The neuropsychological structure of dementia in Alzheimer's disease has been investigated on six patients, of which five have been followed for several years. While, the purpose of this study is to contribute to the understandings of a contradictory fact that the focal signs do appear even in such panencephalic brain disease.
For the convenience of discussion, the period of investigation was divided into two stages, namely, those before and after hospitalizations. Then the clinical symptoms in both stages were studies; particularly forgetfulness and other symptoms in the former stage and focal signs and other general symptoms in the latter stage were described in details. Those focal signs consisted of Korsakow's syndrome, characteristic speech disturbances, disturbances of written language, acalculia, apraxia and agnosia. As the result of this investigation, the following findings were obtained concerning the structure of dementia in this disease.
1: Symptoms in the stage before hospitalization. Notable forgetfulness at the onse t, observed in all patients, would construct Korsakow's syndrome together with disorientation and confabulation which apppeared sooner or later in the progression of the disase. Other abnormalities, considered as the precursors of apparent focal signs in the later stage, began to be manifest episodically or as paroxysms even about this time. Though no post-mortem circumscribed damage was found in some of the cases, these symptoms of this stage were supposed to be due to intermittent claudication in cerebral centers caused by certain vascular disorders.
2: Symptoms in the stage during hospitalization.
a. Speech disturbances: Word am nesia and, further in later stage, alogia were observed. It seemed quite difficult to regard word amnesia as amnestic aphasia if high age of the patients and the presence of amnestic symptoms in them were taken into consideration. Alogia, seemingly akin to jargon aphasia, had also similarities to schizophasia in phenomenology. Agraphia and alexia observed in these patients seemed rather due to apractic and, particularly, to agnostic disturbances than to general amnestic symptoms. In spite of the presence of acalculia,72multiplication was relatively intact, as it connected closely with audito-motor function.
b. Apraxia: Constructive apraxia and dressing apraxia were often found in the patients. Various apractic symptoms observed in them should be discussed chiefly from the view-point of disturbances in temporo-spatial arrangement (order of performance) in which visuo-spatial function was impaired in particular. Visual function seemed to play an important role in the genesis of constructive apraxia in these patients, sb it was also called visual apraxia properly. While, dressing apraxia could here be divided into the following four types; failure in selection of clothes, failure in dressing order, other difficulties in dressing and overlap of clothes. But, the fundamental causes of dressing apraxia might be derangement of order of performance, disoriention and visuo-spatial agnosia.
c. Agnosia: Visuo-spatial agnosia was often observed in them. Topographical disturbances and most of Balint syndrome were especially apparent. The disturbances of motor function such as psychic palsy of gaze and visual ataxia might be implied as partial components of the agnosia.
3: Conclusion. Vari ous types of aphasia, apraxia and agnosia have hitherto been reported as the focal signs in Alzheimer's disease. However, it might be possible to contribute these symptoms to a unitary disturbance, according to the above-mentioned consideration of the author. In other words, this disturbance might be a functional one in connecting and integrating visual function with motor activity, and, therefore, it might also be considered at least as the result of a fairly circumscribed lesion in the brain.
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