Your patient presents with progressive decline in speech and writing; speech is non-fluent with phonological errors. Comprehension and repetition are intact. What is the possible diagnosis?

• A. Progressive nonfluent aphasia
• B. Logopenic progressive aphasia
• C. Semantic dementia
• D. This description does not fit any criteria primary progressive aphasias

Answer: (A)

This pattern points to a nonfluent variant of primary progressive aphasia. The key feature is gradually worsening, effortful, halting speech with phonemic or phonological errors, which reflects trouble with motor planning for speech and often includes agrammatic output. Importantly, comprehension remains relatively preserved early on, and repetition is not primarily impaired, fitting the motor-speech–dominant profile of this variant. Writing impairment often accompanies the speech decline as part of the same language output disruption.

In contrast, the logopenic variant typically shows word-finding pauses and impaired repetition due to difficulties with phonological working memory, so repetition would be notably affected. Semantic dementia features fluent speech but with degraded single-word comprehension and object/meaning knowledge, along with semantic naming problems, which isn’t consistent with intact comprehension and phonological errors described here. The option claiming that this does not fit any primary progressive aphasia would overlook the classic PNFA pattern.