THE TROPHO-NEUROSES OF PARETIC DEMENTIA

Abstract

In presenting for your consideration a brief review of the vasomotor abnormalities exhibited in the clinical history of paretic dementia, I do so, not that I am able to offer anything new, but to accentuate the important part which neuro-angio-paralysis plays in the production of many of the most interesting phenomena of this dreaded malady. The vaso-motor and trophic changes, which are observed in both the early and late stages of the disease, are characteristic and important. Glancing hastily over the clinical picture presented by the early stage of paretic dementia, we find an array of symptoms, some of which, if not all, are found in every case. Among these may be mentioned vertigo, flushing of the face, and other evidences of transient an*nmia and hyperrnmia of the brain; alterations in the tension of the pulse, it being high in the more active forms of the disease and low in the depressive form (Spitzka), frequent attacks of headache, associated with a sense of pressure in the head; occasional slight apoplectiform attacks, and many other symptoms familiar to all who have observed cases of paretic dementia in their incipiency. These symptoms are, however, evanescent in character, failing to furnish satisfactory evidence of structural changes in the interstitial or parenchymatous tissues of the brain, they are explicable only on the hypothesis of vaso-motor paralysis. The mental symptoms at this stage of the disease also bear evidence of very slight cerebral disturbance, and are accounted for more satisfactorily by the theory of functional circulatory disturbances than by the belief that real structural changes in the cerebral tissues have occurred. The slight impairment of the mind, which makes its appearance and progresses so slowly; the sudden attacks of mental confusion, synchronous with the flushing of the face and the attacks of cerebral congestion; the blunting of the finer sensibilities, the mild exhileration, the abnormal development of the Ego, the unnatural changeableness of the moods and temper of a formerly well-balanced