"A well defined type of psychosis which as a rule develops gradually and is characterized by the following symptoms: Impairment of retention (forgetfulness) and general failure of memory more marked for recent experiences; defects in orientation and a general reduction of mental capacity; the attention, concentration and thinking processes are interfered with; there is self-centering of interests, often irritability and stubborn opposition; a tendency to reminiscences and fabrications. Accompanying this deterioration there may occur paranoid trends, depressions, confused states, etc. Certain clinical types should therefore be specified, but these often overlap:
"(a) Simple deterioration: Retention and memory defects, reduction in intellectual capacity and narrowing of interests; usually also suspiciousness, irritability and restlessness, the latter particularly at night.
"(b) Presbyophrenic type: Severe memory and retention defects with complete disorientation; but at the same time preservation of mental alertness and attentiveness with ability to grasp immediate impressions and conversation quite well. Forgetfulness leads to absurd contradictions and repetitions; suggestibility and free fabrication are prominent symptoms. (The general picture resembles the Korsakow mental complex.)
"(c) Delirious and confused types: Often in the early stages of the psychoses and for a long period the picture is one of deep confusion or of a delirious condition. "(d) Depressed and agitated types: In addition to the underlying deterioration there may be a pronounced depression and persistent agitation.
"(e) Paranoid types: Well marked delusional trends, chiefly persecutory or expansive ideas, often accompany the deterioration and in the early stages may make the diagnosis difficult if the defect symptoms are mild.
"(f) Pre-senile types: The so-called 'Alzheimer's disease.' An early senile deterioration which usually leads rapidly to a deep dementia. Reported to occur as early as the fortieth year. Most cases show an irritable or anxious depressive mood with aphasic or apractic symptoms. There is apt to be general resistiveness and sometimes spasticity.
"(g) Other types."
The frequency of senile cases is shown by the fact that of 84,143 admissions to the New York hospitals during a period of sixteen years, 12,017, or 14.2 per cent, were over sixty years of age, while 8.4 per cent were between sixty and seventy years old, and 4.5 per cent between seventy and eighty. Of 49,640 first admissions to the New York state hospitals during eight years 4,724 cases, or 9.52 per cent, were diagnosed as senile psychoses. They constituted 9.63 per cent of the admissions in Massachusetts during 1919 and 10.61 per cent of the 18,336 admissions to twenty-one hospitals in fourteen other states. Of 70,987 admissions to all of the institutions referred to, 6,961, or 9.8 per cent, were senile psychoses.
During a period of eight years in the New York state hospitals, when the present classification was not adhered to absolutely, 4,724 senile psychoses were divided into types as follows:—Simple deterioration, 52.01 per cent; presbyophrenia, 5.75 per cent; delirious and confused states, 12.99 per cent; depressed and agitated forms, 8.25 per cent; and paranoid varieties, 16.23 per cent. During the same period less than one per cent of presenile psychoses were reported. Since the Association's classification has been in use the same institutions show the following distribution of 1,351 senile psychoses during 1918 and 1919:—Simple deterioration, 56.24 per cent; presbyophrenia, 4.14 per cent; delirious and confused states, 13.53 per cent; depressed and agitated forms, 18.65 per cent; and paranoid varieties and presenile forms, less than one per cent. The senile psychoses in the Massachusetts hospitals during 1919 were divided as follows:—Simple deterioration, 56.94 per cent; presbyophrenia, 7.79 per cent; delirious and confused states, 7.45 per cent; depressed and agitated forms, 7.11 per cent; paranoid conditions, 18.64 per cent; and presenile forms, 2.03 per cent. In nineteen hospitals in other states 1,823 cases were classified as follows:—Simple deterioration, 64.39 per cent; presbyophrenia, 11.62 per cent; delirious and confused states, 9.59 per cent; depressed and agitated forms, 4.71 per cent; paranoid conditions, 6.91 per cent; and presenile forms, .27 per cent. The total of 6,842 cases referred to above were, therefore, distributed as to type as follows:—
| Type | Per Cent |
|---|---|
| Simple deterioration | 55.52 |
| Presbyophrenia | 7.40 |
| Delirious and confused states | 11.83 |
| Depressed and agitated forms | 7.26 |
| Paranoid conditions | 13.85 |