ASSESSING THE DEMIENTING PATIENT
In the process which we call dementia, the clinical picture is usually dominated by intellectual disintegration, but feeling and striving are always affected. The general features of the syndrome show a fairly consistent pattern which is varied in the individual case according to the premorbid personality, the age of onset, the nature of the cause, and any local preponderance in the early lesions. The impairment of memory for recent events, which is the earliest change, may be effectively compensated for a considerable time by a surprising ingenuity in concealment, adherence to a rigid daily routine and the use of a notebook. This adjustment breaks down as intellectual grasp weakens and thinking becomes slow, labored and ill defined. Attention is now aroused and sustained with difficulty, the patient tires easily, particularly with any unaccustomed task, and he is prone to become lost in the middle of an argument or sentence. Poverty of thought supervenes in a once richly stored, flexible mind: it shrinks to a small core of ever-recurring, rigidly held ideas and re-evoked memories of the remote past, which may long remain vivid and clear. ( Mayer-Gross, Slater, & Roth, 1969, p. 491)
Nearly every professional contact with a client who has a degenerative brain disease, whether for clinical or research purposes, incorporates some level of formal or informal evaluation of the client's current functioning. Accordingly, it is helpful to begin with a brief review of some of the procedures used in constructing an understanding of the neuropsychological consequences of degenerative brain diseases for individual patients.
Some degree of cognitive failure or functional decline is associated with almost all the degenerative diseases reviewed in this book; these changes are given the generic label of dementia. The Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., rev. (DSM-III-R; American Psychiatric Association 1987) describes dementia as resulting in a deterioration in memory functioning, abstract thinking, judgment,