Dissolution of language

A core feature of FTD is progressive impairment of expressive speech described as dissolution du langage or Sprachverodung.(22) Speech becomes aspontaneous with word-finding difficulties and frequent use of stereotyped comments and set phrases. During the early stage there may be a period of increased pressure of speech. The FTD patient may also loose his or her normal pitch of voice and speaks in an unmodulated inappropriately high tone. The language dysfunction is dominated by dynamic expressive failure rather than by a semantic receptive one, which is in agreement with damage in the frontal cortex especially premotor areas. Echolalia is observed in about 50 per cent of FTD and Pick cases.(18) Finally the patients become mute which in combination with the amimia makes communication extremely difficult. The ability to understand information and instructions usually remains until comparatively late in the course of the disease, as does the ability to write. The handwriting may, however, change in magnitude, spelling, and speed of writing. These disturbances are unlike the temporoparietal type of dysgraphia and global dysphasia observed in Alzheimer's disease. The symptom constellation of palilalia (stereotypy of speech), echolalia, mutism, and amimia (PEMA syndrome of Guiraud) is typical of FTD and seldom found in Alzheimer's disease.

There are important similarities between the speech disorder of early FTD and the clinical spectrum of progressive non-fluent aphasia, ^J.» characterized by effortful speech production and relative preservation of memory and practical abilities. Dementia often develops later in the course, and the underlying degenerative process may be similar to that of FLD, with a predominant and early involvement of the speech-dominant hemisphere.

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