The diagnosis and understanding of apraxia of speech: Why including neurodegenerative etiologies may be important

Purpose: To discuss apraxia of speech (AOS) as it occurs in neurodegenerative disease (progressive AOS [PAOS]) and how its careful study may contribute to general concepts of AOS and help refine its diagnostic criteria. Method: The article summarizes our current understanding of the clinical features and neuroanatomical and pathologic correlates of PAOS and its relationship to primary progressive aphasia (PPA). It addresses similarities and differences between PAOS and stroke-induced AOS that may be relevant to improving our understanding of AOS in general. Conclusions: PAOS is clinical disorder that should be distinguished from PPA. Its recognition is important to clinical care provided by speech-language pathologists, but it also has implications for neurologic localization and diagnosis as well as prediction of underlying pathology and histochemistry. The clinical features of PAOS and stroke-induced AOS have not been explicitly compared, but they may not be identical because PAOS does not follow a vascular distribution, the brunt of cortical pathology is in the premotor and supplementary motor area, and its onset (rather than acute) is slowly progressive with potential for adaptation to gradual impairment. Careful description and study of PAOS may be a valuable source of information for refining our understanding of AOS in general.