Among the relics in all hospitals and asylums for the insane are many in whom the fire of maniacal exaltation has burned out. They lack all consecutive mental activity. To the loss of intellectual power and volition is added the failure of motor power. The subject has become a paralytic and sits or lies in bed, or on the floor, staring vacantly, taking no notice of his surroundings, passing urine and faeces unconsciously, eating every thing placed before him, or put into his mouth, and sometimes picking up and swallowing the most disgusting things.
Speech is often defective in consecu tive dementia. It is slurring or lisping, and sometimes stammering, or syllables arc cut off or dropped out of words. This may be due to structural change in the speech-centre or defect in the conduction of efferent impulses. At times there is mnemonic aphasia.
Diagnosis.—Consecutive dementia re sembles in many respects idiocy and im becility, from which it is easily differen tiated by the history. General paresis rarely offers any difficulty, as the active delusions in this disease differentiate it readily from consecutive dementia.
Prognosis.—Consecutive dementia, be ing due to structural alteration in brain tissue, is, in the present state of knowl edge, incurable. It is often not actively progressive, and the dement may live in good physical health and weakened mental power for many years. In insti tutions for the insane tuberculosis finds most of its victims among the subjects of dementia.
Treatment.—This is purely symptom atic. Systematic employment and care ful attention to nourishment and sleep will make most dements comfortable.
Senile Dementia.
Definition. — Senile dementia is a chronic, progressive weak-mindedness due to structural alteration in the brain occurring in advanced life.
Symptoms and Course.—As the phys ical powers decay with advancing years, the intellectual functions also become imperfect. There is in some cases a gradual alteration of the character of the person.
Memory of recent occurrences usually impaired, while the recollection of past events is sometimes very detailed, if not exact. Old stories are told and retold without remembering that they were told before. The subject becomes suspicious of his relatives and friends, is easily excited and irritated, misplaces articles and, forgetting where they were placed, accuses others of stealing them.
Among the prominent symptoms are increased sexual desire, with diminution of power to perform the sexual act. The patient not rarely makes unseemly ex posure of his person, and, as if conscious of his sexual incapacity, commits inde cent assaults upon young girls.
The senile dement is obstinate and vain. He will not recognize the fact that his physical and mental powers are waning, but insists that he is as capable of conducting his business and other affairs as when in the prime of life. Thus, the doctor who is the victim of beginning senile dementia believes him self more capable than ever of attending to his professional duties, and resents the imputation that he is getting too old to do his work properly. The clergyman knows that he can and does preach bet ter sermons than ever, and attributes the decrease in size of his congregation, if he notices it at all, to the influence of envi ous opponents who are endeavoring to lead his people away for selfish reasons. The story of the Archbishop of Granada in "Gil Blas" is an exquisite example of senile dementia.
Among the more striking physical symptoms are those associated with structural alterations in the central nerv ous system. There is usually a halting or lisping speech; the gait becomes slovenly or shuffling; there is loss of con trol over the sphincters, the urine and alvine evacuations passing into the clothing and bed unconsciously. There are also occasional slight paralytic strokes, sometimes with temporary loss of consciousness. These are, however, generally quickly recovered from.
The sleep is usually disturbed, al though in the later stages the opposite condition, a constant desire to sleep, may be present.
There is often a great tendency to stray away, requiring the patient to be constantly watched.
Senile dementia is rare before the sixtieth year. Its course is usually slow, running over several years. Striking im provement is sometimes observed, though it is rarely permanent. In the later stages when the patients are confined to bed, there are often large bed-sores, which increase the difficulty of treat ment.