Clinical Neuropsychology of Dementia

Abstract

In the late 1970's the study of the dementias of old age took ona vitality and pace that continues unabated. The study of late stage disease slowly gave way to the study of the earliest signs of dementia, the characterization and differentiation among various types of dementia, and an increasing focus on "normal aging" and the transition from cognitive health to the dementia of Alzheimer's disease. Neuropsychology has played a critical role in each of these developments and has improved clinical diagnosis and bolsteredadvances in neurobiological research. This presentation will focus on the neuropsychology of dementia. Early clinical neuropsychological features of Alzheimer's disease, the frontotemporal dementias and cortical Lewy body disease will be described. Clinical neuropsychological profiles, anatomical predilection patterns and neuropathological associations will be compared. At present it is clear that early clinical symptoms ofneurodegenerative dementia reflect the neuroanatomical selectivity of disease according to established principles of brain-behavior relationships. The transition between normal aging and the stage of so-called "mild cognitive impairment" will be discussed with respect to the role of neuropsychology in diagnosing this heterogeneous group of conditions. Finally, some general principles of the consultative role of neuropsychology in a behavioral neurology dementia clinic setting will be outlined.