Primary progressive aphasia nonfluent variant — SCE Neurology MCQ

Correct answer: C — Subtype-specific dementia care with medication and safety review

Subtype-specific dementia care with medication and safety review is the best answer because the vignette describes Primary progressive aphasia nonfluent variant: agrammatic effortful speech localises to nonfluent PPA. Urgent reperfusion assessment with thrombolysis or thrombectomy pathway is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. High-dose intravenous methylprednisolone after excluding infection and Intravenous aciclovir pending diagnostic confirmation are less appropriate because they would require different localisation, timing or test findings; Anticoagulation after excluding contraindications would fit a different syndrome. Clinical pearl: semantic variant has impaired single-word comprehension and anterior temporal atrophy.

Reference: NICE NG97; consensus criteria for dementia syndromes