Is "subcortical dementia" a recognizable clinical entity?

The concept of "subcortical dementia" is controversial, lacking clinical validation and having only a questionable pathological basis. Over 100 patients with Alzheimer's, Parkinson's or Huntington's disease, subdivided into three functional disability stages, were given a brief quantitative neuropsychological assessment. Patients with Huntington's or Parkinson's disease were less intellectually impaired than those with Alzheimer's disease at each functional stage. Criteria for dementia were present in all of the Alzheimer's patients but in only half of the Huntington's and Parkinson's disease groups. Patients with similar overall intellectual function scores had no distinct pattern of neuropsychological test performance. Depression, absent in patients with Alzheimer's disease, was present in half the patients with Huntington's and Parkinson's disease and was correlated with intellectual decline. The concept of subcortical dementia is misleading. The pattern of neuropsychological impairment is not distinct, and the neuropathological basis of dementia in these diseases may result from a combination of cortical and subcortical degeneration.

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