TN 3 (02-10)
DI 23022.485 Primary Progressive Aphasia
PRIMARY PROGRESSIVE APHASIA
PPA; Semantic Dementia
Primary Progressive Aphasia (PPA) is a rare type of dementia characterized by slow erosion of language (aphasia) over a 2-year period. It affects the language and semantic functioning (semantic dementia) and eventually progresses to amnesia. PPA is a subdivision of Pick disease. Recent studies have concluded that individuals with PPA have a specific combination of prion gene variants, although this is not the primary cause of the disorder.
TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING
(1) Clinical exam, (2) Speech/language evaluation that examines word retrieval, sentence formulation, and auditory comprehension skills, and (3) MRI or CT scan of the brain demonstrating atrophy of the brain language areas or of the frontal and temporal lobes.
ICD-9 Code: 784.3
ONSET AND PROGRESSION
Symptoms of PPA begin gradually, usually before the age of 65 years, and worsen over time. Individuals with PPA may become mute and eventually lose the ability to understand spoken or written language within 10 years of diagnosis.
There is currently no effective treatment that can cure or slow the progression of PPA.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation: Documentation of a clinically appropriate longitudinal medical history, speech-language assessment, neurological findings, and neuroimaging consistent with the diagnosis of PPA. Speech/language assessment can determine the ability to express and comprehend oral and written messages. The following is needed: A valid Total Language standard score that is at least 2 1/2 standard deviations below the mean on a comprehensive language test, such as the Oral and Written Language Scales, or an Aphasia Quotient that is in the “severe” range on an aphasia battery such as the Boston Diagnostic Aphasia Examination or Western Aphasia Battery. If the administration of a comprehensive language test or aphasia battery is not possible or speech-language testing is not available, a descriptive statement may be used. This statement should indicate that the claimant is either unable to follow a simple two-step direction without prompting or visual cues, or to spontaneously produce single words or two-word phrases, or both. In addition, brain imaging (MRI or CT scan) documenting atrophy of fronto-temporal regions is necessary.
Suggested Listings for Evaluation:
| || |
* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.