Q. My 79-year-old mother was diagnosed with primary progressive aphasia three years ago. She has been taking Aricept since then. We have seen great degeneration in her ability to reason, comprehend and find a word that seems to be on the tip of her tongue. Is there any other help for her? How much benefit is Aricept for these symptoms?

A. Aphasia is a difficulty with speech, either hearing the spoken word (receptive aphasia) or speaking itself. Aphasia can have many causes, from severe mental retardation, stroke, Alzheimer's disease, or (as in your mother's case) there is sometimes no identifiable cause, and the person is diagnosed with primary progressive aphasia. The difficulty is making a definite diagnosis as to the type of aphasia a person has.

Since Alzheimer's disease is a frequent cause of aphasia, and since Aricept is frequently helpful in patients with Alzheimer's disease, many patients with primary progressive aphasia will be given Aricept as a trial. So, in other words, the Aricept is used primarily with the hope that it is going to work, rather than with the knowledge that it is effective in primary progressive aphasia.

Unfortunately, it appears as though your mother's disease is progressing. This is indeed sad, and there's not much that I know of that can be done to help treat the disease. Certainly, being under the care of a good neurologist will be important. In addition, things to help keep her safe (in other words, if she should become lost how would she be able to find her way back home?) are important. Two good Web pages: http://www.aphasia.org/NAAppa.html and http://www.brain.nwu.edu/core/ppa.html

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