The purpose of this study was to describe the linguistic environment of phonological paraphasias in 3 variants of primary progressive aphasia (semantic, logopenic, and nonfluent) and to describe the profiles of paraphasia production for each of these variants.


Discourse samples of 26 individuals diagnosed with primary progressive aphasia were investigated for phonological paraphasias using the criteria established for the Philadelphia Naming Test (Moss Rehabilitation Research Institute, 2013). Phonological paraphasias were coded for paraphasia type, part of speech of the target word, target word frequency, type of segment in error, word position of consonant errors, type of error, and degree of change in consonant errors.


Eighteen individuals across the 3 variants produced phonological paraphasias. Most paraphasias were nonword, followed by formal, and then mixed, with errors primarily occurring on nouns and verbs, with relatively few on function words. Most errors were substitutions, followed by addition and deletion errors, and few sequencing errors. Errors were evenly distributed across vowels, consonant singletons, and clusters, with more errors occurring in initial and medial positions of words than in the final position of words. Most consonant errors consisted of only a single-feature change, with few 2- or 3-feature changes. Importantly, paraphasia productions by variant differed from these aggregate results, with unique production patterns for each variant.


These results suggest that a system where paraphasias are coded as present versus absent may be insufficient to adequately distinguish between the 3 subtypes of PPA. The 3 variants demonstrate patterns that may be used to improve phenotyping and diagnostic sensitivity. These results should be integrated with recent findings on phonological processing and speech rate. Future research should attempt to replicate these results in a larger sample of participants with longer speech samples and varied elicitation tasks.

