Transient global amnesia and functional retrograde amnesia: contrasting examples of episodic memory loss

We studied 11 patients with transient global amnesia (TGA) and ten patients with functional retrograde amnesia (FRA). Patients with TGA had a uniform clinical picture: a severe, relatively isolated amnesic syndrome that started suddenly, persisted for 4-12 h, and then gradually improved to essentially normal over the next 12-24 h. During the episode, the patients had severe anterograde amnesia for verbal and non-verbal material and retrograde amnesia that typically covered at least two decades. Thirty hours to 42 days after the episode, the patients had recovered completely and performed normally on tests of anterograde and retrograde amnesia. By contrast, patients with FRA had a sudden onset of memory problems that were characterized by severe retrograde amnesia without associated anterograde amnesia and with a clinical presentation that otherwise varied considerably. The episodes persisted from several weeks to more than two years, and some of the patients had not recovered at the time of our last contact with them. The uniform clinical picture of TGA and the variable clinical picture of FRA presumably reflect their respective neurologic ('organic') and psychogenic ('non-organic') aetiologies.     

Transient global amnesia

Transient global amnesia is an alarming but benign disorder of middle age, which prevents both the formation of new memories, and the retrieval of recently formed ones, for some hours. Research over the last 10 years has shed light on the epidemiology, neuropsychology, functional anatomy and differential diagnosis of this distinctive condition, and clarified its management.     

Transient global amnesia after general anesthesia

OBJECTIVE: To investigate the prevalence of coronary artery disease (CAD), atherothrombotic brain infarction (ABI), and peripheral arterial disease (PAD) in older Hispanics and the association with risk factors in this population. DESIGN: A retrospective analysis of charts from all Hispanics seen during January 1996 through July 1997 at an academic hospital-based geriatrics practice. SETTING: An academic, hospital-based, primary care geriatrics practice staffed by fellows in a geriatrics training program and by full-time faculty geriatricians. PATIENTS: One hundred sixty women and 53 men, mean age 80 +/- 8 years (range 64 to 100), were included in the study. MEASUREMENTS AND MAIN RESULTS: Of 213 Hispanics in the study, 59 (28%) had documented CAD, 43 (20%) had ABI, 34 (16%) had PAD, and 90 (42%) had either CAD, ABI, or PAD. Serum total cholesterol and triglycerides were measured in 202 of 213 subjects (95%). Serum high-density lipoprotein cholesterol was measured in 137 of 213 patients (64%). Other risk factor data were documented in all patients. Multiple logistic regression analysis performed in 202 patients using the variables age, gender, cigarette smoking, hypertension, diabetes mellitus, obesity, serum total cholesterol, and serum triglycerides showed statistically significant associations between prevalent CAD, ABI, or PAD and age (P = .002, odds ratio (OR) = 1.083), cigarette smoking (P = .002, (OR) = 3.865), hypertension (P = .007, (OR) = 2.749), diabetes mellitus (P = .028, (OR) = 2.386), obesity (P = .014, (OR) = 2.608), serum total cholesterol (P < 0.001, (OR) = 1.025), and serum triglycerides (P = .017, (OR) = .993). CONCLUSIONS: Either CAD, ABI, or PAD was present in 42% of 213 older Hispanics. There were statistically significant associations between prevalent CAD, ABI, or PAD in older Hispanics and risk factors, including age, cigarette smoking, hypertension, diabetes mellitus, obesity, and serum total cholesterol.     

Transient global amnesia resulting from mild trauma.

Presents case studies of 2 males (aged 18 and 19 yrs) with clinical manifestations and neuropsychological evaluations which confirm the diagnosis of transient global amnesia (TGA). In both cases, the episodes were a result of light traumas. It is proposed that TGA was triggered by vascular changes resulting from a mild (whiplash or head) trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transient global amnesia after cerebral angiography with iohexol

Transient global amnesia is an unusual neurologic phenomenon that occasionally occurs after angiography, usually of the cerebral vessels. It represents a benign event, and normal function is ultimately restored, but the amnesia may be frightening for both the patient and the physician until its nature is recognized. The authors describe two cases of transient global amnesia occurring after cerebral angiography with iohexol, outline the criteria for the diagnosis and discuss the proposed mechanism of the phenomenon.     

The use of indirect memory tests to assess malingered amnesia: A study of metamemory.

Many techniques have been suggested for identifying criminal suspects who are simulating amnesia for events surrounding a crime. The present research focuses on indirect memory tests as a potential means of discriminating between those who genuinely suffer from amnesia and those who are simulating. Ss studied a list of words and subsequently performed either a word completion or a fragment completion task. Under normal indirect test instructions, typical priming effects were observed. When Ss were motivated to simulate amnesia for the list, target completion rates were consistently, and sometimes reliably, below baseline completion rates. This finding is contrary to the performance of genuine amnesics, whose performance on indirect tests typically mirrors that of normal Ss. Indirect tests may prove useful in discriminating genuine and simulating amnesics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceptual and conceptual memory processes in global amnesia.

