Neuropsychology has an important role in a comprehensive psychogeriatric evaluation, especially in the assessment of dementia where the diagnosis is based on behavior. Current issues in the neuropsychology of aging and dementia in the oldest-old are discussed: the principal problem in the prevailing normative approach to discriminating between normal cognitive aging and pathology; the greater interindividual variability and, as a consequence, a need for subclassifications of individuals according to well-defined criteria; tests designed for cognitively impaired elderly and a contextual neuropsychological assessment procedure. Data from two ongoing Swedish studies of the oldest-old, illustrating some of these issues, are presented.