Logopenic Variant Primary Progressive Aphasia Presenting with Severe Depressive Syndrome and Suicidal Behaviour: A Case Report

Abstract

Background: Logopenic variant Primary Progressive Aphasia (lvPPA) is a language-predominant neurodegenerative syndrome characterized by progressive word retrieval deficits, impaired phonological processing, and hesitant speech. Unlike classical amnestic presentations of Alzheimer's disease, patients with LvPPA often present with language impairment as the earliest and most disabling symptom. Psychiatric manifestations may coexist and contribute to diagnostic complexity.

Case Presentation: A 62-year-old male presented with progressively worsening language impairment characterized predominantly by difficulty retrieving words and interrupted speech production. Family members reported that the patient frequently knew what he intended to communicate but was unable to retrieve appropriate words. Symptoms began approximately 18 months before evaluation and progressively worsened over time. Over the subsequent months, the patient developed depressive symptoms characterized by low mood, apathy, reduced motivation, feelings of worthlessness, and social withdrawal. Neuropsychiatric symptoms intensified and culminated in a suicidal attempt by ingestion of washing fluid approximately three months before presentation. Magnetic resonance imaging demonstrated minimal nonspecific white matter microangiopathic changes without major structural abnormalities or significant cortical atrophy. Florbetaben F18 amyloid PET imaging demonstrated diffuse cortical amyloid positivity involving frontal, temporal, parietal, and posterior cingulate–precuneus regions with minimal associated atrophy, supporting Alzheimer-spectrum pathology. The clinical profile and biomarker findings were considered most consistent with logopenic variant Primary Progressive Aphasia.

Conclusion: This case highlights the importance of recognizing atypical Alzheimer-spectrum presentations in individuals presenting with progressive language dysfunction and psychiatric symptoms.