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A diagnosis of Alzheimer's disease (AD) can only be made in the presence of significant impairments in at least two areas of cognitive function, [1,2] and episodic memory loss is one of the most common symptoms early in dementia. Nevertheless, studies on the neuropsychological characteristics of AD revealed the existence of various ``subgroups'' of individuals who initially present with specific patterns of deficits. Patients in these subgroups meet the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association [2] criteria for the diagnosis of probable AD but exhibit distinctive cognitive profiles, such as pronounced deficits in visuospatial functions, lexical/semantic abilities, and executive functions. [3-6] The analysis of AD patient subgroups reveals important information about patterns of CNS functional abnormalities, which are assumed to reflect the structural integrity of the brain. These patterns of impairment correspond to the altered regional CNS function as revealed by PET, [7,8] demonstrating a close link between loss of brain function and abnormal cognition. To the extent that patterns of impairment consistent with theoretical notions of brain-behavior relationships are uncovered, patients with specific neuropsychological characteristics may have different cortical areas affected. A few studies have attempted to further elucidate the nature of these subgroups. For example, Martin et al. [5] found correlations between general deficit pattern (lexical/semantic versus visuospatial) and regional cerebral glucose metabolism, and Becker [3] found differential rates of decline among some of the subgroups.
Within the domain of memory, it is possible to identify subgroups of patients with either a profound amnesic syndrome and normal executive functions or with a significant dysexecutive syndrome and normal secondary memory. [3,9] A subsequent longitudinal analysis [10] revealed that the pattern of decline in these two subgroups of patients differs, with the dysexecutive patients demonstrating a dramatic loss of …
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