Clinical Findings in Presenile Dementia A Report of 50 Cases

Fifty clinically diagnosed cases of presenile dementia were reviewed retrospectively, noting recorded symptomatology and findings on mental status, neurological and ancillary examinations at the time of definitive diagnosis. Manifest symptoms were numerous and varied over time but not in any uniform fashion which would allow the identification of stages of illness. The most frequent symptom was change in personality or behavior (78 per cent of the sample) whereas the most consistent symptom longitudinally was impairment of memory (present in at least 50 per cent of patients over time). A significant association of patient age at the time of symptom onset and at first physician contact with the character of the presenting symptoms at these times was identified. When symptoms were characteristically psychiatric rather than neurological in nature, patients had significantly earlier onset and earlier physician contact. Formal mental status examinations were notable in their consistently high frequency of classical signs of organic brain syndrome. Manifestations of psychosis and of a catastrophic reaction were uncommon. Neurological examination was abnormal in 84 per cent of the sample, with the most frequent finding being the presence of one or more release reflexes. Pneumoencephalography or computerized cerebral axial tomography was abnormal in all cases, in part a function of selection criteria. Electroencephalography was abnormal in 69 per cent of 48 cases, showing diffuse slowing in all but two instances. A normal electroencephalogram was present significantly more often when cerebral atrophy was limited to the cortical surfaces than when ventricular dilatation was present. Release reflexes were found to be significantly more common among patients with an abnormal as opposed to a normal electroencephalogram. No significant correlations among pattern and degree of cerebral atrophy, findings on neurological examination, signs of organic brain syndrome, and patient age and sex were apparent. Interpretation and implications of the results are discussed. The variability of clinical findings among patients, as well as over time, makes the establishment of specific diagnostic criteria difficult and raises again the question of whether presenile dementia constitutes a distinct clinical entity in the absence of tissue diagnosis.