... 2008Nosubjectivecomplaintsofmemorydecit.Nomemorydecitevidentonclinicalinterview.Subjectivecomplaintsofmemorydecit,mostfrequentlyinfollowingareas:(a)forgettingwhereonehasplacedfamiliarobjects;(b)forgettingnamesoneformerlyknewwell.Noobjectiveevidenceofmemorydecitonclinicalinterview.Noobjectivedecitsinemploymentorsocialsituations.Appropriateconcernwithrespecttosymptomatology.Earliestclear-cutdecits.Manifestationsinmorethanoneof the followingareas:(a)patientmayhavebecomelostwhentravelingtoanunfamiliar location; (b)co-workersbecomeawareofpatient'srelativelypoorperformance;(c)word and namendingdecitbecomesevidenttointimates;(d)patientmayreadapassageorabook and retainrelativelylittlematerial;(e)patientmaydemonstratedecreasedfacilityinrememberingnamesuponintroductiontonewpeople;(f)patientmayhavelostormisplacedanobjectofvalue;(g)concentrationdecitmaybeevidentonclinicaltesting.Objectiveevidenceofmemorydecitobtainedonlywithanintensiveinterview.Decreasedperformanceindemandingemployment and socialsettings.Denialbeginstomanifestin the patient.Mildtomoderateanxietyaccompaniessymptoms.Clear-cutdecitoncarefulclinicalinterview.Decitsmanifestinfollowingareas:(a)decreasedknowledgeofcurrent and recentevents;(b)mayexhibitsomedecitinmemoryofonespersonalhistory;(c)concentrationdecitelicitedonserialsubtractions;(d)decreasedabilitytotravel,handlenances,etc.Frequentlynodecitinfollowingareas:(a)orientationtotime and place;(b)recognitionoffamiliarpersons and faces;(c)abilitytotraveltofamiliarlocations.Inabilitytoperformcomplextasks.Denialisdominantdefensemechanism.Flatteningofaffect and withdrawalfromchallengingsituationsfrequentlyoccur.Patientcannolongersurvivewithoutsomeassistance.Patientisunableduringinterviewtorecallamajorrelevantaspectoftheircurrentlives,e.g.,anaddressortelephonenumberofmanyyears, the namesofclosefamilymembers(suchasgrandchildren), the nameof the highschoolorcollegefromwhichtheygraduated.Frequentlysomedisorientationtotime(date,dayofweek,season,etc.)ortoplace.Aneducatedpersonmayhavedifcultycountingbackfrom40by4sorfrom20by2s.Personsatthisstageretainknowledgeofmanymajorfactsregardingthemselves and others.Theyinvariablyknowtheirownnames and generallyknowtheirspouse’s and children’snames.Theyrequirenoassistancewithtoileting and eating,butmayhavesomedifcultychoosing the properclothingtowear.Mayoccasionallyforget the nameof the spouseuponwhomtheyareentirelydependentforsurvival.Willbelargelyunawareofallrecentevents and experiencesintheirlives.Retainsomeknowledgeoftheirpastlivesbutthisisverysketchy.Generallyunawareoftheirsurroundings, the year, the season,etc.Mayhavedifcultycountingfrom10,bothbackward and, sometimes,forward.Willrequiresomeassistancewithactivitiesofdailyliving,e.g.,maybecomeincontinent,willrequiretravelassistancebutoccasionallywillbeabletotraveltofamiliarlocations.Diurnalrhythmfrequentlydisturbed.Almostalwaysrecalltheirownname.Frequentlycontinuetobeabletodistinguishfamiliarfromunfamiliarpersonsintheirenvironment.Personality and emotionalchangesoccur.Thesearequitevariable and include:(a)delusionalbehavior,e.g.,patientsmayaccusetheirspouseofbeinganimpostor,maytalktoimaginaryguresin the environmentortotheirownreectionin the mirror;(b)obsessivesymptoms,e.g.,personmaycontinuallyrepeatsimplecleaningactivities;(c)anxietysymptoms,agitation and evenpreviouslynonexistentviolentbehaviormayoccur;(d)cognitiveabulia,i.e.,lossofwillpowerbecauseanindividualcannotcarryathoughtlongenoughtodetermineapurposefulcourseofaction.Allverbalabilitiesarelostover the courseofthisstage.Frequentlythereisnospeechatall,onlyunintelligibleutterances and rareemergenceofseeminglyforgottenwords and phrases.Incontinentofurine,requiresassistancetoileting and feeding.Basicpsychomotorskills,e.g.,abilitytowalk,arelostwith the progressionofthisstage. The brainappearstonolongerbeabletotell the bodywhattodo.Generalizedrigidity and developmentalneurologicreexesarefrequentlypresent.Level ... Ask the patienttoplacehandson the clockshowing the timetobe10minutesafter11.Patientswith faulty conceptualization may be drawn to placing the hands at 10 and 11 rather than at 11 and 2, or they may ... Ask the patienttoplace the numberson the circlelikeaclock.Notewhether the patientusesappropriate planning in distributing the numbers properly, or whether the patient perseverates or forgets the task and continues numbering past 12• Ask the patienttoplacehandson the clockshowing the timetobe10minutesafter11.Patientswith...