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Frontotemporal Decreases in rCBF Correlate with Degree of Dysnomia in Primary Progressive Aphasia

Department of Radiology, Division of Nuclear Medicine, University of Alabama at Birmingham Medical Center, Birmingham, Alabama

Correspondence: For correspondence or reprints contact: James M. Mountz, MD, PhD, University of Alabama at Birmingham Medical Center, Division of Nuclear Medicine, 619 S. 19th St., JT J260, Birmingham, AL 35233-6835.

ABSTRACT

Primary progressive aphasia (PPA) is an uncommon degenerative dementia characterized by gradual impairment of language function with initial sparing of the memory domain. Using semi-quantitative ^99mTc-hexamethyl propyleneamine oxime (HMPAO) brain SPECT as a measure of regional cerebral blood flow (rCBF), we investigated the relationship between reduced ^99mTc-HMPAO uptake and the severity of dysnomia in PPA. Methods: Seven light-handed patients with PPA had their dysnomia assessed by the Boston Naming Test (BNT), a subtest of the Boston Diagnostic Aphasia Examination. Neuroimaging studies, including Tc-HMPAO brain SPECT, CT, and MRI, were performed. Correlational analysis between reduced rCBF and BNT was performed. Results: Brain SPECT showed a reduction in ^99mTc-HMPAO uptake involving the frontal and temporal lobes in all 7 patients. CT and MRI showed mild to moderate cerebral atrophy in 4 patients. Low scores on the BNT correlated with low frontotemporal ^99mTc-HMPAO (Spearman r = 0.97, P = 0.004) in the 5 patients with left-hemisphere involvement. Conclusion: Decreased rCBF to the frontotemporal region characterized the cerebral abnormalities associated with PPA. The finding of focal rCBF abnormalities in the right hemisphere of 2 right-handed women corroborates that PPA symptoms may arise from a "non-left-dominant"-hemisphere degenerative process. Our results support the usefulness of rCBF SPECT imaging as a diagnostic aid in PPA.

Key Words: progressive aphasia • ^99mTc-HMPAO brain SPECT • Boston Naming Test

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