Non-fluent agrammatic variant of primary progressive aphasia in a bilingual Mandarin/English speaker: a case report

Non-fluent agrammatic variant of primary progressive aphasia (nfvPPA) is a neurodegenerative condition associated with effortful speech and agrammatism in language production. The neuropsychological assessment and diagnosis of nfvPPA in bilingual patients is not well characterized. This case report describes a 66-year-old bilingual Mandarin/English speaking male patient who experienced gradual progression of aphasia in both languages with initial preferential sparing of Mandarin.

The patient was seen for a comprehensive neuropsychological evaluation administered primarily in Mandarin Chinese with select subtests in English. Language functioning was assessed using the Bilingual Aphasia Screening Test.

Consistent with a diagnosis of nfvPPA, the patient's neuropsychological assessment revealed agrammatism, apraxia of speech, and impaired comprehension of complex commands. Preserved language abilities included single-word comprehension, object knowledge, and lexical discrimination. In other domains, verbal and visual memory were impaired, while attention, processing speed, visuospatial skills, and motor functioning were preserved.

This case illustrates a comprehensive neuropsychological battery to assess for nfvPPA in bilingual patients. This case also has implications for understanding the clinical presentation and progression of symptoms for bilingual patients, highlighting the complex interaction between neurodegeneration and bicultural language representation.