Beyond the heterogeneity of cognitive and behavioral disorders observed in demented patients, there exists a prevalence of certain types of deficits early in the disease. The identification of these deficits could therefore contribute to the early diagnosis of dementia.
For example, two types of impairments seem to be particularly frequent and occur early in the course of Alzheimer’s disease: executive (controlled) function and episodic memory impairments. However, there remains some uncertainties concerning the best discriminating executive or episodic memory measures to use. It is possible that executive and episodic memory deficits are not global in nature and that, at least in the early stages of the disease, there is some specificity of impairment. A better understanding of executive and episodic memory impairments in Alzheimer patients should lead to a selection of the best tasks that could be used as specific and accurate cognitive predictors of Alzheimer’s disease. Similarly, others forms of dementia seem also to be associated with distinct neuropsychological characteristics. Furthermore, in a rehabilitation perspective, the objective of neuropsychological assessment is not only to identify cognitive, mood, and behavioral deficits but also to understand their nature, to find preserved abilities and optimization factors, and to examine the impact of these deficits on daily life activities. The neuropsychologists have also to establish the optimal conditions that enable them to receive informed consent from the patient and family members and to analyze the factors that could contribute to acceptance or refusal of participation in the rehabilitation program.
Considering the existing possibilities of early diagnosis, the neuropsychologist will be more frequently confronted with the assessment and rehabilitation of very mild demented patients who are still relatively autonomous, professionally active, and aware of their disease and related deficits. Thus, it clearly appears that, more than ever, assessment and intervention in dementia should be developed by considering the patient as a responsible participant.
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