Subcortical dementia: a clinical approach.

At present there is no specific treatment for cortical dementia. On the other hand, many of the disorders listed as subcortical dementia will respond, at least to some degree, to appropriate treatment; some can be completely reversed. Dementia is a serious disability, and discovery of those demented individuals who may respond to treatment is of obvious importance. It would appear that many, possibly a majority of demented patients, have a disorder other than Alzheimer or Pick varieties of cortical dementia. It can be hoped that many individuals currently diagnosed as ASD, primary dementia, senile dementia, or OBS and relegated to a custodial or nursing-home existence would respond to treatment sufficiently to enjoy a better existence in their remaining years. The strongest tool in the physician's diagnostic armamentarium for discerning such individuals is the clinical examination outlined here. The clinical pictures of the cortical and the subcortical types of dementia are often sharply different and offer a promising lead for the management of dementia.