... distributing the numbers properly, or whether the patient perseverates or forgets the task and continues numbering past 12• Ask the patient to placehandson the clockshowing the time to be10minutesafter11.Patientswith ... 2008Nosubjectivecomplaintsofmemorydecit.Nomemorydecitevidentonclinicalinterview.Subjectivecomplaintsofmemorydecit,mostfrequently in followingareas:(a)forgettingwhereonehasplacedfamiliarobjects;(b)forgettingnamesoneformerlyknewwell.Noobjectiveevidenceofmemorydecitonclinicalinterview.Noobjectivedecits in employmentorsocialsituations.Appropriateconcernwithrespect to symptomatology.Earliestclear-cutdecits.Manifestations in morethanoneof the followingareas:(a)patientmayhavebecomelostwhentraveling to anunfamiliarlocation;(b)co-workersbecomeawareofpatient'srelativelypoorperformance;(c)word and namendingdecitbecomesevident to intimates;(d)patientmayreadapassageorabook and retainrelativelylittlematerial;(e)patientmaydemonstratedecreasedfacility in rememberingnamesuponintroduction to newpeople;(f)patientmayhavelostormisplacedanobjectofvalue;(g)concentrationdecitmaybeevidentonclinicaltesting.Objectiveevidenceofmemorydecitobtainedonlywithanintensiveinterview.Decreasedperformance in demandingemployment and socialsettings.Denialbegins to manifest in the patient.Mild to moderateanxietyaccompaniessymptoms.Clear-cutdecitoncarefulclinicalinterview.Decitsmanifest in followingareas:(a)decreasedknowledgeofcurrent and recentevents;(b)mayexhibitsomedecit in memoryofonespersonalhistory;(c)concentrationdecitelicitedonserialsubtractions;(d)decreasedability to travel,handlenances,etc.Frequentlynodecit in followingareas:(a)orientation to time and place;(b)recognitionoffamiliarpersons and faces;(c)ability to travel to familiarlocations.Inability to performcomplextasks.Denialisdominantdefensemechanism.Flatteningofaffect and withdrawalfromchallengingsituationsfrequentlyoccur.Patientcannolongersurvivewithoutsomeassistance.Patientisunableduringinterview to recallamajorrelevantaspectoftheircurrentlives,e.g.,anaddressortelephonenumberofmanyyears, the namesofclosefamilymembers(suchasgrandchildren), the nameof the highschoolorcollegefromwhichtheygraduated.Frequentlysomedisorientation to time(date,dayofweek,season,etc.)or to place.Aneducatedpersonmayhavedifcultycountingbackfrom40by4sorfrom20by2s.Personsatthisstageretainknowledgeofmanymajorfactsregardingthemselves and others.Theyinvariablyknowtheirownnames and generallyknowtheirspouse’s and children’snames.Theyrequirenoassistancewithtoileting and eating,butmayhavesomedifcultychoosing the properclothing to wear.Mayoccasionallyforget the nameof the spouseuponwhomtheyareentirelydependentforsurvival.Willbelargelyunawareofallrecentevents and experiences in theirlives.Retainsomeknowledgeoftheirpastlivesbutthisisverysketchy.Generallyunawareoftheirsurroundings, the year, the season,etc.Mayhavedifcultycountingfrom10,bothbackward and, sometimes,forward.Willrequiresomeassistancewithactivitiesofdailyliving,e.g.,maybecomeincontinent,willrequiretravelassistancebutoccasionallywillbeable to travel to familiarlocations.Diurnalrhythmfrequentlydisturbed.Almostalwaysrecalltheirownname.Frequentlycontinue to beable to distinguishfamiliarfromunfamiliarpersons in theirenvironment.Personality and emotionalchangesoccur.Thesearequitevariable and include:(a)delusionalbehavior,e.g.,patientsmayaccusetheirspouseofbeinganimpostor,maytalk to imaginarygures in the environmentor to theirownreection in the mirror;(b)obsessivesymptoms,e.g.,personmaycontinuallyrepeatsimplecleaningactivities;(c)anxietysymptoms,agitation and evenpreviouslynonexistentviolentbehaviormayoccur;(d)cognitiveabulia,i.e.,lossofwillpowerbecauseanindividualcannotcarryathoughtlongenough to determineapurposefulcourseofaction.Allverbalabilitiesarelostover the courseofthisstage.Frequentlythereisnospeechatall,onlyunintelligibleutterances and rareemergenceofseeminglyforgottenwords and phrases.Incontinentofurine,requiresassistancetoileting and feeding.Basicpsychomotorskills,e.g.,ability to walk,arelostwith the progressionofthisstage. The brainappears to nolongerbeable to tell the body what to do.Generalizedrigidity and developmentalneurologicreexesarefrequentlypresent.Level ... conceptualization may be drawn to placing the hands at 10 and 11 rather than at 11 and 2, or they may fail the task completelyFoldalongthisline to administerCognitive impairment in the elderly – reCognition,...