Differential Diagnosis of Primary Progressive Apraxia of Speech in a Nonnative English-Speaking Patient: A Clinical Case Study

Abstract

Purpose: This case study details the approach to differential diagnosis in characterizing a progressive communication difficulty in a nonnative English-speaking patient. Method: The patient is a multilingual gentleman in his late 60s with a 3-year history of progressive difficulty speaking clearly who presented for evaluation of communication difficulties. Prior to speech evaluation, he was diagnosed with stress-related speech changes by one provider, parkinsonism by another, and primary progressive aphasia by a third provider. A thorough speech and language evaluation, including a detailed case history, was conducted. Results: The patient described a progressive difficulty in enunciating, but not coming up with words; this was present across languages spoken. On exam, the patient exhibited phonetic predominant apraxia of speech, nonverbal oral apraxia, and no more than equivocal aphasia, yielding an overall shared speech and neurologic diagnosis of primary progressive apraxia of speech. Conclusion: This case demonstrates the importance of differential diagnosis of motor speech disorders and a detailed case history, particularly when speech difficulties are the first and only neurological symptom.