The clinical symptoms, both mental and physical, are varied, depending in the first place on the distribution and severity of the vascular cerebral disease and probably to some extent on the mental make-up of the person.
The most important mental symptoms (particularly if the arteriosclerotic disease is diffuse) are impairment of mental tension, i.e., interference with the capacity to think quickly and accurately, to concentrate and to fix the attention; fatigability and lack of emotional control (alternate weeping and laughing). Often a tendency to irritability is marked; the retention is impaired and with it there is more or less general defect of memory, especially in the advanced stages of the disease, or after some large destructive lesion occurs.
Pronounced psychotic symptoms may appear in the form of depression (often of the anxious type), suspicions or paranoid ideas, or episodes marked by confusion.
To be included in this group are the psychoses following cerebral softening or hemorrhage if due to arterial disease. (Autopsies in state hospitals show that in arteriosclerotic cases softening is relatively much more frequent than hemorrhage.)
Differentiation from senile psychosis is sometimes difficult, particularly if the arteriosclerotic disease manifests itself in the senile period. The two conditions may be associated; when this happens preference should be given in the statistical report to the arteriosclerotic disorder.
High blood pressure, although usually present, is not essential for the diagnosis of cerebral arteriosclerosis.