Verbal and non-verbal semantic impairment: From fluent primary progressive aphasia to semantic dementia

Selective disturbances of semantic memory have attracted the interest of many investigators and the question of the existence of single or multiple semantic systems remains a very controversial theme in the literature. OBJECTIVES: To discuss the question of multiple semantic systems based on a longitudinal study of a patient who presented semantic dementia from fluent primary progressive aphasia. METHODS: A 66 year-old woman with selective impairment of semantic memory was examined on two occasions, undergoing neuropsychological and language evaluations, the results of which were compared to those of three paired control individuals. RESULTS: In the first evaluation, physical examination was normal and the score on the Mini-Mental State Examination was 26. Language evaluation revealed fluent speech, anomia, disturbance in word comprehension, preservation of the syntactic and phonological aspects of the language, besides surface dyslexia and dysgraphia. Autobiographical and episodic memories were relatively preserved. In semantic memory tests, the following dissociation was found: disturbance of verbal semantic memory with preservation of non-verbal semantic memory. Magnetic resonance of the brain revealed marked atrophy of the left anterior temporal lobe. After 14 months, the difficulties in verbal semantic memory had become more severe and the semantic disturbance, limited initially to the linguistic sphere, had worsened to involve non-verbal domains. CONCLUSIONS: Given the dissociation found in the first examination, we believe there is sufficient clinical evidence to refute the existence of a unitary semantic system.