Abstract
Although commonly known as movement disorders, progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) may present with changes in speech and language alongside or even before motor symptoms. The differential diagnosis of these two disorders can be challenging, especially in the early stages. Here we review their impact on speech and language. We discuss the neurobiological and clinical-phenomenological overlap of PSP and CBS with each other, and with other disorders including non-fluent agrammatic primary progressive aphasia and primary progressive apraxia of speech. Because language impairment is often an early and persistent problem in CBS and PSP, there is a need for improved methods for language screening in primary and secondary care, and more detailed language assessments in tertiary healthcare settings. Improved language assessment may aid differential diagnosis as well as inform clinical management decisions.
Highlights
Language impairment is increasingly recognised as a feature of many neurodegenerative conditions and is not restricted to the primary progressive aphasias (PPA)
We focus on the speech and language changes caused by progressive supranuclear palsy (PSP) and the corticobasal syndrome (CBS), and their relationship to PPA
More recent studies suggest that language impairment is common in CBS [16, 17, 51, 56] and PSPs [57–59], which we summarise here
Summary
Language impairment is increasingly recognised as a feature of many neurodegenerative conditions and is not restricted to the primary progressive aphasias (PPA). CBS, on the other hand, can present with syntactic errors, phonological errors, paraphasias, and speech apraxia [17, 51, 101] as well as impaired syntactic knowledge [114] and phonological processing [101] Differences between these studies hinder clear and generalisable conclusions, including differences in diagnostic criteria, sample sizes, test materials and threshold values for impaired performance. Dysgraphia was claimed to be the most common language-related abnormality in CBS by Huang et al [51], its nature was not described and limb apraxia was noted in all patients Errors both in writing and oral spelling (the latter used by Graham et al [101] to avoid the impact of motor deficits on handwriting) in CBS have included article omissions, letter substitutions and omissions, and a mixture of phonologically plausible and non-phonologically plausible spelling errors [101, 120–122]
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