Primary progressive aphasia (PPA) is an insidiously progressive clinical syndrome that includes at its core an impairment in language. From a clinical perspective, there are a variety of diagnostic challenges; international consensus has only recently been reached on the nomenclature for specific clinical subtypes. There are at present no established treatments, and efforts to develop treatments have been hampered by the lack of standardized methods to monitor progression of the illness. This is further complicated by the multiplicity of underlying neuropathologies. Although measures developed from work with stroke aphasia and from work with disorders such as Alzheimer’s disease and frontotemporal dementia have provided a valuable foundation for monitoring progression, PPA presents unique challenges to clinicians aiming to quantify impairments for the purposes of full characterization and monitoring, and ultimately with the goal of designing clinical trials of interventions to make a meaningful difference in patients’ lives. In this review, I will summarize the main points made in my presentation at the 2010 International Conference on Frontotemporal Dementia, expand from there to summarize our current approach to monitoring progression of PPA, and finally will outline some ideas about goals for the development of better tools for this purpose.