Clinical Manifestations

Area of Science:

• Neurology
• Neuroscience
• Linguistics

Background:

• Diagnosing primary progressive aphasia (PPA) presents significant challenges, requiring precise identification of language impairment and variant classification.
• Socio-economic factors in low- and middle-income countries (LMICs) exacerbate diagnostic difficulties for PPA.
• A novel PPA diagnostic roadmap was developed at Fleni (Argentina) to overcome these barriers.

Purpose of the Study:

• To present a PPA diagnostic roadmap tailored for resource-limited settings.
• To integrate clinical, neuropsychological, neuroimaging, and biomarker data for accurate PPA diagnosis and classification.
• To streamline diagnostic processes and reduce delays in PPA assessment.

Main Methods:

• The roadmap integrates clinical experience and literature, adapting Gorno-Tempini et al. (2011) criteria.
• It involves a multi-stage approach: initial neurological assessment, laboratory tests, cognitive MRI, and neuropsychological evaluation (Stages 1 & 2).
• Specialized language assessments (Stage 3) and advanced biomarkers/genetic testing (Stage 4) are incorporated for variant classification.

Main Results:

• Stages 1 and 2 are feasible in LMICs, utilizing accessible laboratory tests, MRI, and Spanish-language neuropsychological assessments.
• Baseline PPA diagnosis and imaging confirmation are achievable through initial stages.
• Specific PPA variant classification (Stages 3 & 4) faces limitations due to access to language specialists and high costs of advanced studies.

Conclusions:

• The Fleni PPA diagnostic roadmap provides a framework to guide professionals in resource-limited regions.
• It optimizes the diagnostic process by leveraging available resources while acknowledging limitations in advanced diagnostic capabilities.
• The roadmap aims to improve diagnostic accuracy and efficiency for PPA in diverse healthcare settings.