Zusammenfassung
Die neuropsychologische Untersuchung kann einen Beitrag zur differenzialdiagnostischen
Klärung der Demenzerkrankungen im Frühstadium leisten. Das gelingt besonders dann,
wenn anatomische Befallsmuster der Grunderkrankung zu charakteristischen Profilen
neuropsychologischer Ausfälle führen. Die Variabilität ist jedoch bereits für einzelne
Erkrankungen groß und gerade bei älteren Menschen können sich zudem verschiedene Pathologien
mischen. Bei im Vordergrund stehenden Gedächtnisstörungen sowie Wortfindungsstörungen
und ggf. semantischen Paraphasien ist in erster Linie an eine Alzheimersche Erkrankung
zu denken. Treten zudem vermehrt räumlich-konstruktive Störungen in den Vordergrund
und sind Störungen von Aufmerksamkeit und Exekutivfunktionen deutlich, kann dies ein
Hinweis auf eine beginnende Lewy-Körperchen Demenz sein. Bei erhaltenen räumlich-konstruktiven
Fähigkeiten und relativ geringen Gedächtnisstörungen in Kombination mit Veränderungen
des Verhaltens und der sozialen Kompetenz muss an eine frontotemporale Demenz gedacht
werden. Patienten mit subkortikaler vaskulärer Demenz und insbesondere Patienten mit
progressiver supranukleärer Blickparese (PSP) sind ebenfalls vor allem in den Bereichen
der Exekutive und Aufmerksamkeit gestört, hinzu tritt insbesondere bei der PSP eine
deutliche psychomotorische Verlangsamung. Die trifft auch für kognitive Einschränkungen
bei depressiven Patienten zu, sie zeichnen sich zusätzlich oft bereits durch zögerliche
Bearbeitung und Selbstzweifel bei der Testung aus.
Abstract
In the early stages of diseases leading to dementia, neuropsychological testing can
be informative for differential diagnosis. This works particularly well in diseases
where the underlying pathoanatomical pattern induces specific and characteristic neuropsychological
deficit profiles. Yet, even within defined disease entities, variability is high,
and in the elderly several pathologies may coincide or interact. Predominance of mnestic
difficulties along with word finding difficulties and maybe semantic paraphasia suggests
Alzheimer's disease. Additional spatial disorientation and constructive dysfunction
as well as attentional deficits and compromised executive functions can point at beginning
diffuse Lewy body disease. Relative preservation of spatial orientation and memory
in combination with alterations of social behavior should bring frontotemporal dementia
to mind. In subcortical vascular dementia and in progressive supranuclear palsy (PSP),
patients display prominent disturbances of executive and attentional functions, and
in PSP they additonally show marked psychomotor slowing. While sharing this latter
feature, depressed patients will also be noted as lacking confidence during formal
testing.
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Dr. A. Rösler
Albertinen-Haus · Zentrum für Geriatrie · Wissenschaftliche Einrichtung an der Universität
Hamburg
Sellhopsweg 18 - 22
22459 Hamburg
Email: alexander.roesler@albertinen.de
