Journal

The Japanese journal of neuropsychology

[Vol.32 No.3 contents]
Japanese/English

Full Text of this Article
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ArticleTitle Disentangling dementia from neuropsychological perspectives
Language J
AuthorList Toshiya Fukui
Affiliation Kawasaki Memorial Hospital
Publication Japanese Journal of Neuropsychology: 32 (3), 229-238, 2016
Received
Accepted
Abstract One of the difficulties in making a diagnosis of dementia is well mirrored in a frequently asked question of what and how cognitive functions should be impaired for the diagnosis of dementia. Dichotomizing cognitive levels into normal and impaired in a top-down fashion does not help to solve this problem. The purpose of this article is to introduce an alternative bottom-up strategy that requires first to investigate the contents and degree of cognitive impairments, and then consider whether a combination of cognitive impairments is worth a diagnosis of dementia. This method is based on the fundamental understanding that dementia represents a combination of various cognitive deficits.
For a better understanding, a 64 year-old male is presented as a model patient, and his symptoms are disentangled from neuropsychological viewpoints. The patient himself noticed a hint of cognitive decline and his concerns over the possibility of dementia lead him to visit our hospital. His family noticed that he showed an increasing tendency to repeat his statements and questions; he became easily lost in whatever he was doing when interrupted halfway through; he immediately lost track of his share of household chores once he was concentrated on one of them; and he often misplaced his belongings. These symptoms may be mistakenly interpreted as results of memory disturbance: this disturbing tendency to ascribe any symptoms to amnesia is called "Alzheimerization" that is hazardous obstruction to the diagnosis of non-Alzheimer type dementia. In fact, these symptoms are instead closely associated with deficits in attention, various frontal functions including execution, psychomotor speed, set changing, volition, inductive reasoning and other, language, visuospatial abilities, praxia as well as memory. Although this patient was only mildly affected, a wide range of impairments in cognition, not confined to memory, lead to a diagnosis of mild dementia instead of "age-related forgetfulness". Thus, a neuropsychological bottom-up approach to symptoms of dementia may help avoid Alzheimerization in the processes of differential diagnosis of dementia. Further, this strategy may make it easier to interpret the cognitive symptoms in association with functional localizations of the brain.
Keywords dementia, neuropsychology, Alzheimerization, functional localization, differential diagnosis

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