Dementia

“ Here, then, is the document, written in an accursed house by a brain closed to the world's sights and sounds—a brain left alone and unwarned to the mercies and mockeries of powers that no seeing, hearing man has ever stayed to face. Contradictory as it is to all that we know of the universe through physics, chemistry, and biology, the logical mind will classify it as a singular product of dementia—a dementia communicated in some sympathetic way to the man who burst out of that house in time. And thus, indeed, may it very well be regarded so long as Dr. Arlo Morehouse maintains his silence. ”

“ The Care of Patients in a Condition of Dementia.—It is to be remembered that dementia may be either, a condition of chronic insanity without recovery, or a less permanent state of mental enfeeblement following the acute attack, and from which recovery may be hoped. In the first of these conditions there is little to be done except to care for the patient. Many are able to do some work, and should be allowed, encouraged, and taught to do it. Others do not know enough to dress, feed, or care for themselves. ”

“ Chronic Dementia is generally caused by the gradual action on the mind of grief or anxiety, by severe pain, mania, apoplexy, paralysis, or repeated attacks of epilepsy.
Senile Dementia is a form which is incidental to aged persons, and commences gradually with such symptoms as loss of memory for recent events, dulness of perception, and inability to fix the attention. Later on the reasoning powers begin to fail, and finally, memory, reason, and power of attention, are quite lost, the muscular power and force remaining intact. In the last stage there is simply bare physical existence. ”

“ The name is a very unhappy one, for the dementia is not always precocious, nor in all cases is there dementia. Unfortunately the disease is too often incurable; even in the best cases, in those that recover, where the outside public would not observe any abnormality, there is always really present some defect in the emotional life. The picture presented by the disease is extraordinarily diverse; generally there is some disorder of feeling, frequently delusions and hallucinations. As a rule there is nothing to be found in the brain. ”

“ Although wide differences of opinion still exist on many points, the conviction seems to be gaining ground more and more that dementia praecox on the whole represents a well-defined disease entity, and that we are justified in regarding the majority at least of the apparently dissimilar clinical types here described as the manifestations of a single disease process. ”

“ Everyone has seen such people who are partially or hopelessly demented. It may come from diseases, such as epilepsy and syphilis; alcohol produces it.
Senile dementia is the result of old age and of acquired brain disease. It is different from simple old age or dotage. In old age the mind is weakened, but the patient is conscious of it, such a person forgets a name or date and gropes about in his memory to find it. ”

“ MOST psychiatrists state or tacitly assume that dementia praecox is a disease of a steadily progressive nature, where the first symptom of dementia is a signal for relentless degradation of the patient's mental capacity except in the sphere of the more mechanical, intellectual functions. ”

“ The patient in direct proportion to the degree of his dementia loses his capacity to recognize the reality of his environment or his relationship to it, and builds up more and more a world of his own in which he lives untroubled by the demands of adaptation. No one who has ever argued with a paranoic will forget how keen a sense of reality he may retain, how logical his arguments are, and how reasonable his delusions appear, if only some one point be granted. ”

“ Beyond a tendency on the part of some patients to adopt a whining and complaining manner, the mind remains very clear; in fact, the good nature and complaisance of most of the patients, in spite of the severity of the symptoms, is a matter of common observation. Dementia may, however, complicate a case of the disease. ”

“ As a rule where the patient has passed through the various stages of paranoia, dementia, with symptoms of imbecility, closes the scene. The paranoia may not always follow the course mapped out for it. Stages may be skipped, several forms of delusions may become prominent in the life of the individual at about the same time. The main feature of the disease is its progressive character, and its diagnosis depends on the queerness exhibited all during the course of life, as well as on the presence of hereditary neurotic influences. ”

“ The clinical forms of dementia praecox shown in his last edition are as follows:—dementia simplex, hebephrenia, simple depressive or stuporous dementia, depressive delusional dementia, circular, agitated and periodic forms, katatonia, paranoid types (dementia paranoides gravis and mitis, hallucinatory and paranoid feeblemindedness) and confusional speech or schizophasia. ”

“ Excitements, depressions, confusional states, deliria, deteriorations, mental mechanisms of any and all kinds, occurring late in life, were usually disposed of without any effort at differentiation by the very convenient method of relegating them to the obscure domain of senile dementia. ”

“ He can not be made to understand that the sending of flowers and photographs and letters is entirely distasteful to the chosen one. Fortunately, after a time, in many of these cases, a state of dementia sets in, and then the patients become mild-mannered imbeciles whom it is not at all difficult to manage. ”

“ General Paralysis of the Insane, Paralytic Dementia.—This is a most interesting form of dementia. It is closely allied to, if not identical with, locomotor ataxy. Its most prominent and characteristic symptom consists in delusions of great power, exalted position, and unlimited wealth—megalomania. The exaltation is universal, and the patient may maintain at one and the same time that he is running a theatrical company, that he is the Prince of Wales, and that he is the Almighty. ”

“ If attendants will watch their patients as they come out of acute mania or melancholia and become quiet, they will often notice that they gain in flesh and become demented. The dementia may be but partial, or so very complete that the patient knows nothing. From this they may gradually go on to improvement, or even recovery. They need all the care demanded by the confirmed dement, and, in addition, advantage must be taken of every means to promote recovery. They must be well fed, regularly taken out for exercise, and, as they are able, encouraged to employ themselves. ”

