Diagnosis.—The history of the case is usually sufficient to prevent mistake. Some tardy cases of general paresis may be confounded with senile dementia, but a short period of observation should be sufficient to make a definite diagnosis.
The causation of senilo insanities con sidered as those so remote as to have been beyond control, those in action in earlier periods of life, and those in action when senility is impending. Under the second class, which are within the range of medical direction, are principally the causes of vascular change and prema ture senility of the arteries. These are chronic alcoholism, syphilis, gout, rheu matism, venereal excess, great and pro longed physical strain, and intense and long-continued mental application, with anxiety or worry and lack of self-con trol. Ralph Lyman Parsons (Med. Record, Oct. 10, '90).
Reports on 192 autopsies in two years. In a large number of senile dements the fundamental cause consisted in atherom atolls degeneration of the cerebral blood vessels and in the frequently resulting atrophy of the brain. These anatomical changes stand as the basis of senile de mentia. Adolf Meyer (Path. Report, Ill. East. Hosp. for the Insane, '96).
Prognosis.—This is unfavorable. Re covery of normal mental function never takes place.
Treatment.—The treatment is symp tomatic. The patient needs constant care to keep him clean, to prevent stray ing off, and to avert injury likely to re sult from his carelessness.
When there is defective circulation a mild stimulant may be useful. Sleep is
?best induced by malt liquors, paralde Iyde, trional, or opium. Chloral should e avoided on account of its depressing effects.
Epileptic Dementia.
Definition.—A form of dementia oc curring in advanced stages of epilepsy, due to structural alterations in brain tissue.
Symptoms and Course.—A large pro portion of epileptics are attacked by a secondary dementia, which is usually progressive.
In the early stages there are frequent outbreaks of violence, which may be due to hallucinations or delusions. The epileptic dement is often extremely dan gerous from the sudden and unpro voked character of the violent outbreaks. He is usually quarrelsome with the weak and peaceably inclined, but soon acquires a wholesome respect for those who strike back. He usually makes constant coin plaints, often false, of ill-usage on the part of others. Untruthfulness is so fre quent among epileptic dements that it may be almost regarded as a character istic.
In advanced cases the failure of the mental and physical powers becomes very noticeable. The speech is affected and control of the sphincters is lost. Most patients die in status epilepticus, of intercurrent pneumonia, or of exhaus tion.
Treatment.—All epileptic dements should he placed in appropriate institu tions on account of the danger from out breaks of violence. The usual remedies for epilepsy may delay the progress of the dementia, but no hope of arresting it can be entertained.