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Image of the brain circled to show part of the brain effected by Nonfluent/Agrammatic PPA

Nonfluent/Agrammatic Variant PPA

Nonfluent/Agrammatic Variant PPA (nfvPPA) is one type of Primary Progressive Aphasia.
nfvPPA causes the brain to slowly lose the ability to put sentences together and/or coordinate the movements to speak.

This happens because of changes in parts of the brain that help with:

  • Including important grammar markers
  • Planning and programming the movements of speech

nfvPPA can make it hard to:

  • Speak as fast as you used to
  • Speak as clearly and smoothly as you used to
  • Get words out, even when you know what you want to say
  • Put together and understand sentences with complex grammar

Some people with nfvPPA may have:

  • Problems with both producing speech and including grammar
  • Problems with only grammar

Note: If you have only problems with producing speech, but no problems with language,  learn more about Primary Progressive Apraxia of Speech, a type related to nfvPPA. 

At first, you may only have a little difficulty. It may be very mild at first, or not happen very often.

Early stages of nfvPPA

At first, you may only have a little difficulty. It may be very mild at first, or not happen very often. 

Things that are not a problem for you in the earlier stages of nfvPPA:

  • Knowing what things are (object knowledge stays strong)
  • Knowing what words mean (especially simple, everyday ones)
  • Social behavior and personality stay mostly the same
  • Memory for life events and familiar people 

In the earlier stages, voice banking can help you use technology tools to speak later on. The iPhone has a built-in tool called Personal Voice that lets you do this from your phone. 

Non-speech/language things that may happen with nfvPPA

  • Movement problems, like stiffness or balance issues
  • Changes in voice (like sounding quieter, hoarse, or lower)
  • Trouble with hand movements and gestures

What causes nfvPPA?

Man and woman in front of a gate in Africa

nfvPPA  is caused by changes in the brain over time.
The biggest change happens in the area:

  • Toward the bottom of the frontal lobe
  • Above the top of the left temporal lobe


These parts help you use grammar and plan speech movements.

In nfvPPA, these brain areas start to shrink.
This is called atrophy (say: AT-ruh-fee), which means the brain cells are slowly getting damaged or dying.

What causes the brain to shrink?
The shrinking happens because of abnormal protein tangles in your brain.
In nfvPPA, the most common protein tangle is Tau tangles with 4 building blocks

What are tau tangles?

Tau tangles (say: TOW tang-gulls) are twisted threads of protein inside your brain cells.
They block the cells from working right, so they can’t stay healthy or send messages.

Over time, these tau tangles cause your brain cells to die.
As more brain cells are lost, the brain shrinks in that area.

That’s why it becomes harder to speak clearly or use full sentences—because the part of your brain that helps with those skills is damaged.

Are there other names for nonfluent/agrammatic variant PPA?

People use different names and short forms (also called acronyms) to talk about nonfluent/agrammatic variant primary progressive aphasia. Here are the most common ones:

  • nfvPPA
    This is the most common short form. It stands for nonfluent/agrammatic variant primary progressive aphasia.
  • nf-PPA or PPA-nonfluent or PPA-G
    Some researchers use these versions.G stands for grammar.
  • PPAOS
    This stands for primary progressive apraxia of speech. Some people with nfvPPA also have PPAOS, or PPAOS may come first.
  • Nonfluent aphasia
    This is a shorter name, but it doesn’t show that the condition is progressive.
    Saying nfvPPA is more clear and accurate
Learn more about a related type, Primary Progressive Apraxia of Speech (PPAOS)

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