“It Looks Like an Island”

This chapter presents the case of “Catherine,” a 49-year-old woman referred for memory difficulties and suspected depression, who was ultimately diagnosed with early-onset dementia of the Alzheimer's type. A multimethod, longitudinal assessment was conducted over twenty-six months, including a medical, neurological, and neuropsychological evaluation, as well as two Rorschach assessments according to Exner's Comprehensive System. The first Rorschach revealed marked constriction, reduced adaptive resources, social withdrawal, vague and avoidant information processing, and significantly disorganized thinking, alongside some preserved capacity to mentalize. The follow-up Rorschach, while psychometrically invalid due to a low number of responses, offered valuable qualitative information consistent with advanced neurocognitive deterioration, including stimulus-bound responding, semantic perseverations, and a loss of the interpretive stance. Across both administrations, the Rorschach provided unique insights into Catherine's emotional experience, cognitive decline, and social withdrawal—elements not fully captured by traditional neuropsychological tests. The chapter illustrates how Rorschach data can contribute meaningfully to differential diagnosis, longitudinal monitoring, understanding individual strengths and weaknesses, and therapeutic engagement with both patients and their families in the context of progressive neurocognitive disorders.