Clinically Kraepelin[168] divides the arteriosclerotic psychoses into deteriorations, or milder forms of mental enfeeblement, dementias, depressions, excitements, late epilepsies, and apoplectic dementia. In the milder forms there is a gradual change in the entire psychic personality, with a later development of more marked changes, either physical, mental or both. The early symptoms are a general reduction of the mental capacity and an impairment of memory. The patient tires easily and loses all evidences of energy, with no inclination to undertake anything new. Familiar names and dates are forgotten. Recent occurrences are particularly lost to memory. The real is confused with the false. In business the patient becomes careless and unreliable, overlooks important transactions and forgets appointments. There are often subjective feelings of impending illness. The mood becomes depressed, whining and tearful. Irritability and outbursts of anger occasionally appear, characterized by a marked emotional instability, varying rapidly from tears to laughter. Suicidal tendencies are sometimes noted. Mild confusional states may be induced by alcoholic indulgences. Early physical symptoms are headache, sensations of fulness and pressure in the head, followed by a feeling of dizziness, fatigue, exhaustion, debility, etc. Sooner or later, following a seizure of some kind, neurological signs appear—drooping of the mouth, lateral deviation of the tongue, weakness of an arm, dragging of one leg, loss of sensation on one side, ankle clonus, an increase, decrease or inequality of the patellar reflexes, and sometimes a Babinski reflex. The pupils are very likely to be unequal and sluggish in reaction. The features present a tired, sleepy expression and speech becomes tremulous and monotonous. There may be a difficulty in finding words, or the misuse of words. There are usually tremors of the fingers and movements are uncertain, the gait being unsteady. Romberg's symptom may be present. Dizzy spells and fainting attacks also occur, sometimes followed by genuine convulsions. Apoplectiform seizures may be observed, with unconsciousness for hours or days. These may be followed by sensory or motor aphasia, unilateral paralysis with or without disturbances of sensation, hemianopsia, alexia, agraphia, asymbolism or apraxia. Cardiac disturbances with anxieties are often complications. These apoplectiform and other severe attacks sometimes occur a long time after mental symptoms have appeared. They are likely to recur, mental deterioration progressing rapidly with the repetition of the seizures.