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cortical versus frontal-subcortical dementia

Cortical dementias have amnesia, aphasia, apraxia & disturbances of the cortical association areas. Alzheimer's disease exemplifies cortical dementia. Most other dementias have predominantly frontal-subcortical features from involvement of the frontal-subcortical circuits in the basal ganglia, thalamus & subcortical white matter (see below). Frontal-subcortical dementias are characterized by slowed mental processing, difficulty in memory retrieval, increased prominence of affective disturbances, relative sparing of language & presence of movement disorders. The AIDS dementia complex exemplifies frontal-subcortical dementia. Features of cortical versus frontal-subcortical dementia: 1) psychomotor speed - cortical: normal - frontal-subcortical: slow 2) complex attention - cortical: normal - frontal-subcortical: abnormal 3) executive function - cortical: normal to abnormal - frontal-subcortical: abnormal 4) information management - cortical: abnormal sequential steps - frontal-subcortical: abnormal for complex steps 5) memory - cortical: amnesia (poor recognition) - frontal-subcortical: abnormal retrieval, cuing helps 6) communication (language) - cortical: aphasia, anomia, decreased verbal fluency - frontal-subcortical: - dysarthria, decreased verbal fluency, perseveration with frontal involvement 7) visuospatial - cortical: abnormal - frontal-subcortical: abnormal 8) affect - cortical: unconcerned, unaware - frontal-subcortical: apathy, depression, disinhibition 9) motor - cortical: normal - frontal-subcortical: abnormal movements, gait or tone

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aphasia attention assessment dysarthria executive function assessment memory assessment

References

  1. Mendez, M. In: Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw Hill, New York, 2000, pg 89, 90
  2. Kristi Wagner Steh, West Los Angeles VA, GRECC, Dec 2003 - Cummings JL, The Neuropsychiatry of Alzheimer's Disease and Related Dementias, Martine Dunitz LTD, Taylor & Francis Group, London (2003) - Mendez MF & Cummings JL, Dementia: A Clinical Approach, Butterworth & Heinemann, Philadelphia (2003)