One notable consideration is that the expert opinions and treatment models that have been published typically reflect the practices of a particular team or service rather than reflecting consensus recommendations or more widely endorsed practices. Such clinicians would benefit from published consensus on best practice principles to guide them through the myriad of decisions and practicalities that are encountered when working with individuals with PPA and their support networks. An exploratory survey, for example, indicated that only 57% of SLPs in the USA had heard of PPA ( n = 105). Still, for clinicians who are less experienced in either their careers or in working with PPA caseloads, treatment decisions can be challenging. have advocated for a phased treatment approach, whereby the SLT/P works to optimise language abilities at every stage, whilst responding to future decline.
Of critical importance, treatment decisions must be informed by understanding of aphasia and typical language mechanisms, as well as the changing nature of symptoms and the critical need for proactive, anticipatory, and ongoing care. Whilst drawing on established intervention approaches is often appropriate, significant differences in application need to be considered, with management of PPA falling somewhere in along the continuum of aphasia and dementia care. In other instances, SLT/Ps have adapted models from dementia care to inform their practice. Many of the interventions used in PPA have been adapted from the stroke-induced aphasia field and will be familiar to clinicians. Knowledge of which interventions is most appropriate for managing PPA at a particular stage or context requires an understanding of the progressive and evolving nature of PPA, as well as consideration of other critical factors (e.g., environmental, personal, value-based variables) that influence person-centred management decisions. A range of factors influence service delivery including: (i) awareness of the SLT/P role by potential referring parties, (ii) SLT/P knowledge and confidence in managing PPA, and (iii) the availability of funding to offer proactive and long-term services (or even the complete lack of funding or contractual arrangements for PPA within SLT/P services). Surveys completed in Australia, Germany, and the UK have, however, revealed variability and limitations in SLT/P service provision. Given that communication difficulties are the most prominent symptoms experienced by people with PPA in the early and mid-stages of disease, SLT/Ps play a central role in the care pathway, supporting individuals and their families, both at the time of diagnosis, and across the continuum of care. Phased treatment models, alongside case examples, have been proposed to assist people with PPA to functionally communicate and participate as successfully as possible for as long as they can adjusting the focus of treatment and support in response to the progression and evolution of the clinical presentation over time. The needs of individuals living with PPA and their families change over time as the condition evolves, requiring ongoing and long-term support that remains dynamic and relevant to the individual. As such, a gap in knowledge exists that increases the difficulties clinicians face when making management decisions. It remains unclear which interventions are most effective or most important to consider at different stages of the condition. Multiple interventions have emerged as being well-suited to ameliorate the impact of PPA. Speech and language therapists/pathologists (SLT/Ps), have worked for many years with people with PPA, albeit typically in small numbers. In the later stages of the condition, symptoms evolve towards a more global dementia presentation and changes in episodic motor function, memory, behaviour and personality may emerge, overlapping with other dementia syndromes. As there are currently no curative treatments for PPA, the condition progresses relentlessly over time. The condition affects around three in 100 000 people however, the true prevalence is difficult to determine due to heterogeneity of the underlying pathologies. Individuals with PPA present with difficulties in speech and language on an initial background of no, or few cognitive impairments. Primary progressive aphasia (PPA) is a rare dementia syndrome associated with slow and continuous decline of language function.