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This chapter addresses the clinical process of making a diagnosis of dementia, and decisions made about whether the patient appears to have a cortical or subcortical dementia. The mini-mental state examination (MMSE) is a useful instrument for grading established dementia but is insensitive for detecting the early stages of dementia of Alzheimer's type (DAT). Having established that the patient has a genuine dementia, the next step is to determine the cause. As memory impairment is a virtually universal feature of the dementias and is in many instances the earliest and most salient feature, a contemporary cognitive model of memory is reviewed briefly. Alzheimer's accounts for approximately two-thirds of all cases of dementia. A wide range of basal ganglia and white matter diseases may result in a pattern of subcortical dementia. Huntington's disease is the commonest genetic disorder to cause dementia.
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