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my favorites is the speedometer chart type A speedometer displays one or more key figures in the form of a pointer The speedometer is divided into several value ranges, and the user immediately sees the value range in which the pointer is currently positioned A speedometer only displays one data column of the data provider This is the basic speedometer with no color groups, but it is dramatic enough to catch your interest In the Copyright by SAP AG case of the speedometer chart, I typically turn off the parameter to Swap Display Axis since a swap of pointers with other values in this situation would not show correctly or make any sense The Swap Display Axes setting in the Web Item Parameters tab of the WAD is shown here

pation with personal worries and anxiety, which prevent the focusing of attention on anything except their own problems Even during mental tests, their performance may be impaired by emotional blocking, in much the same way as the worried student blocks during an examination ( experiential confusion ) When such patients are calmed by reassurance and encouraged to try harder, their mental function improves, indicating that intellectual deterioration has not occurred Conversely, it is helpful to remember that demented patients rarely have suf cient insight to complain of mental deterioration; if they admit to poor memory, they do so without conviction or full appreciation of the degree of their disability The physician must not rely on the patient s statements alone in gauging the ef ciency of mental function and should seek corroboration from family members Yet another problem is that of the impulsive, cantankerous, and quarrelsome patient who is a constant source of distress to employer and family Such changes in personality and behavior (as, for example, in Huntington disease) may precede or mask early intellectual deterioration The neuropsychiatric symptoms associated with metabolic, endocrine, or toxic disorders (eg, Cushing syndrome, vitamin B12 de ciency, hypercalcemia, uremia, etc) may present dif culties in diagnosis because of the wide variety of clinical pictures by which they manifest themselves Drowsiness or stupor and asterixis are the surest signs of a metabolic or drug-induced encephalopathy, but they are not always present Psychosis with hallucinations and a great deal of uctuation in behavior also bespeak an exogenously caused confusional state, with the exception that Lewy-body dementia also has these characteristics Whenever any such metabolic or toxic disorder is suspected, a thorough review of the patient s medications is crucial Medications with atropinic activity, for example, can produce an apparent dementia or worsen a structurally based dementia, as discussed in Chap 20 Occupational exposure to toxins and heavy metals should also be explored, but this is an infrequent cause of dementia; therefore slight or even moderately elevated levels of these chemicals in the blood should be interpreted cautiously It is also useful to keep in mind that seizures are not a usual component of the degenerative dementias; when they are present, they generally do not appear until a very late stage Once it is decided that the patient suffers from a dementing condition, the next step is to determine by careful physical examination whether there are other neurologic signs or indications of a particular medical disease This enables the physician to place the case in one of the three categories in the bedside classi cation (see above and Table 21-3) Ancillary examinations such as CT, MRI, electroencephalography (EEG), lumbar puncture, measurement of blood urea nitrogen as well as serum concentrations of calcium and electrolytes, and nally liver function tests should be carried out in most cases The MRI and CT are of major importance in objectifying hydrocephalus, lobar atrophy, leukoencephalopathy, cerebrovascular disease, tumor, and subdural hematoma Testing for syphilis, vitamin B12 de ciency, and thyroid function is also done almost as a matter of routine because the tests are simple and the dementias they cause are reversible These are supplemented in individual circumstances by serologic testing for human immunode ciency virus (HIV) infection, measurement of copper and ceruloplasmin levels (Wilson disease), heavy metal concentrations in urine or tissues, serum cortisol levels, and drug toxicology screening The nal step is to determine, from the total clinical picture, the particular disease within any one category.

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MEMORY AND THE AMNESIC SYNDROME (KORSAKOFF SYNDROME; AMNESIC SYNDROME (See also Chap 41)

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