Nervenheilkunde 2007; 26(08): 651-658
DOI: 10.1055/s-0038-1626910
Kompetenznetz — Demenzen
Schattauer GmbH

Neuropsychologische Untersuchung von Patienten bei Demenzverdacht

Neuropsychological examination of patients with suspected dementia
K. Schmidtke
1   Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinik Freiburg
,
M. Hüll
1   Zentrum für Geriatrie und Gerontologie Freiburg, Universitätsklinik Freiburg
› Author Affiliations
Further Information

Publication History

eingegangen am: 02 April 2007

Publication Date:
20 January 2018 (online)

Zusammenfassung

Eine neuropsychologische Untersuchung sollte das erste Diagnoseverfahren bei Verdacht auf eine beginnende demenzielle Erkrankung sein. Sie umfasst Anamnese, psychischen Befund und Testuntersuchung. Kurzverfahren wie der Mini- Mental-Test dienen vor allem zur Schweregradbestimmung einer bereits deutlicheren demenziellen Symptomatik, bei beginnenden Demenzerkrankungen und noch unklarer Diagnose sind aufwändigere Testserien angezeigt. Die neuropsychologische Testuntersuchung beantwortet die Frage, ob ein objektives Defizit vorliegt, identifiziert das Profil der gestörten kognitiven Leistungen, ordnet es gegebenenfalls einem Grundtyp der Demenz zu und trägt so zur Differenzialdiagnose bei. Neben Demenzerkrankungen ist auch die Diagnose einer “leichten kognitiven Beeinträchtigung” von Bedeutung, die vielfach das Vorlaufstadium von Demenzen darstellt, vor allem in Hinblick auf die erhoffte künftige Verfügbarkeit von Medikamenten, die die Progression dieser Erkrankungen verlangsamen.

Summary

A neuropsychological examination should be the first step when a dementing illness is suspected. It encompasses history taking, psychological assessment and testing. Screening tests like the Mini-MentalStatus-Examination are mainly useful for the staging of established dementias, while the work-up of early and unclear cases requiresa more elaborate series of tests. The neuropsychological examination confirms or excludes the presence of an objective cognitive deficit, identifies the profile of impaired and preserved abilities, assigns it to one of several types of dementia and thereby assists in the making ofa diagnosis. The diagnosis of mild cognitive impairment, frequentlya prodrome of dementia, is equally important, namely with regard to the expected future availability of disease-modifying drugs.

