Clinical Features of Other Dementias

Dementias can be calssified into cortical, subcortical, cortical-subcortical and multifocal ones based on the major pathological distribution within the brain. The literatures of recent knowledge about clinical features of other dementias than Alzheimer's and vascular ones, which were most frequently experienced by many clinicians were reviewed. That is, cortical dementias such as Pick's disease, frontal lobe type dementia and non-Alzheimer's type lobar atrophy including fronto-temporal dementia, progressive dysphasia, fronto-temporal dementia with motor neuron disease, and alcohol-related dementia were reviewed. Subcortical dementias such as dementias accompanying Parkinson's disease, Huntington's disease and progressive supranuclear palsy, and cortical-subcortical dementias such as Lewy body dementiaq and cortical-basal degeneration were also reviewed. As multifocal dementias, prion dementias including KUru, Creutzfeldt-Jakob disease, fatal familial insomnia and Gerstmann-Strussler-Sheinker syndrone, and AIDS dementia were also reviewed.

Clinical Manifestation of Dementias

Symptoms of dementia vary widely according to the etiology, nature, progression of the causative disease. Not only various cognitive and non-cognitive features are present in any given point of evaluation, but also it is very common to note the ups and downs of such symptoms in an individual patient as the disease progress. Although cortical degenerative dementia such as Dementia of Alzheimer's Type typically show cognitive deficit in language, memory, praxis etc. in its early stage, it is unwise to confine such symptoms to be characteristic only in cortical dementias. Likewise, neurologic symptoms or changes in affect, personality and behavior, frequently seen in vascular dementia or other subcortical degenerative dementias should be understood as a part of whole cognitive and behavioral symptomatic gamut. As a logical conclusion, when evaluating the symptoms of a dementic patient, all the physical, neurologic, and neuropsychiatric evaluation must be applied as well as neuropsychological assessments. In addition, attention must be paid on the patients' functionality of daily living, reversibility, and appropriateness of services by family members or caregivers.

Symptomatology of Dementia

Dementia can be defined as an acquired persistent impairment of intellectual func-tion with compromise in at least three of the mental activities such as language, memory, visuospatial skill, emotion or personality, and cognition. The purposes of diagnosing a dementia syndrome are to search systemically for various etiologies, to differentiate reversible or irreversible dementia, cortical or subcortical dementia, and degenerative or nondegenerative dementia, and to apply to patients neurocognitive rehabilitation or other specific trea-tment strategies. The evaluation of dementia includes neuropsychiatric history taking, neuropsychological assessment, neurologic examination, neuroimaging studies, and laboratory studies. It is impossible to evaluate dementic patients only with clinical signs, symptoms, and neuropsychiatric histories. But I will address specific neurologic or neuropsychiatric symptoms and signs of various dementias to und-erstand them as classification.