Graded, multi-dimensional intragroup and intergroup variations in primary progressive aphasia and post-stroke aphasia

Language impairments caused by stroke (post-stroke aphasia) and neurodegeneration (primary progressive aphasia) have overlapping symptomatology, nomenclature and are classically divided into categorical subtypes. Surprisingly, primary progressive aphasia (PPA) and post-stroke aphasia (PSA) have rarely been directly compared in detail. Rather, previous studies have compared certain subtypes (e.g., semantic variants) or have focussed on a specific cognitive/linguistic task (e.g., reading). This study assessed a large range of linguistic and cognitive tasks across the full spectra of PSA and PPA. We applied varimax-rotated principal component analysis to explore the underlying structure of the variance in the assessment scores. Similar phonological, semantic and fluency related components were found for PSA and PPA. A combined principal component analysis across the two aetiologies revealed graded intragroup and intergroup variations on all four extracted components. Classification analysis was employed to test, formally, whether there were any categorical boundaries for any subtypes of PPA or PSA. Semantic dementia formed a true diagnostic category (i.e., within group homogeneity and distinct between group differences), whereas there was considerable overlap and graded variations within and between other subtypes of PPA and PSA. These results suggest that (a) a multi-dimensional rather than categorical classification system may be a better conceptualisation of aphasia from both causes, and (b) despite the very different types of pathology, these broad classes of aphasia have considerable features in common.