Clinical Features

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Impairment of memory, particularly recent memory, is gradual and progressive. Remote memories are often preserved. Impairment of memory and orientation with preservation of motor and speech abilities is said to be characteristic of the onset of Alzheimer's disease. 10 Degenerative dementias, such as Alzheimer's disease, may be divided into early, middle, and late stages.11 Early in the disease, complaints of memory loss, naming problems, or forgetting items are common. The middle stage shows progression of these problems plus loss of reading, decreased performance in social situations, and losing directions. Late stage of the illness may include extreme disorientation, inability to dress and perform self-care, and personality change. Typically, the onset of symptoms is slow and gradual; if the onset of symptoms is acute the possibility of a reversible process (T§ble,.221-Z) is increased. Clinical features of Alzheimer's disease or other dementias may include affective symptoms such as depression and anxiety, behavioral disorders, and speech difficulties.

Vascular or multi-infarct dementia has symptoms similar to AD but may have findings on physical examination of exaggerated or asymmetric deep tendon reflexes, gait abnormalities, or weakness of an extremity.11

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