Although gradual global progression is one of the cardinal features of primary degenerative dementia of the Alzheimer type, clinical observation of patients suggested that there is some variability in the degree and rapidity of decline of different symptoms of this illness. In particular, it appeared that language fluency and self-awareness of memory problems did not decline simultaneously. This study was designed to test the hypothesis that an inverse relationship exists between self-awareness and fluency in patients with Alzheimer's disease. Thirty-two patients suffering from Alzheimer's disease were divided into two groups on the grounds of presence or absence of self-awareness of memory handicaps. These patients were also assessed in regard to fluency using a three-point scale devised for this purpose. A significant inverse association was found between self-awareness and fluency. This appeared to be a specific relationship, unrelated to global indicators of function including Mini-Mental Status Evaluation, Aphasia Screening Test scores or demographic features. Possible implications of this with reference to intracerebral localization issues in mild-moderate Alzheimer's disease are discussed.K E Y WORDS-Alzheimer's disease, language, fluency, self-awareness, memory.

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