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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