Multidimensional cognitive deficit in logopenic variant primary progressive aphasia: a case report

INTRODUCTION: Logopenic variant primary progressive aphasia (lvPPA) is a language-led presentation of Alzheimer's disease that is easily overlooked in older patients with vascular and systemic comorbidities. CASE PRESENTATION: We report a 78-year-old right-handed Asian woman with hypertension, diabetes, hepatic cirrhosis, and coronary artery disease who developed insidious word-finding difficulty progressing to severe anomia, impaired sentence repetition, and multidomain cognitive decline. Serial Indonesian MMSE, MoCA-Ina, Consortium to Establish a Registry for Alzheimer's Disease (CERAD), and Tes Afasia untuk Diagnosis, Informasi, dan Rehabilitasi (TADIR) assessments showed early amnestic and executive deficits followed by dominant phonological and naming impairment, while MRI revealed left-predominant temporo-parietal and medial temporal atrophy with small-vessel white matter disease, consistent with mixed Alzheimer and vascular pathology. She received donepezil, low-dose clobazam, and targeted speech-language and cognitive rehabilitation with partial symptomatic benefit. CONCLUSION: This case highlights the importance of detailed language assessment and culturally adapted neuropsychological batteries to identify lvPPA within mixed dementia in resource-limited settings.