Inflectional morphology in primary progressive aphasia and Alzheimer's disease: A systematic review

• This review focuses on inflectional morphology.
• It discusses studies on primary progressive aphasia and Alzheimer's disease.
• Results challenge predictions about expected morphological inflection performance.
• Severity scales and longitudinal studies are needed.

Consensus recommendations for three variants of primary progressive aphasia (PPA), the non-fluent/agrammatic, logopenic and semantic variants, were published in 2011 [Gorno-Tempini et al., 2011]. These recommendations describe the most characteristic language impairments for each variant. However, studies using these criteria in larger groups of patients revealed serious limitations concerning their application. Some of these limitations are related to imprecisions in the description of language features, especially for grammatical features. The aim of this review was to examine studies of inflectional morphology in three variants of PPA and in the disease that is the most relevant for differential diagnosis, namely Alzheimer's disease. MedLine, CINAHL and PsycINFO electronic databases were searched to retrieve all relevant peer-reviewed articles published in English language journals. Despite the focus that has been placed on agrammatism by the consensus recommendations, the studies reviewed do not systematically report impairments of inflectional morphology in the non-fluent/agrammatic variant. Studies also show that some individuals with the logopenic variant present with substantial inflection impairments. Contrary to expectations, some studies reveal the presence of morphological difficulties in the semantic variant. These difficulties concern mostly the production of irregular, low-frequency verbs while regular verbs are spared. Similar difficulties are also reported in studies of people with Alzheimer's disease. Overall, the results show the need to more clearly define the criteria related to grammar and morphology and to better characterise impairment severity. Future research on primary progressive aphasia and other degenerative diseases with language impairments will help refine our expectations regarding language features that characterise each profile.