Covert processing of words and pictures in nonsemantic variants of primary progressive aphasia

The inability to name objects (anomia) is one of the most common findings in the neurologic examination of primary progressive aphasia (PPA). In the semantic variant of PPA, the anomia is profound and reflects a combination of object naming and word comprehension deficits. In contrast, nonsemantic variants of PPA display a more selective impairment of object naming, without corresponding impairments of word comprehension. The aim of the present study was to explore the nature of the anomia in nonsemantic variants of PPA with a sensitive chronometric test of covert word/picture association. We tested priming effects in 12 patients with nonsemantic variant of PPA and 18 controls. Stimuli consisted of written words and line pictures of concrete objects. Within-format (word-word and picture-picture) and cross-format (word-picture and picture-word) priming effects were assessed by measuring the shortening of response times to the second versus initial presentation of corresponding stimulus pairs. In addition to the expected impairment of picture-to-word priming, a condition simulating object naming, the nonsemantic PPA patients also showed unexpected impairments of word-to-picture and word-to-word priming. Picture-to-picture priming was preserved, demonstrating the selectivity of the deficit for lexical processing. These findings show that the information processing bottleneck in patients with nonsemantic variants of PPA is not confined to the stage of lexical access but that it also extends into the prior levels of lexical semantics. The boundaries between the semantic and nonsemantic variants are therefore far from rigid.