A NOTE ON TYPE OF ONSET IN RELATION TO CLINICAL TYPE IN GENERAL PARALYSIS
Abstract
1. In a series of 74 cases of general paralysis, the earliest onset of the disease was marked, in 57 (77 per cent), by abnormality in the emotional sphere of one of two forms: Irritability (in 29), or a seclusive and apathetic type of reaction (in 15); in 13 cases there occurred first the one and then the other as an early symptom.
2. Little correlation appears to exist between the type of onset, in this sense, and the clinical type of general paralysis which later develops, save with regard to the "manic" cases of the fully developed disease; for the patients with an "irritable" onset contributed 30 per cent of the "manic" cases as compared with 19 per cent of the latter in the group as a whole, while 100 per cent of these cases had an "irritable" rather than a "seclusive" type of onset when either of these forms of emotional alteration had a place among the earliest changes observed. In this respect the expansive cases did not differ from the group as a whole. On the part of the simple dementing cases there was, of the two, a slight tendency toward seclusiveness rather than irritability as an initial or early symptom.
3. Loss of weight, increased tendency to sleep, and perhaps also forgetfulness, when these appeared among the earliest symptoms noted, were without significance with regard to the clinical type of paresis which subsequently developed.
4. Of 11 patients who very early exhibited speech defect, all but one fell later into the category of simple dementing cases.
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