Neuropsychological markers of dementia on visual-spatial tasks: a comparison between Alzheimer's type and vascular forms of dementia.

The incidence of the "closing-in" phenomenon and of the tendency to give "primitive answers" on the Raven's Colored Matrices was studied in 50 normal subjects and in two groups of Alzheimer's type (n = 41) and of vascular (n = 35) dementia patients, carefully matched as for the overall severity of dementia and the degree of visual-spatial impairment. The aims of this research were to determine if these patterns of behavior can be considered as neuropsychological markers of dementia and if their incidence is similar in the two dementia groups. Results show that both the closing-in phenomenon and the tendency to give globalistic and odd responses on the Raven's Colored Matrices are good markers of dementia and that, in particular, they point to a degenerative, rather than to a vascular form of dementia. From the clinical point of view, these data suggest that a qualitative analysis of the patient's behavior can increase the diagnostic efficacy of neuropsychological tests and that neuropsychological markers of dementia point more to Alzheimer's disease (considered as the most prototypic form of dementia) than to a vascular form of dementia even when the two groups of patients are well balanced in terms of visual-spatial impairment and the overall severity of dementia.

[1]  Alistair Burns,et al.  Observations on the brains of demented old people. B.E. Tomlinson, G. Blessed and M. Roth, Journal of the Neurological Sciences (1970) 11, 205–242; (1968) 7, 331–356 , 1997 .

[2]  C. P. Hughes,et al.  Predictive features in mild senile dementia of the Alzheimer type , 1984, Neurology.

[3]  D. Benson,et al.  Dementia: A Clinical Approach , 1983 .

[4]  J. Wade,et al.  The clinical diagnosis of Alzheimer's disease. , 1987, Archives of neurology.

[5]  H. Chui,et al.  Clinical subtypes of dementia of the Alzheimer type , 1985, Neurology.

[6]  R. Mayeux,et al.  Heterogeneity in dementia of the Alzheimer type , 1985, Neurology.

[7]  C. Caltagirone,et al.  Gangliosides in the treatment of mental deterioration , 1977, Acta psychiatrica Scandinavica.

[8]  J Marshall,et al.  Subcortical arteriosclerotic encephalopathy: a clinical and radiological investigation. , 1981, Journal of neurology, neurosurgery, and psychiatry.

[9]  J. Meyer,et al.  Analysis of intellectual and cognitive performance in patients with multi-infarct dementia, vertebrobasilar insufficiency with dementia, and Alzheimer's disease. , 1975, Journal of neurology, neurosurgery, and psychiatry.

[10]  G. Gainotti.  A quantitative study of the "closing-in" symptom in normal children and in brain-damaged patients. , 1972, Neuropsychologia.

[11]  C. Caltagirone,et al.  Poor performance of right brain-damaged patients on Raven's coloured matrices: Derangement of general intelligence or of specific abilities? , 1977, Neuropsychologia.

[12]  M. Roth,et al.  Old Age Mental Disorders in Newcastle upon Tyne , 1964, British Journal of Psychiatry.

[13]  A. Larue,et al.  Clinical differentiation of primary degenerative and multi-infarct dementia: a critical review of the evidence. Part II: Pathological studies. , 1983 .

[14]  J. Raven.  Guide to using the Coloured Progressive Matrices. , 1958 .

[15]  M. Kopelman.  The Cholinergic Neurotransmitter System in Human Memory and Dementia: A Review , 1986, The Quarterly journal of experimental psychology. A, Human experimental psychology.

[16]  Alex Martin,et al.  Word production and comprehension in Alzheimer's diseáse: The breakdown of semantic knowledge , 1983, Brain and Language.

[17]  C Caltagirone,et al.  Validity of some neuropsychological tests in the assessment of mental deterioration , 1979, Acta psychiatrica Scandinavica.

[18]  C. Fisher.  Lacunar strokes and infarcts , 1982, Neurology.

[19]  R. Elston,et al.  Specificity of the clinical diagnosis of dementia , 1975, Journal of the Neurological Sciences.

[20]  R. Tissot,et al.  [Apropos of some problems caused by apraxia in dementias]. , 1960, L'Encephale.

[21]  T. Erkinjuntti,et al.  Neuropsychological differentiation between normal aging, Alzheimer's disease and vascular dementia , 1986, Acta neurologica Scandinavica.

[22]  J Marshall,et al.  Cerebral blood flow in dementia. , 1975, Archives of neurology.

[23]  Kathryn A. Bayles,et al.  Language function in senile dementia , 1982, Brain and Language.

[24]  W. Mayer-gross.  Further Observations on Apraxia , 1936 .

[25]  P. Fischer,et al.  Nonspecificity of semantic impairment in dementia of Alzheimer's type. , 1988, Archives of neurology.

[26]  W. Mayer-gross.  Some Observations on Apraxia , 1935 .

[27]  R. Katzman.,et al.  Intrusions as a sign of Alzheimer dementia chemical and pathological verification , 1982, Annals of neurology.

[28]  R. Bartus,et al.  The cholinergic hypothesis of geriatric memory dysfunction. , 1982, Science.

[29]  I. Janota.  Dementia, deep white matter damage and hypertension: ‘Binswanger's disease’ , 1981, Psychological Medicine.

[30]  G. Gainotti,et al.  Verbal memory disorders in Alzheimer's disease and multi-infarct dementia , 1989, Journal of Neurolinguistics.

[31]  L. Costa,et al.  Patterns of behavioral deficit associated with visual spatial neglect. , 1969, Cortex; a journal devoted to the study of the nervous system and behavior.

[32]  S. Brinkman,et al.  Measurement of cholinergic drug effects on memory in alzheimer's disease , 1983, Neurobiology of Aging.

[33]  M. Roth,et al.  Cortical neuronal counts in normal elderly controls and demented patients , 1983, Neurobiology of Aging.