Visuospatial Function

Visuospatial impairment in AD may affect either constructional or visuoperceptive ability, and these may reflect the involvement of the dorsal or ventral streams of neuronal processing, respectively. Constructional impairment is unlikely to be a presenting symptom, but it can be detected through formal assessment and may relate to parietal lobe dysfunction, particularly in the right hemisphere. Assessment procedures include the block design subtest from the Wechsler Adult Intelligence Scale, which usually reveals impairment in moderate dementia but can detect difficulties in the mild form. A simpler alternative is to require the patient to draw a series of line drawings, with drawing impairment frequently observed in early AD. There are some indications that drawing to command (e.g., the patient is requested to "draw a clock'') is more sensitive than copying drawings. Additionally, copying three-dimensional figures such as a cube tends to reveal impairment more readily than copying unidimensional figures. Many of these procedures, however, may confound constructional dysfunction with problems of praxis or planning. Visuoperceptual impairment may in part underlie impairment associated with naming objects. This is supported by the fact that naming impairment is increased when photographs of objects or line drawings are used rather than the actual objects.

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