Primary progressive aphasia beginning with psychiatric disorder

Abstract

Primary progressive aphasia (PPA), frontotemporal dementia (FTD), and semantic dementia (SD) are clinical subtypes of frontotemporal lobar degeneration (FTLD). PPA is characterized by marked changes in language ability.1 Although anxiety is identified in 39% of FTLD subjects, agitation, irritability, and depression may also be observed.2 Frustration and anxiety have been frequently reported as early symptoms of PPA, but they are commonly construed by patients and their relatives as secondary consequences of the social embarrassment caused by the difficulty with language.3 Similarly, the avoidance of social situations by these patients is frequently interpreted as a reaction to the loss of language abilities. Here, we report a patient with PPA who initially presented with panic attacks. To the best of our knowledge, this is the first case of PPA manifesting with panic attacks as the first symptom. This case provides further evidence of the variable and circumscribed nature of the clinical presentation of focal cerebral degeneration.