Presenile Dementia: Further Experience with an Anticoagulant‐Psychotherapy Regimen*

Abstract

The principles of an anticoagulant-psychotherapy regimen for presenile dementia are discussed. Short histories are given of 10 patients (including one with Huntington's chorea as well as dementia) who responded well to this treatment. It is important to keep the blood prothrombin time at 2.0-2.5 times the control time. The earlier treatment is started, the better the result. Even in cases in which there is n o significant improvement, the prevention of further deterioration is of great value. If properly controlled, this regimen is relatively safe and can maintain or improve the quality of life for dementia patients. When brain deterioration is observed in patients past the age of 70, it is usually accepted as an unfortunate manifestation associated with the aging process. However, when observed in patients of the 40-60 age group, it is one of the most puzzling problems in medicine. Traditionally, age 6 5 is arbitrarily chosen as the dividing line for nomenclature: after that age the brain deterioration is called senile dementia; before that age it is called presenile dementia. It is our hypothesis that they both represent variations of cerebrovascular insufficiency, regardless of age. This paper concerns our recent experience with a therapeutic regimen developed during the past eleven years. Ten patients have responded favorably to this treatment in such a way as to refute the general belief that presenile dementia is an irreversible disorder with a steady downhill course.Nineteen years of general practice have afforded the writer ample opportunity for ob-

Senile‐Presenile Dementia: Follow‐Up Data on an Effective Psychotherapy‐Anticoagulant Regimen*

“…Also discussed was the proposition that these diseases, as well as organic dementia due to arteriosclerosis and several other similar syndromes, have the same cause, i.e., cerebrovascular insufficiency. Brain ischemia as a fundamental factor in dementia has been even more firmly established by our continuing success with treatment (3). Additional support is provided by the numerous reports in the literature that indicate the various ways in which the brain can be deprived of blood.…”

Huntington's Disease: Improvement with an Anticoagulant‐Psychotherapy Regimen

“…Because of this hopeless prognosis and because she showed early signs of organic dementia (in‐distinguishable from presenile dementia except that she had choreic movements), she was offered a trial of treatment that the senior author had found effective in many patients with presenile dementia (2). The entire situation was explained to her and her husband and they requested the recommended trial.…”

“…Treatment was begun in December 1973 after they had signed an “informed consent” form. Anticoagulant therapy was combined with psychotherapy which includes the cooperation of the patient and the family, as described in previous papers (2–4). Warfarin sodium (Coumadin) was used as the anticoagulant.…”

Hypochondriasis Associated with Organic Brain Syndrome: A New Approach to Therapy

“…Sometimes the hypochondriacal symptom is the presenting problem. For example, in a previous paper (4) we described the case of a 60‐year‐old man who complained of pain in the chest wall since the time of a surgical incision there. He had such persistent pain that a sympathectomy was performed to provide some relief.…”