Presbyphrenia

PRESBYPHRENI, a variety of senile dementia characterized by a sharp disturbance of the ability to memorize and recall memory while retaining some emotional reactivity and, to a partial extent, even the ability of formal thinking, and with relatively correct behavior. The disease begins in advanced age (after 65–70 years) and develops slowly; a more rapid development (within several months and even weeks) is less common. The patient becomes extremely forgetful, especially a sharp weakening of memory for recent events. New impressions are almost completely not memorized; only affectively colored experiences are usually retained in memory for a relatively long time. Memory for distant events is preserved better, but also weakened. Knowledge and professional skills are lost. Only everyday information, various trifles necessary in everyday life and connected with habits, to a greater or lesser extent, are preserved. Gaps in memory are often filled with false memories, confabulations (similar to the Korsakoff syndrome). Due to the disturbance of memory and the ability to memorize, orientation in place, time, and to a partial extent in the surroundings is disturbed. At the same time, the patient is capable of correct inferences and judgments within the limits accessible to him, and does not make gross logical errors. Usually he is good-natured, affable, accessible, emotionally mobile, capable of participating in the experiences of those around him, understands jokes, and is aware, although not entirely, of his pathological condition. Behavior is generally correct, courteous, although misunderstandings are possible due to the disturbance of orientation. In addition, such patients are often characterized by night restlessness, fidgetiness. Hallucinations are usually absent; delusional ideas (most often of persecution) occur episodically, not occupying an important place in the picture of the disease. Focal phenomena (in cases not complicated by arteriosclerosis) do not occur. The course is not disturbed (except for forgetfulness of one's own names, terms, etc.). During the disease, fluctuations are possible, but more often the picture of the disease remains unchanged for several years. In other cases, the disease passes into the ordinary form of senile dementia (with emotional blunting, disturbances on the part of consciousness, disturbances in the sphere of drives, completely incorrect behavior, etc.). Death occurs from senile marasmus or from accidental somatic diseases. The prognosis is generally unfavorable. Treatment consists of maintaining the patient's strength. Diagnosis does not present great difficulties. Differentiation has to be made from arteriosclerotic psychoses (to which the focal nature of disturbances is characteristic), Korsakoff's psychosis (see) (more early age, polyneuritis), and from other forms of senile dementia (to which emotional blunting, sharp disturbance of behavior, less pronounced disturbances of memorization, etc., are characteristic). Pathological anatomy of P., as well as of other forms of senile dementia, is characterized by diffuse degenerative changes in nervous tissue, fatty transformation of nervous elements, Alzheimer's changes of fibrils, the presence of senile drusen, peculiar changes of glia, etc.; the vessels in cases without complicated arteriosclerosis are little changed. Thus, anatomical changes confirm the belonging of P. to senile dementia.

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