Cortical and Subcortical Dementias: What's the Difference?

Cortical and Sub-Cortical Dementia
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Cortical or Subcortical?

Depending on which part of the brain is suspected as the primary location of dementia, the type of dementia may be classified as either cortical or subcortical. That area will typically demonstrate more physical changes initially, such as atrophy (shrinkage). However, as dementia progresses, the symptoms and effects of both groups of dementia begin to affect multiple areas of the brain.

Cortical Dementia Defined

The cortex of the brain (the word cortical refers to the cortex) is the part most people are familiar with - in appearance at least. The characteristic twists and turns of the outer layers play an important role in processing information and functions such as language and memory.

Cortical dementia is typically associated with the brain's gray matter. When these outer layers are affected, which is the case with Alzheimer's, frontotemporal dementia, Binswanger's disease and Creutzfeldt-Jakob disease, there are problems with memory, the inability to find the right words and in understanding what others are saying (aphasia).

Subcortical Dementia Defined

As the term suggests, these are dementias believed to initially affect structures below the cortex (sub means below) and are more associated with the brain's white matterHuntington's disease, Parkinson's dementia and AIDS dementia complex are three examples of conditions classified as subcortical dementia.

It is more common to see changes in personality and a slowing down of thought processes in subcortical dementias. Language and memory functions often appear largely unaffected in the earlier stages of these dementias.

Suggested Resources


International Journal of English Language Education. 2013. Volume 1, No. 2. Cortical and Subcortical Dementias: A Psychoneurolinguistic Approach.

Neurobiology of Aging. 2015 Apr;36(4):1743-50. Progressive cortical thinning and subcortical atrophy in dementia with Lewy bodies and Alzheimer's disease.

-Edited by Esther Heerema, MSW

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