ArcaMax

DEAR DR ROACH: My husband will be 80 in a couple of months. He is experiencing what I fear is primary progressive aphasia (PPA). He will not agree to get tested. Five years ago, a neuropsychiatrist diagnosed him with slight cognitive deficiencies. He struggles to find words, uses incorrect words, and has a poor concept of time. His short-term memory is not good.

He is able to perform all activities of daily living (ADLs). He had a transient ischemic attack four years ago and a heart attack that resulted in two stents three years ago. From my reading, I do not believe there is any treatment other than speech therapy for PPA, and he would not agree to it because he doesn't think anything is amiss. I would like your opinion as to treatment and a prognosis. -- B.E.

ANSWER: PPA is a degenerative disease of the brain in a class called frontotemporal dementias. These used to be called "Pick's disease" and are similar to other dementias; however, there are some specific characteristics of frontotemporal dementias that an expert knows how to search for.

It is not always straightforward to make the diagnosis of PPA. The condition tends to start at a younger age than Alzheimer's, most commonly in the 50s. The hallmark of PPA is early and progressive language impairment. The person is often able to perform their ADLs early on in the disease. Many patients are unconcerned about the loss of language function, which sounds like an issue for your husband.

Making the diagnosis is really important, but I understand that he is making it impossible for you. An MRI can help support the diagnosis and exclude other causes.

Unfortunately, there are no treatments now that can slow or stop the progression of frontotemporal dementia. The prognosis is variable between people, but many people with PPA have isolated language defects before a more global type of dementia becomes prevalent. Behavioral changes are frequent, and some people experience a loss of motor control.

I am very sorry that I can't be more certain about his diagnosis and even more sorry that you are facing this diagnosis without being able to get him the medical and home care that might help him (and certainly support you).

DEAR DR. ROACH: My husband and I contracted norovirus when our granddaughter came home from college at Christmas. We both became violently sick but recovered without side effects. My question is, are we immune from contracting it again as it is in the recent news? We are planning a cruise in June and worry about this virus. -- L.S.

ANSWER: Unfortunately, the immunity to norovirus is strain-specific, and most experts think that immunity to a specific norovirus strain lasts for only about six months. So, you will be losing whatever immunity you may have had by the time of the cruise. Worse, there are more than 40 genotypes, and each has different variants. So, you really cannot count on immunity to prevent another infection.

The risk of acquiring norovirus on a cruise ship is small; in a 10-day cruise, the risk is less than 0.5%. You can reduce this risk through hand hygiene, which means washing your hands with soap and water. You'll want to wash your hands before eating and, if there is an outbreak on board, far more often.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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