Presenile dementia due to widespread degeneration of brain cells into tangled, threadlike structures; first described by the German neurologist Alois Alzheimer (1864- 1915) in 1907.Unlike senile dementia, the cortical atrophy in this rare disease begins around fifty years of age, progresses rapidly, and often leads to severe language impairment. The behavioral and intellectual symptoms vary widely from case to case, but three general stages are frequently observed. Stage 1 involves gradual loss of memory, poor perception and reasoning, and inefficiency in everyday tasks. In stage 2, intellectual and emotional impairment become widespread, and confabulation, depression, and irritability are common symptoms. As the disease progresses, the patient begins to wander restlessly about, laughs and cries without apparent reason, frequently develops slurred speech and loses the ability to read and write (alexia, agraphia). In the third, or terminal, stage, the patient is increasingly disoriented and incoherent, cannot recognize relatives, and becomes so feeble and emaciated that he can only lead a vegetative existence. Occasional remissions occur in the earlier stages of Alzheimer’s disease, but in most instances the patient dies within four or five years. Treatment consists mainly of routine medical, nursing and custodial care. Although the cause of the disease is still unknown, research indicates that it might be due to a metabolic defect which may be either acquired or inherited. See senile psychosis (general), brain disorders. Illustrative Case: Alzheimer’s disease W.M. was admitted to the hospital at the age of fifty-two. The patient’s early life, including medical history, does not appear to have been significant. The onset of his mental disorder was so insidious that his wife was able to give only an approximate date. About five or six years before his admission, he began to show less affection toward his family. His wife added that at about the same time “he grew lazy and his interests gradually dulled. He had a habit of just sitting around the house. For years he has not mentioned the payment of the interest on his mortgage or his taxes.” About three years before admission his wife noticed that he could not tell time correctly and that he would make errors in writing a check. “He would set out for the store to buy feed for his cows and forget to do so. One time he wanted to walk to his father’s place, thinking that it was just down the road, whereas it was a matter of sixty miles. He grew confused, and on one occasion he stopped the car in the middle of an intersection. He would put on his trousers backward and his overalls inside out. Sometimes, when a dish of food was put on the table for the whole family, he would eat the entire amount himself.” The preadmission history is obviously that of an insidiously developing and progressive dementia. On admission the patient appeared to be older than he actually was. He was completely disoriented for time and place. He did not know whether his home was in Pennsylvania or New Jersey. On the day of admission he said he was thirty- four years of age; on the following day he gave his age as twenty-five and a few weeks later, as eighty. He was careless and untidy in dress and wandered about the ward in a confused and bewildered manner, often mistaking the nurse for his wife.On admission, general hyperreflexia (unusually active reflexes) was noted, but there were no other neurological abnormalities. Prior to his death his extremities showed spasticity. The patient became incontinent AMBIVALENCE 65 of urine; he gradually became weaker and even more demented. In August 1945, nearly two and one half years after admission, he suffered a rather typical epileptic eizure. About September 1, 1945 he became comatose and died nine days later.