“ The disease picture, even when it appears, has a certain duration and independence. The whole course of the disease is quite narrowly limited in time, and goes on either to recovery or dementia. 6. No tendency to periodicity of the attacks or the grouping of symptoms. 7. Sanity and insanity are sharply defined, and in striking contrast." In this group he includes mania, melancholia, acute curable dementia and primary [492] hallucinatory delirium. He describes hysteria, neurasthenia, etc., under the psychic degenerations with paranoia and speaks of them as constitutional neuroses. ”

“ Alzheimer's disease, a major brain disorder, results in the progressive loss of mental faculties, often beginning with impairment of memory, learning, attention, and judgment. While some types of dementia are curable, Alzheimer's disease is not. In time, it erodes thought, feeling, and behavior and leads to death. ”

“ The morphologically-minded psychiatrist would say: This is just a typical case of dementia praecox; it is the essence of insanity, of madness, to talk of nothing but mysteries; the standpoint of the diseased mind towards the world is displaced, is “mad.” What is no sin for the normal, the patient finds a sin. ”

“ The simple melancholia marking the first stage of paralytic dementia is characterized by noticeable although often slight mental impairment—a distinctly diminished capacity for work, of which the individual himself is not seldom conscious, whereas in the disease simple melancholia the mind's usual power is exerted, provided its attention can be withdrawn from morbid introspection and concentrated upon any subject, as it commonly can be for a while. ”

“ This takes us at once into the field of nervous or mental pathology: the first symptom of paralytic dementia is not the trembling, or alteration of speech, or interruption of certain reflex actions, or muscular weakness, nor the real and actual delirium. The symptom which first manifests itself as an indication of profound disturbance in the personality of the unfortunate victim of this cruel disease is an almost unheralded alteration of the natural character and conduct. The man who hitherto has been a good husband and father, becomes a profligate, spendthrift and gambler ”

“ In cases of dementia, arising apparently from continued pressure on the brain, the surface, from the general bad habit of the system, is liable to sores, boils, and ulcerations. This cannot be called a cutaneous disease; it is rather a symptom of the diseased state of the brain, than itself the cause of insanity. ”

“ In certain cases this disruption of the organs of mind shows itself in old age, and here, it is evident, we have to distinguish what is known as senile dementia from the impairment of faculty incident to old age. ”

“ The mental symptoms may be entirely overlooked in the first stage. There is a gradual progressive deterioration of the personality, with a loss of efficiency, impairment of memory, and failure of judgment. There may be episodes of excitement, depression or delirium, with or without hallucinations and delusions, the latter being either hypochondriacal or grandiose. "The demented type, without marked delusions or sensory falsifications, is the truly typical variety of the disease and the dementia the basal element of all forms" (White) . ”

“ What is of chief concern is that I may succeed in showing my readers how, by certain psychological investigations, I reached certain views, which I deem fit for the stimulation of the problems of the individual psychological basis of dementia præcox in a new and fruitful direction. ”

“ It is clear that the intention is to distinguish mental deficiency from senile dementia, from hysteria and from insanity, in which there is a temporary or permanent loss of mental ability rather than a failure to develop. ”

“ Some of us will die from the top down with dementia more or less developed, while for others some vegetative organ will collapse and drag down with it all the rest of our powers, which might otherwise go on for a decade or two. ”

“ Like all victims of dementia præcox, when the disorder conditions bizarre conduct for the first time in mid-maturity, he becomes profoundly egocentric, neglectful of his appearance and of his person, and callously insensitive to the feelings and rights of others. ”

“ This case was a most striking sample of a great number of a similar description, who are the subjects and victims of this perverse and irregular mental excitation, which become, without proper management, more confirmed cases of mania and melancholia, which continuance in this state for a sufficient time, produces disease, and disorganization of the brain, and ultimately terminates in incurable dementia, either of a partial or more general character. ”

“ The so-called lucid intervals are not uncommon until the final stage of absolute dementia, when attention, memory, judgment, conception, connection of ideas, imagination, desires, the exercise of the senses, general sensibility, after becoming more and more imperfect are at last completely suspended. ”

“ He found little tendency to senile dementia and many of even the very aged had their mental faculties intact and took a keen interest in passing events, possessed clear judgment, and were full of thought for the present and future welfare of others. “It is no less satisfactory to find that the active, even severe and long-continued intellectual activity of the matured brain seems in no way to impair its enduring qualities, and that good, earnest, useful employment of the body and mind are200 not only compatible with but even conducive to longevity.” ”

“ On the other hand, many persons first suffer from mental derangement at an advanced period of life without at the same time manifesting any marked failure of mental power, while others only manifest their insanity as a result of the decay of their mental faculties.
From this statement it will be seen that senile insanity is a complex of different conditions, some of them accompanied by dementia, others without dementia.
Senile Dementia is distinguished occasionally into “senile” properly so called, and “presenile” dementia, which supervenes at middle age or even earlier. ”

“ The varying degrees in which the various portions of the cortex, medullary portion, and different ganglia of the brain may be involved in the morbid process naturally give rise to a great variety in the symptoms, mental and physical, sensory and motor, emotional and intellectual, and in the relative preponderance of one or another in individual cases. The usual symptoms of any form of mental disease may for a time obscure the dementia which sooner or later must appear in general paralysis, and which, as has already been said, is the only mental symptom universally present in all cases. ”

“ A more decided step in the development of the dementia praecox concept was the description by Kahlbaum of katatonia in 1874. This may be ushered in by an early stage strongly suggesting hebephrenia but terminating usually in a depression followed by states of excitement, stupor and dementia. The characteristic [442] features of the disease are the peculiar catatonic stupor so-called, and forms of excitement differing materially from those exhibited in the manic-depressive psychoses. Hallucinations and delusions are almost invariably present. ”