... RefertoCommunityMental Health Services for signicant and complexmental health conditionsaffecting the health and care of the patient and caregiverRationaleAlzheimer’sdisease(AD) and relateddementiasareprogressive,irreversibledegenerativebraindiseases ... Read the words on this page and then do what it says.Then,hand the person the sheetwithCLOSEYOUREYESonit.If the subjectjustreads and doesnotcloseeyes,youmayrepeat:Read the words ... 2008Nosubjectivecomplaintsofmemorydecit.Nomemorydecitevidentonclinicalinterview.Subjectivecomplaintsofmemorydecit,mostfrequentlyinfollowingareas:(a)forgettingwhereonehasplacedfamiliarobjects;(b)forgettingnamesoneformerlyknewwell.Noobjectiveevidenceofmemorydecitonclinicalinterview.Noobjectivedecitsinemploymentorsocialsituations.Appropriateconcernwithrespecttosymptomatology.Earliestclear-cutdecits.Manifestationsinmorethanoneof the followingareas:(a)patientmayhavebecomelostwhentravelingtoanunfamiliarlocation;(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 spouseuponwhomtheyareentirelydependent for survival.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...