Brain Advance Access originally published online on October 18, 2007
Brain 2008 131(1):8-38; doi:10.1093/brain/awm251
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Review Article |
Word-finding difficulty: a clinical analysis of the progressive aphasias
1Dementia Research Centre, Department of Neurodegenerative Disease, Institute of Neurology, University College London, Queen Square, London WC1N 3BG and 2Division of Neuroscience and Mental Health, Imperial College London, London W12 0NN, UK
Correspondence to: Dr Jason Warren, Dementia Research Centre, Institute of Neurology, Queen Square, London WC1N 3BG, UK E-mail: jwarren{at}drc.ion.ucl.ac.uk
The patient with word-finding difficulty presents a common and challenging clinical problem. The complaint of ‘word-finding difficulty’ covers a wide range of clinical phenomena and may signify any of a number of distinct pathophysiological processes. Although it occurs in a variety of clinical contexts, word-finding difficulty generally presents a diagnostic conundrum when it occurs as a leading or apparently isolated symptom, most often as the harbinger of degenerative disease: the progressive aphasias. Recent advances in the neurobiology of the focal, language-based dementias have transformed our understanding of these processes and the ways in which they breakdown in different diseases, but translation of this knowledge to the bedside is far from straightforward. Speech and language disturbances in the dementias present unique diagnostic and conceptual problems that are not fully captured by classical models derived from the study of vascular and other acute focal brain lesions. This has led to a reformulation of our understanding of how language is organized in the brain. In this review we seek to provide the clinical neurologist with a practical and theoretical bridge between the patient presenting with word-finding difficulty in the clinic and the evidence of the brain sciences. We delineate key illustrative speech and language syndromes in the degenerative dementias, compare these syndromes with the syndromes of acute brain damage, and indicate how the clinical syndromes relate to emerging neurolinguistic, neuroanatomical and neurobiological insights. We propose a conceptual framework for the analysis of word-finding difficulty, in order both better to define the patient's complaint and its differential diagnosis for the clinician and to identify unresolved issues as a stimulus to future work.
Key Words: aphasia; progressive aphasia; anomia; dementia; speech and language
Abbreviations: PPA, primary progressive aphasia; PNFA, progressive non-fluent aphasia; PSP, progressive supranuclear palsy; CBD, corticobasal degeneration; AD, Alzheimer's disease; AOS, apraxia of speech; DLB, dementia with Lewy bodies; FTD-MND, frontotemporal dementia associated with motor neuron disease; SD, semantic dementia; VaD, vascular dementia
Received March 27, 2007. Revised September 14, 2007. Accepted September 18, 2007.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  J. C. Goll, S. J. Crutch, J. H. Y. Loo, J. D. Rohrer, C. Frost, D.-E. Bamiou, and J. D. Warren Non-verbal sound processing in the primary progressive aphasias Brain, October 1, 2009; (2009) awp235v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. T.-D. Fonseca, E. Guedj, F-X. Alario, V. Laguitton, O. Mundler, P. Chauvel, and C. Liegeois-Chauvel Brain regions underlying word finding difficulties in temporal lobe epilepsy Brain, October 1, 2009; 132(10): 2772 - 2784. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Rohrer, J. D. Warren, M. Modat, G. R. Ridgway, A. Douiri, M. N. Rossor, S. Ourselin, and N. C. Fox Patterns of cortical thinning in the language variants of frontotemporal lobar degeneration Neurology, May 5, 2009; 72(18): 1562 - 1569. [Abstract] [Full Text] [PDF]
|
|