DE MENZA
The more or less rapid and complete loss of previously acquired ideational patrimony, occurring in youth or more often after the full development of maturity, due to functional alterations or anatomical lesions of the psychic zones of the cerebral cortex. The faculty of emotional control and the higher powers of intelligence (logic, critical judgment) are particularly affected; the functional block or focal destruction of the localization zones of certain categories of sensory or psychomotor images contributes to the manifestation and aggravation of the mental defect. *De mentia* differs from amentia in that the disturbance of intelligence is linked to the incomplete or insufficient development of the nervous centers.
As regards causes: *de mentia* senilis (linked to involutional processes proper to age), *de mentia* encephalomalacia (from softening and destruction of central nervous elements due to hemorrhages or obstructions of cerebral vessels), *de mentia* syphilitica (from syphilitic lesions of cerebral circulation, similar to those of cerebral arteriosclerosis, or from destruction of cortical elements by spirochetes, as in *de mentia* paralytica), *de mentia* schizophrenica (v. SCHIZOPHRENIA), *de mentia* epileptica, etc. The clinical picture of *de mentia* is usually progressive and irreparable.
DEMENTIA PARALYTICA PROGRESSIVA (PROGRESSIVE PARALYSIS, CHRONIC PERIENCEPHALITIS)
A nervous and particularly mental disease caused by the localization of the spirochete of syphilis in the cerebral cortex; it usually strikes men who were previously healthy and sound of mind, in middle age (30-50 years), who in their youth contracted syphilis, either treating it imperfectly or not at all. The course, though marked by inevitable progression, leads to death in a few years (1-5) in 40% of cases, even with proper treatment, after having caused a complete dissolution of intelligence and character, and a total ruin of the physical organism.
The disease begins with a progressive and slow weakening of intelligence, at first such that it may be attributed to a simple neurasthenic condition (apathy, inactive behavior); subsequently it unfolds in the picture of an ever more manifest *de mentia*, with the gradual disappearance of mnemonic traces, first the most recent, then the most remote and personal (place of birth, marital status, number of children, profession, etc.). Of great importance are the disturbances of the affective sphere (indifference to what happens in the environment and to one's own grave physical decline, which progresses in parallel with the intellectual decline). Deceptive periods of remission may suggest recovery; but the illness inevitably resumes its course to the final consequences.
At intervals, a characteristic psychic exaltation of an euphoric type may appear, by which the patient, despite reality, is convinced of his excellent physical and intellectual condition, assumes a smiling demeanor, becomes loquacious and turbulent; combined with the demential state, true forms of megalomaniacal delusion develop in the patient. At other times, particularly in the early stages of the disease when mental conditions are still good, intelligent patients, aware of their state, may fall into such sadness as to be driven to suicide.
Characteristic of the morbid picture are the symptoms linked to lesions of the motor cortical zones, namely the particular disturbances of speech and writing. The first, dysarthria, in advanced stages makes speech completely incomprehensible due to profound modifications, transpositions, and mutilations of syllables in words. The disturbances of writing (dysgraphia) reveal both the paralytic motor disorder and the mental alterations of the patient; in it appear irregularities of the graphic sign with shaky, uncertain, irregular letters, sometimes reduced to mere scribbles, while the ideational content of the writing becomes empty, puerile, meaningless, clearly betraying the demential state of the patient.
Alongside the mental symptoms, in progressive paralytic dementia nervous symptoms also appear: alterations of pupillary and tendon reflexes, uncertain spastic gait (ataxia), severe alterations of sensitivity up to complete loss of it, disturbances affecting the bladder, in some cases lesions of the cerebral nerves with paralysis of the eyes, tongue, etc., particularly in cases where lesions of the spinal cord also intervene (taboparalysis).
To assess the social gravity of the disease, it suffices to consider the percentage (3-5%) of individuals who, having contracted syphilis, develop progressive paralytic dementia, and, among those hospitalized in asylums, the ratio (ca. 10%) of patients with progressive paralytic dementia to the totality of the mentally ill.
Antisyphilitic treatment, combined with the artificial induction of febrile attacks by inoculating the plasmodium of malaria (malariotherapy), can lead to recovery in 25-30% of patients, and to a similar percentage of patients showing a fair improvement.