ability to suboptimal comportment).

http://www.ncbi.nlm.nih.gov/pubmed/23997827

This is a good review from the MGH FTD unit.

Thank you sooo much. I will have to review the records to find out.
What medications help with these behavioral difficulties?
Have you ever used Nudexta for this?
I have recommended Depakote.

 

[PikminOC]

how much seroquel is he on?. and is he on any other meds like Dopa/benzos etc.? obviously if its an acute change, Im assuming u have checked for TMEs/head injury etc

Not on Dopa or benzos.
50 sero in am 100 at night from neuro.
Haldol for outbursts but patient spits it out.
The family doesn't tell the neurologist of the falls. I told the neurologist.

 

[PikminOC]

Thank you for the article too!