This paper describes internal psychological changes occurring secondary to the cognitive alterations of dementia of the Alzheimer's type. The relevance of psychodynamic models is reviewed with special emphasis on the interaction of dementia on processes conceptualized through self-psychology and object relations. Processes which are specifically altered by dementia of the Alzheimer's type and which are essential to the maintenance of the self, are memory, reality testing, insight and aspects of premorbid personality development. Clinical implications are outlined including environmental response to the patient's narcissistic needs, and containment of anxiety behavior.
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