A case of disfluency in sentence-level speech

Abstract

ABSTRACT 【Introduction】We herein present a case of a patient who sought medical attention owing to difficulties in producing sentence‐level speech, despite demonstrating fluency at the word level. When speaking in sentences, the patient exhibited disfluencies characterized by hesitation, pauses, and uneven sound connections. The patient was aware of these difficulties and noted a decline in speech rate. Over time, the disfluency progressively worsened. 【Subject】The patient was a right‐handed individual in his 80s. Cognitive function tests conducted during the initial evaluation and at a 15‐month follow‐up indicated normal cognitive performance. The Standard Language Test of Aphasia revealed disfluency during sentence‐level speech tasks, but no decline was observed in other tasks. These findings suggested that the patient did not present with typical aphasia. No motor dysfunctions of the orofacial muscles or tongue, orofacial apraxia, or dysarthria were detected. Additionally, no consistent sound distortions were noted. 【Evaluations】The patient’s clinical symptoms were analyzed using medical records and longitudinal speech data obtained from follow‐up evaluations during outpatient visits. The factors contributing to his speech difficulties were examined from the perspectives of primary progressive aphasia and primary progressive apraxia of speech (PPAOS). 【Conclusion】PPAOS is a syndrome associated with neurodegenerative disease, characterized by the progressive development of apraxia of speech without accompanying aphasia. Key features include a “slow overall speech rate,” “extended intervals between syllables, words, or phrases,” and “increased speech difficulty with longer or more complex utterances.” The clinical symptoms observed in this patient aligned with the diagnostic criteria for PPAOS and were classified as the prosodic variant of PPAOS.