A 66-year-old right-handed man presented with cognitive impairment. His cognitive decline began 5 years before presentation. Initially, he would misuse words that apparently were similar to words within the same category. He subsequently had trouble naming people and poor comprehension, which affected him at work. One year before presentation, he had 12 hours of amnesia, consistent with TGA, and 6 months before presentation, he had another episode of amnesia, which lasted 6 hours. The findings of outside head imaging and lumbar puncture did not reveal any cause for his amnesia. When he was first examined, he had a severe aphasia that precluded formal bedside cognitive testing. When he was asked to give the year or the month, he was unable to do so. However, when he was asked to point to the date on the calendar, he easily pointed to the correct date. He scored 0 on a verbal letter fluency test (letter F) and was able to come up only with 3 animals in 60 seconds on an animal fluency test, although he had 12 years of formal education. He had significant trouble naming and difficulty with the meaning of words; eg, he was only able to name 3 out of 10 of the first 20 items on the Boston Naming Test.7 He did not know what a lobster or a key was. When asked “What color is grass,” he said white. He recalled 2 out of 4 items that were given to him. He had considerable insight into his deficits and was frustrated by limitations in his self-expression and comprehension. His motor examination was notable only for mild ataxia. Formal neuropsychometric testing revealed aphasia with a marked deficit in auditory comprehension, word finding impairment, and semantic paraphasias. His visual-constructional ability was preserved. Magnetic resonance imaging showed focal left anterior medial temporal lobe atrophy (Figure). Single-photon emission computed tomography revealed severe decreased perfusion in the left temporal neocortex, with a 30% to 40% reduction compared with the right temporal lobe, as well as mild (10%-20%) decreased middle and lower left frontal lobe perfusion (Figure). Given his poor naming ability and loss of word meaning, semantic paraphasias, and poor comprehension, in association with focal left anterior medial temporal lobe atrophy on magnetic resonance imaging and focal left temporal hypoperfusion on single-photon emission computed tomography, his presentation was believed to be most consistent with a semantic variant of PPA.