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The manifestations are many and varied and include problems with orientation, short or fluctuating attention span, loss of recent memory and recall, impaired judgment, emotional lability, lack of initiative, impaired impulse control, inability to reason through problems, depression (worse in mild to moderate types), confabulation (not limited to alcohol organic brain syndrome), constriction of intellectual functions, visual and auditory hallucinations, and delusions Physical findings will naturally vary according to the cause The EEG usually shows generalized slowing in delirium

centrate, maintain attention, and sustain purposeful behavior ( Sundowning mild to moderate delirium at night is more common in patients with preexisting dementia and may be precipitated by hospitalization, drugs, and sensory deprivation) There is a marked deficit of short-term memory and recall Anxiety and irritability are common Amnesia is retrograde (impaired recall of past memories) and anterograde (inability to recall events after the onset of the delirium) Orientation problems follow the inability to retain information Perceptual disturbances (often visual hallucinations) and psychomotor restlessness with insomnia are common Autonomic changes include tachycardia, dilated pupils, and sweating The average duration is about 1 week, with full recovery in most cases Delirium can coexist with dementia

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(See also 4) Dementia is characterized by chronicity and deterioration of selective mental functions Onset is insidious over months to years in most cases Formal cognitive screens can quantify impairments and point to the need for further evaluation The Mini-Mental State Examination produces a numerical score with up to 30 points given for correct answers to questions (likely organic < 27 points) (see Figure 4 3) Specific cognitive assessment must be performed, since many patients are able to cover a deficit in routine conversation

The C# equals operator (==) tests for equality between the objects on either side of the operator. This operator evaluates to a Boolean value (true or false). Thus, the statement:

Delirium (acute confusional state) is a transient global disorder of attention, with clouding of consciousness, usually a result of systemic problems (eg, drugs, hypoxemia) Onset is usually rapid The mental status fluctuates (impairment is usually least in the morning), with varying inability to con-

Disorder Intoxication Drug withdrawal Long-term effects of alcohol Infections Endocrine disorders Possible Causes Alcohol, sedatives, bromides, analgesics (eg, pentazocine), psychedelic drugs, stimulants, and household solvents Withdrawal from alcohol, sedative-hypnotics, corticosteroids Wernicke-Korsakoff syndrome Septicemia; meningitis and encephalitis due to bacterial, viral, fungal, parasitic, or tuberculous organisms or to central nervous system syphilis; acute and chronic infections due to the entire range of microbiologic pathogens Thyrotoxicosis, hypothyroidism, adrenocortical dysfunction (including Addison s disease and Cushing s syndrome), pheochromocytoma, insulinoma, hypoglycemia, hyperparathyroidism, hypoparathyroidism, panhypopituitarism, diabetic ketoacidosis Hypoxia, hypercapnia Fluid and electrolyte disturbances (especially hyponatremia, hypomagnesemia, and hypercalcemia), acid-base disorders, hepatic disease (hepatic encephalopathy), renal failure, porphyria Deficiency of vitamin B1 (beriberi), vitamin B12 (pernicious anemia), folic acid, nicotinic acid (pellagra); proteincalorie malnutrition Subdural hematoma, subarachnoid hemorrhage, intracerebral bleeding, concussion syndrome Myocardial infarctions, cardiac arrhythmias, cerebrovascular spasms, hypertensive encephalopathy, hemorrhages, embolisms, and occlusions indirectly cause decreased cognitive function Primary or metastatic lesions of the central nervous system, cancer-induced hypercalcemia Ictal, interictal, and postictal dysfunction Autoimmune disorders, including systemic lupus erythematosus, Sj gren s syndrome, and AIDS Alzheimer s disease, Pick s disease, multiple sclerosis, parkinsonism, Huntington s chorea, normal pressure hydrocephalus Anticholinergic drugs, antidepressants, H2-blocking agents, digoxin, salicylates (chronic use), and a wide variety of other over-the-counter and prescribed drugs

This separation minimizes coupling between related program components and, in some cases, eliminates the need for recompiling a program if a resource element changes. For example, imagine you are developing an application and are implementing error-handling routines. Commonly, programmers hardcode error strings into the application code. If you decide to change an error message, you must recompile the program. File forks change this scenario. Instead, you add error strings to the resource fork within the string resource. Now, if an error message changes, it is independent of the program code no recompilation is required. Figure C.4 shows a typical resource fork for an application.

Respiratory disorders Metabolic disturbances Nutritional deficiencies Trauma Cardiovascular disorders Neoplasms Seizure disorders Collagen-vascular and immunologic disorders Degenerative diseases Medications

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consequences of one s actions are often present The course depends on the underlying cause (eg, frontal lobe contusion may resolve completely)

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