Supplemental Materials



  • Ardila, A., & Rosselli, M. (1993). Language deviations in aphasia: A frequency analysis.Brain and Language, 44(2), 165–180.
  • Ash, S., Evans, E., O'Shea, J., Powers, J., Boller, A., Weinberg, D., … Grossman, M. (2013). Differentiating primary progressive aphasias in a brief sample of connected speech.Neurology, 81(4), 329–336.
  • Berg, T. (2006). A structural account of phonological paraphasias.Brain and Language, 96(3), 331–356.
  • Bird, H., Ralph, M. A. L., Patterson, K., & Hodges, J. R. (2000). The rise and fall of frequency and imageability: Noun and verb production in semantic dementia.Brain and Language, 73(1), 17–49.
  • Botha, H., Duffy, J. R., Whitwell, J. L., Strand, E. A., Machulda, M. M., Schwarz, C. G., … Josephs, K. A. (2015). Classification and clinicoradiologic features of primary progressive aphasia (PPA) and apraxia of speech.Cortex, 69, 220–236.
  • Burns, M. S., & Canter, G. J. (1977). Phonemic behavior of aphasic patients with posterior cerebral lesions.Brain and Language, 4(4), 492–507.
  • Canter, G. J., Trost, J. E., & Burns, M. S. (1985). Contrasting speech patterns in apraxia of speech and phonemic paraphasia.Brain and Language, 24(2), 204–222.
  • Caramazza, A., Berndt, R. S., & Basili, A. G. (1983). The selective impairment of phonological processing: A case study.Brain and Language, 18(1), 128–174.
  • Cordella, C., Dickerson, B. C., Quimby, M., Yunusova, Y., & Green, J. R. (2017). Slowed articulation rate is a sensitive diagnostic marker for identifying non-fluent primary progressive aphasia.Aphasiology, 2, 241–260.
  • Croot, K., Ballard, K., Leyton, C. E., & Hodges, J. R. (2012). Apraxia of speech and phonological errors in the diagnosis of nonfluent/agrammatic and logopenic variants of primary progressive aphasia.Journal of Speech, Language, and Hearing Research, 55(5), S1562–S1572.
  • Davies, M. (2008). The corpus of contemporary American English: 520 million words, 1990–present. Retrieved from http://corpus.byu.edu/coca/
  • Dell, G. S., Schwartz, M. F., Martin, N., Saffran, E. M., & Gagnon, D. A. (1997). Lexical access in aphasic and nonaphasic speakers.Psychological Review, 104(4), 801–838.
  • Ellis, A. W., Miller, D., & Sin, G. (1983). Wernicke's aphasia and normal language processing: A case study in cognitive neuropsychology.Cognition, 15(1), 111–144.
  • Gagnon, D. A., Schwartz, M. F., Martin, N., Dell, G. S., & Saffran, E. M. (1997). The origins of formal paraphasias in aphasics' picture naming.Brain and Language, 59(3), 450–472.
  • Gorno-Tempini, M. L., Brambati, S. M., Ginex, V., Ogar, J., Dronkers, N. F., Marcone, A., … Miller, B. L. (2008). The logopenic/phonological variant of primary progressive aphasia.Neurology, 71(16), 1227–1234.
  • Gorno-Tempini, M. L., Dronkers, N. F., Rankin, K. P., Ogar, J. M., Phengrasamy, L., Rosen, H. J., … Miller, B. L. (2004). Cognition and anatomy in three variants of primary progressive aphasia.Annals of Neurology, 55(3), 335–346.
  • Gorno-Tempini, M. L., Hillis, A. E., Weintraub, S., Kertesz, A., Mendez, M., Cappa, S. E. E. A., … Manes, F. (2011). Classification of primary progressive aphasia and its variants.Neurology, 76(11), 1006–1014.
  • Gorno-Tempini, M. L., & Pressman, P. (2016). Introduction to primary progressive aphasia.In G. Hickock, & S. Small (Eds.), Neurobiology of language (pp. 935–952). Cambridge, MA: Academic Press.
  • Gunawardena, D., Ash, S., McMillan, C., Avants, B., Gee, J., & Grossman, M. (2010). Why are patients with progressive nonfluent aphasia nonfluent?.Neurology, 75(7), 588–594.
  • Haley, K., Jacks, A., Richardson, J., & Wambaugh, J. (2017). Perceptually salient sound distortions and apraxia of speech: A performance continuum.American Journal of Speech-Language Pathology, 31, 631–640.
  • Henry, M. L., & Gorno-Tempini, M. L. (2010). The logopenic variant of primary progressive aphasia.Current Opinion in Neurology, 23(6), 633–637.
  • Henry, M. L., Wilson, S. M., Babiak, M. C., Mandelli, M. L., Beeson, P. M., Miller, Z. A., & Gorno-Tempini, M. L. (2016). Phonological processing in primary progressive aphasia.Journal of Cognitive Neuroscience, 28(2), 210–222.
  • Hodges, J. R., & Patterson, K. (1996). Nonfluent progressive aphasia and semantic dementia: A comparative neuropsychological study.Journal of the International Neuropsychological Society, 2(6), 511–524.
  • Jefferies, E., Lambon Ralph, M. A., Jones, R., Bateman, D., & Patterson, K. (2004). Surface dyslexia in semantic dementia: A comparison of the influence of consistency and regularity.Neurocase, 10(4), 290–299.
  • Josephs, K. A., Duffy, J. R., Strand, E. A., Machulda, M. M., Senjem, M. L., Master, A. V., … Whitwell, J. L. (2012). Characterizing a neurodegenerative syndrome: Primary progressive apraxia of speech.Brain, 135(Pt. 5), 1522–1536. https://doi.org/10.1093/brain/aws032
  • Jung, Y., Duffy, J. R., & Josephs, K. A. (2013). Primary progressive aphasia and apraxia of speech.Seminars in Neurology, 33, 342–347.
  • Kay, J., & Ellis, A. (1987). A cognitive neuropsychological case study of anomia: Implications for psychological models of word retrieval.Brain, 110(3), 613–629.
  • Kellogg, M. K. (1994). Conceptual mechanisms underlying noun and verb categorization: Evidence from paraphasia.Proceedings of the Annual Meeting of the Berkeley Linguistics Society, 20(1), 300–309.
  • Leyton, C. E., Ballard, K. J., Piguet, O., & Hodges, J. R. (2014). Phonologic errors as a clinical marker of the logopenic variant of PPA.Neurology, 82(18), 1620–1627.
  • Mesulam, M. (1982). Slowly progressive aphasia without generalized dementia.Annals of Neurology, 11(6), 592–598.
  • Mesulam, M. (1987). Primary progressive aphasia—Differentiation from Alzheimer's disease.Annals of Neurology, 22(4), 533–534.
  • Mesulam, M. (2001). Primary progressive aphasia.Annals of Neurology, 49(4), 425–432.
  • Moss Rehabilitation Research Institute. (2013). Philadelphia Naming Test (PNT) Scoring Protocol. Retrieved from http://www.mrri.org/philadelphia-naming-test (September 28, 2015).
  • Neary, D., Snowden, J. S., Gustafson, L., Passant, U., Stuss, D. T., Black, S. E., … Benson, D. F. (1998). Frontotemporal lobar degeneration: A consensus on clinical diagnostic criteria.Neurology, 51(6), 1546–1554.
  • Patterson, K., Graham, N., & Hodges, J. R. (1994). The impact of semantic memory loss on phonological representations.Journal of Cognitive Neuroscience, 6(1), 57–69.
  • Patterson, K., & MacDonald, M. C. (2006). Sweet nothings: Narrative speech in semantic dementia.In S. Andrews (Ed.), From inkmarks to ideas: Current issues in lexical processing (pp. 299–317). Hove, United Kingdom: Psychology Press.
  • Petroi, D., Duffy, J. R., Strand, E. A., & Josephs, K. A. (2014). Phonologic errors in the logopenic variant of primary progressive aphasia.Aphasiology, 28(10), 1223–1243.
  • Rohrer, J. D., Ridgway, G. R., Crutch, S. J., Hailstone, J., Goll, J. C., Clarkson, M. J., & Ourselin, S. (2010). Progressive logopenic/phonological aphasia: Erosion of the language network.NeuroImage, 49(1), 984–993.
  • Schwartz, M. F., Wilshire, C. E., Gagnon, D. A., & Polansky, M. (2004). Origins of nonword phonological errors in aphasic picture naming.Cognitive Neuropsychology, 21, 159–186.
  • Sepelyak, K., Crinion, J., Molitoris, J., Epstein-Peterson, Z., Bann, M., Davis, C., … Hillis, A. E. (2011). Patterns of breakdown in spelling in primary progressive aphasia.Cortex, 47, 342–352.
  • Stark, J. A., & Dressler, W. U. (1990). Agrammatism in German: Two case studies.In L. Menn & L. Obler (Eds.), Agrammatic aphasia: A cross-language narrative sourcebook. Philadelphia, PA: John Benjamins.
  • Wilson, S. M., Henry, M. L., Besbris, M., Ogar, J. M., Dronkers, N. F., Jarrold, W., … Gorno-Tempini, M. L. (2010). Connected speech production in three variants of primary progressive aphasia.Brain, 133(7), 2069–2088.
  • Woollams, A. M., Ralph, M. A. L., Plaut, D. C., & Patterson, K. (2007). SD-squared: On the association between semantic dementia and surface dyslexia.Psychological Review, 114(2), 316–339.

Additional Resources