Speech and language functions were assessed in 18 patients with multi-infarct dementia (MID) and 14 with dementia of the Alzheimer type (DAT). The age range and dementia severity of the two groups were comparable. We used a speech and language battery assessing 37 elements of verbal output to characterize alterations in the patients. MID patients had more abnormalities of motor aspects of speech, whereas DAT patients had empty speech, more marked anomia, and relative sparing of motor speech functions. The results demonstrate that speech and language differ in MID and DAT. In addition, MID patients exhibited common clinical features despite the heterogeneity of the syndrome.

To study dementia in the extremely aged, I evaluated 40 centenarians with a mean age of 101.6 years (range: 100–107). The group completed 5.8 years of education, on average. Bradyphrenia and bradykinesia were common and most had impaired awareness and concern. The Folstein Mini-Mental State Exam and Washington University''s Clinical Dementia Rating Scale indicated moderately advanced dementia in more than half; 4 had a clinical pattern that suggested senile dementia of the Alzheimer''s type. A common pattern of dementia emerged consisting of preserved awareness of the environment, normal participation in conversations, mild bradyphrenia and bradykinesia with normal latency to respond to questions and memory impairment with diminished ability to learn new information. They had a constricted universe with limited awareness of events outside their personal sphere; they repeated themes and topics endlessly. This study suggests senile dementia is common in centenarians.

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The number of individuals over age 100 years in the United States will increase from 25,000 in 1986 to more than 108,000 by the year 2000. Despite this expected growth there is almost no information about their intellectual function. This is unfortunate since the study of centenarians offers valuable insight into the effects of aging upon the central nervous system. It may also clarify whether Alzheimer''s disease represents premature aging. To better understand their mental state, I evaluated 20 centenarians (17 women and 3 men) with a mean age of 101.75 years. The group completed on average 6.6 years of education and each had 4 illnesses and took 3.5 prescribed drugs. Eighty percent were in nursing homes, mostly due to inadequate social supports. Caregivers had thought that the majority were not demented. During evaluation, 75% had impaired vision while half had disturbed hearing. The speed of thought and body movement were slowed significantly. Centenarians had poor awareness of their environment, in general (p = 0.0019) and had impaired judgement (p = 0.006). Additionally, only 3 individuals had a history and examination to suggest Alzheimer''s disease. Unfortunately, the Folstein Mini-Mental State Exam (MMSE) and the Washington University Clinical Dementia Rating (CDR) were often difficult to score. Mean scores for the MMSE of 7.5 (1 standard deviation, 7.134) and the CDR of 2.08 (1.07) suggested dementia. These observations suggest that impaired intellectual function may be common in this group but there are several limitations on evaluating and interpreting such data.

We compare high-resolution cardiac gated brain magnetic resonance imaging of 19 young healthy subjects with a small group of demented subjects - mainly probable senile dementia of the Alzheimer type (SDAT) - with varying degrees of ventricular enlargement. Computer-measured ventricular volume demonstrated cyclic ventricular size variations in all subjects. During cardiac systole, the lateral ventricles vary in size, an average of 10% in the young cohort (0.109 ± 0.061); the lateral ventricles enlarge, often after an initial decrease in size. A later volume expansion may occur, but the amount varies between subjects. One healthy 60-year-old subject, whose ventricles were slightly larger than those of the younger individuals, and all of the demented subjects, had less enlargement when compared to the average young subject. Two demented subjects with ventriculomegaly had small fluctuations: one had only 6.9% variation, the other subject with larger ventricles had no enlargement. One individual with SDAT had more than a 24% volume change while another subject''s increase was delayed. Our results suggest a complex interplay between blood flow, brain compliance and CSF outflow resistance. This small study further suggests that the choroid plexus plays an important role in systole-related lateral ventricular changes, that changes in choroid plexus function may occur in hydrocephalus and that CSF dynamics may be impaired in SDAT disease.