Dear Dr. Roach: About a year ago, my 77-year-old wife started to have some trouble speaking, and in some cases remembering or forming words. It’s not so bad that you don’t understand her and it’s not constant. But it’s there just the same. The family thought she may have had a TIA, as at the time she had been drinking quite a lot — she has since totally stopped — but saw no other symptoms. She saw her doctor a couple months ago, and he felt she hadn’t had a TIA and wanted to send her to a speech therapist.
The speech therapist felt that she may be under stress and to see a counsellor. In the meantime, she’s seen a neurologist who has tested her extensively. The diagnosis is she is suffering from PPA (primary progressive aphasia).
There is a lot of information on this condition on the internet. But how does one get through all of this to see what is most successful and/or current? Will her fight involve medication, therapy, something else or all of them? Can you tell us what the latest and most successful direction may be?
Primary progressive aphasia is a type of dementia, in the group of frontotemporal dementias, named for the part of the brain most affected. These diseases include what used to be called Pick’s disease. The underlying cause seems to be deposits of abnormal proteins in the brain. This is similar to Alzheimer’s disease, though the proteins are different. Word-finding difficulties are the hallmark early symptom of PPA.
Unfortunately, there are no currently approved medication treatments for PPA that can slow down or stop the progression of the disease. Treatment is aimed at relieving symptoms and ensuring the safety of the person affected by PPA. Driving, for example, can become dangerous early on in the course of PPA.
Speech therapy is an important part of treatment in the early stages of the disease, and swallowing evaluation becomes important as the disease progresses, since people with more advanced disease are prone to aspiration — breathing food particles into the lung can cause lung damage and infection.
Although there are currently no approved treatments available, extensive work is being done, especially with medications that may block the tau proteins, which accumulate in the brain. In the meantime, compassionate care will help both you and your wife. Medications can help with some of the behavioural changes that often accompany the word-finding difficulties. I recommend getting more information from the National Aphasia Association at aphasia.org.
Dear Dr. Roach: My son is in his mid-20s and has been a vegan for four years. After getting dangerously thin and weak, he was recently diagnosed with celiac disease. He is now so fearful of eating gluten that he will eat only from paper plates and uses disposable utensils for every meal. He also will not eat anything that has been cooked in a pot or pan that may have been used to cook anything with gluten, even though it has been carefully washed.
I have two questions. The first, could becoming a vegan have anything to do with causing his celiac disease? The second, is it likely that gluten will contaminate cooking/eating instruments after being washed in a dishwasher or by hand?
I am unaware of any reason that a vegan diet would increase risk of developing celiac disease, a sensitivity to a protein found in gluten, which is mostly found in wheat, rye and barley.
Machine-washing plates will remove gluten. Hand-washing should be done with a separate sponge from those used to clean gluten-containing plates.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu