... 2008Nosubjectivecomplaints of memorydecit.Nomemorydecitevidentonclinicalinterview.Subjectivecomplaints of memorydecit,mostfrequently in followingareas:(a)forgettingwhereonehasplacedfamiliarobjects;(b)forgettingnamesoneformerlyknewwell.Noobjectiveevidence of memorydecitonclinicalinterview.Noobjectivedecits in employmentorsocialsituations.Appropriateconcernwithrespecttosymptomatology.Earliestclear-cutdecits.Manifestations in morethanone of the followingareas:(a)patientmayhavebecomelostwhentravelingtoanunfamiliarlocation;(b)co-workersbecomeaware of patient'srelativelypoorperformance;(c)word and namendingdecitbecomesevidenttointimates;(d)patientmayreadapassageorabook and retainrelativelylittlematerial;(e)patientmaydemonstratedecreasedfacility in rememberingnamesuponintroductiontonewpeople;(f)patientmayhavelostormisplacedanobject of value;(g)concentrationdecitmaybeevidentonclinicaltesting.Objectiveevidence of memorydecitobtainedonlywithanintensiveinterview.Decreasedperformance in demandingemployment and socialsettings.Denialbeginstomanifest in the patient.Mildtomoderateanxietyaccompaniessymptoms.Clear-cutdecitoncarefulclinicalinterview.Decitsmanifest in followingareas:(a)decreasedknowledge of current and recent events;(b)mayexhibitsomedecit in memory of onespersonalhistory;(c)concentrationdecitelicitedonserialsubtractions;(d)decreasedabilitytotravel,handlenances,etc.Frequentlynodecit in followingareas:(a)orientationtotime and place;(b)recognition of familiarpersons and faces;(c)abilitytotraveltofamiliarlocations.Inabilitytoperformcomplextasks.Denialisdominantdefensemechanism.Flattening of affect and withdrawalfromchallengingsituationsfrequentlyoccur.Patientcannolongersurvivewithoutsomeassistance.Patientisunableduringinterviewtorecallamajorrelevantaspect of theircurrentlives,e.g.,anaddressortelephonenumber of manyyears, the names of closefamilymembers(suchasgrandchildren), the name of the highschoolorcollegefromwhichtheygraduated.Frequentlysomedisorientationtotime(date,day of week,season,etc.)ortoplace.Aneducatedpersonmayhavedifcultycountingbackfrom40by4sorfrom20by2s.Personsatthisstageretainknowledge of manymajorfactsregardingthemselves and others.Theyinvariablyknowtheirownnames and generallyknowtheirspouse’s and children’snames.Theyrequirenoassistancewithtoileting and eating,butmayhavesomedifcultychoosing the properclothingtowear.Mayoccasionallyforget the name of the spouseuponwhomtheyareentirelydependentforsurvival.Willbelargelyunaware of all recent events and experiences in theirlives.Retainsomeknowledge of theirpastlivesbutthisisverysketchy.Generallyunaware of theirsurroundings, the year, the season,etc.Mayhavedifcultycountingfrom10,bothbackward and, sometimes,forward.Willrequiresomeassistancewithactivities of dailyliving,e.g.,maybecomeincontinent,willrequiretravelassistancebutoccasionallywillbeabletotraveltofamiliarlocations.Diurnalrhythmfrequentlydisturbed.Almostalwaysrecalltheirownname.Frequentlycontinuetobeabletodistinguishfamiliarfromunfamiliarpersons in theirenvironment.Personality and emotionalchangesoccur.Thesearequitevariable and include:(a)delusionalbehavior,e.g.,patientsmayaccusetheirspouse of beinganimpostor,maytalktoimaginarygures in the environmentortotheirownreection in the mirror;(b)obsessivesymptoms,e.g.,personmaycontinuallyrepeatsimplecleaningactivities;(c)anxietysymptoms,agitation and evenpreviouslynonexistentviolentbehaviormayoccur;(d)cognitiveabulia,i.e.,loss of willpowerbecauseanindividualcannotcarryathoughtlongenoughtodetermineapurposefulcourse of action.Allverbalabilitiesarelostover the course of thisstage.Frequentlythereisnospeechatall,onlyunintelligibleutterances and rareemergence of seeminglyforgottenwords and phrases.Incontinent of urine,requiresassistancetoileting and feeding.Basicpsychomotorskills,e.g.,abilitytowalk,arelostwith the progression of thisstage. The brainappearstonolongerbeabletotell the bodywhattodo.Generalizedrigidity and developmentalneurologicreexesarefrequentlypresent.Level ... 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 ... be increased when co-administrated with memantine.OtherAgents: Use of GinkgoBiloba,VitaminE,anti -in ammatorydrugs(suchasNSAIDs),estrogen and statins is not recommended. There is insufficient...