 
  • Literatur

  • 1 Ala TA, Hughes LF, Kyrouac GA, Ghobrial MW, Elble RJ. Pentagon copying is more impaired in dementia with Lewy bodies than in Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2001; 70: 483-488.
  • 2 Ballard CG. Definition and diagnosis of dementia with Lewy bodies. Dement Geriatr Cogn Disord 2004; 17 (Suppl. 01) 15-24.
  • 3 Barth S, Schonknecht P, Pantel J, Schroder J. Mild cognitive impairment and Alzheimer’s disease: an investigation of the CERAD-NP test battery. Fortschr Neurol Psychiatr 2005; 73: 568-576.
  • 4 Bartolini M, Coccia M, Luzzi S, Provinciali L, Ceravolo MG. Motivational symptoms of depression mask preclinical Alzheimer’s disease in elderly subjects. Dement Geriatr Cogn Disord 2005; 19: 31-36.
  • 5 Beeri MS, Schmeidler J, Sano M, Wang J, Lally R, Grossman H, Silverman JM. Age, gender, and education norms on the CERAD neuropsychological battery in the oldest old. Neurology 2006; 67: 1006-1010.
  • 6 Benke T, Donnemiller E. The diagnosis of frontotemporal dementia. Fortschr Neurol Psychiatr 2002; 70: 243-251.
  • 7 Bierman EJ, Comijs HC, Jonker C, Beekman AT. Effects of anxiety versus depression on cognition in later life. Am J Geriatr Psychiatry 2005; 13: 686-693.
  • 8 Calderon J, Perry RJ, Erzinclioglu SW, Berrios GE, Dening TR, Hodges JR. Perception, attention, and working memory are disproportionately impaired in dementia with Lewy bodies compared with Alzheimer’s disease. J Neurol Neurosurg Psychiatry 2001; 70: 157-164.
  • 9 Del Ser T, Hachinski V, Merskey H, Munoz DG. Clinical and pathologic features of two groups of patients with dementia with Lewy bodies: effect of coexisting Alzheimer-type lesion load. Alzheimer Dis Assoc Disord 2001; 15: 31-44.
  • 10 Diehl J, Monsch AU, Aebi C, Wagenpfeil S, Krapp S, Grimmer T, Seeley W, Forstl H, Kurz A. Frontotemporal dementia, semantic dementia, and Alzheimer’s disease: the contribution of standard neuropsychological tests to differential diagnosis. J Geriatr Psychiatry Neurol 2005; 18: 39-44.
  • 11 Eustace A, Coen R, Walsh C, Cunningham CJ, Walsh JB, Coakley D, Lawlor BA. A longitudinal evaluation of behavioural and psychological symptoms of probable Alzheimer’s disease. Int J Geriatr Psychiatry 2002; 17: 968-973.
  • 12 Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, Broich K, Belleville S, Brodaty H, Bennett D, Chertkow H, Cummings JL, de LM, Feldman H, Ganguli M, Hampel H, Scheltens P, Tierney MC, Whitehouse P, Winblad B. () Mild cognitive impairment. Lancet 2006; 367: 1262-1270.
  • 13 Huber W, Poeck K, Weniger D, Willmes K. Aachener Aphasie Test (AAT). Göttingen, Toronto, Zürich: C. J. Hogrefe; 1983
  • 14 Kaltreider LB, Cicerello AR, Lacritz LH, Honig LS, Rosenberg RN, Cullum MC. Comparison of the CERAD and CVLT list-learning tasks in Alzheimer’s disease. Clin Neuropsychol 2000; 14: 269-274.
  • 15 Laatu S, Revonsuo A, Jaykka H, Portin R, Rinne JO. Visual object recognition in early Alzheimer’s disease: deficits in semantic processing. Acta Neurol Scand 2003; 108: 82-89.
  • 16 Monsch AU. Neuropsychological examination in evaluating dementia. Schweiz Rundsch Med Prax 1997; 86: 1340-1342.
  • 17 Oswald WD, Fleischmann UM. Psychometrics in aging and dementia: advances in geropsychological assessments. Arch Gerontol Geriatr 1985; 04: 299-309.
  • 18 Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis. Arch Gen Psychiatry 2006; 63: 530-538.
  • 19 Powlishta KK, Von Dras DD, Stanford A, Carr DB, Tsering C, Miller JP, Morris JC. The clock drawing test is a poor screen for very mild dementia. Neurology 2002; 59: 898-903.
  • 20 Satzger W, Hampel H, Padberg F, Bürger K, Nolde T, Ingrassia G, Engel RR. Zur praktischen Anwen-dung der CERAD-Testbatterie als neuropsychologisches Defizitscreening. Nervenarzt 2001; 72: 196-203.
  • 21 Scheurich A, Müller MJ, Siessmeier T, Bartenstein P, Schmidt LG, Fellgiebel A. Validating the DemTect with 18-fluoro-2-deoxy-glucose positron emission tomography as a sensitive neuropsychological screening test for early alzheimer disease in patients of a memory clinic. Dement Geriatr Cogn Disord 2005; 20: 271-277.
  • 22 Schmidtke K, Hüll M, Talazko J. Posterior cortical atrophy: variant of Alzheimer’s disease? A case series with PET findings. J Neurol 2005; 252: 27-35.
  • 23 Schmidtke K, Hüll M. Neuropsychological differentiation of small vessel disease, Alzheimer’s disease and mixed dementia. J Neurol Sci 2002; 203–204: 17-22.
  • 24 Schmidtke K, Olbrich S. The Clock Reading Test – validation of an instrument for the diagnosis of dementia and disorders of visuo-spatial cognition. International Psychogeriatrics 2007; 19: 307-321.
  • 25 Schmidtke K, Hermeneit S. High rate of conversion to Alzheimer’s disease in a cohort of amnestic MCI patients. International Psychogeriatrics. 2007 im Druck.
  • 26 Schumann G, Halsband U, Kassubek J, Gustin S, Heinks T, Jüngling FD, Hüll M. Combined semantic dementia and apraxia in a patient with frontotemporal lobar degeneration. Psychiatry Res 2000; 20: 21-29.
  • 27 Shulman KI. Clock-drawing: is it the ideal cognitive screening test?. Int J Geriatr Psychiatry 2000; 15: 548-561.
  • 28 Simard M, van Reekum R, Cohen T. A review of the cognitive and behavioral symptoms in dementia with Lewy bodies. J. Neuropsychiatry Clin. Neurosci 2000; 12: 425-450.
  • 29 Zahn R, Buechert M, Overmans J, Talazko J, Specht K, Ko CW, Thiel T, Kaufmann R, Dykierek P, Jüngling F, Hüll M. Mapping of temporal and parietal cortex in progressive nonfluent aphasia and Alzheimer’s disease using chemical shift imaging, voxel-based morphometry and positron emission tomography. Psychiatry Res 2005; 140: 115-131.