To determine whether global amnesia reflects a selective deficit in conceptual processing, amnesic and control Ss performed 4 memory tasks that varied processing and retrieval requirements. A study-phase modality (auditory/visual) manipulation validated the nature of processing (perceptual and conceptual) engaged by each task. Amnesic patients were impaired on perceptual and conceptual explicit memory tasks (word-fragment and word-associate cued recall) and were intact on perceptual and conceptual implicit memory tasks (word-fragment completion and word association). These results are consistent with the view that limbic-diencephalic structures damaged in amnesia mediate, in part, processes typically engaged during explicit retrieval. The results are inconsistent, however, with the characterization of that deficit as being one of conceptual processing per se. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transient global amnesia: implicit/explicit memory dissociation and PET assessment of brain perfusion and oxygen metabolism in the acute stage

OBJECTIVES: To assess explicit memory and two components of implicit memory--that is, perceptual-verbal skill learning and lexical-semantic priming effects--as well as resting cerebral blood flow (CBF) and oxygen metabolism (CMRO2) during the acute phase of transient global amnesia. METHODS: In a 59 year old woman, whose amnestic episode fulfilled all current criteria for transient global amnesia, a neuropsychological protocol was administered, including word learning, story recall, categorical fluency, mirror reading, and word stem completion tasks. PET was performed using the (15)O steady state inhalation method, while the patient still exhibited severe anterograde amnesia and was interleaved with the cognitive tests. RESULTS: There was a clear cut dissociation between impaired long term episodic memory and preserved implicit memory for its two components. Categorical fluency was significantly altered, suggesting word retrieval strategy--rather than semantic memory--impairment. The PET study disclosed a reduced CMRO2 with relatively or fully preserved CBF in the left prefrontotemporal cortex and lentiform nucleus, and the reverse pattern over the left occipital cortex. CONCLUSIONS: The PET alterations with patchy CBF-CMRO2 uncoupling would be compatible with a migraine-like phenomenon and indicate that the isolated assessment of perfusion in transient global amnesia may be misleading. The pattern of metabolic depression, with sparing of the hippocampal area, is one among the distinct patterns of brain dysfunction that underlie the (apparently) uniform clinical presentation of transient global amnesia. The finding of a left prefrontal hypometabolism in the face of impaired episodic memory and altered verbal fluency would fit present day concepts from PET activation studies about the role of this area in episodic and semantic memory encoding/retrieval. Likewise, the changes affecting the lenticular nucleus but sparing the caudate would be consistent with the normal performance in perceptual-verbal skill learning. Finally, unaltered lexical-semantic priming effects, despite left temporal cortex hypometabolism, suggest that these processes are subserved by a more distributed neocortical network.     

Searching for metamemory–memory connections: A developmental study.

To determine the nature and strength of metamemory–memory connections, 178 children from kindergarten, 1st, 3rd, and 5th grades participated in 2 sessions. Metamemory was assessed during Session 1 by an extensive introspective interview. Memory strategies and performance were independently measured during Session 2 on 3 tasks: free sort, cognitive cuing, and alphabet search. Metamemory–memory correlations were significant when data were combined across grades. Most within-grade correlations were not significant and did not generalize across memory tasks. Amount of knowledge about strategies failed to distinguish between individuals who used vs did not use relevant knowledge; that is, irrelevant aspects of memory correlated as highly and frequently with memory in comparison with task-specific or general knowledge about strategies. Finally, contingency analyses failed to support the contention that metamemory is a necessary prerequisite for successful memory. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Episodic memory and metamemory in Parkinson’s disease patients.

This study investigated episodic memory and metamemory for verbs and nouns in patients who have cognitive impairments associated with Parkinson’s disease (PD). PD patients and healthy control participants were asked to recall word pairs and provide feeling-of-knowing (FOK) judgments for the items they were unable to recall. This was followed by a 4-alternative recognition test. PD patients were impaired in both recall and recognition, compared with controls. In terms of metamemory, PD patients were less confident in their ability to recognize the unrecalled items in a future recognition test. Most important, accuracy of PD patients’ FOK judgments was not above chance and was lower than that of control participants. The PD group correctly recognized fewer verbs than nouns, but type of material (verb vs. noun) had no impact on recall or FOK judgments. In addition, contribution of executive functions to FOK accuracy was different in PD patients and controls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships between metamemory, memory predictions, and memory task performance in adults.

A cross-sectional sample of adults recalled categorized word lists and narrative texts. Subjects gave performance predictions before each of 3 recall trials for each task. Older subjects had poorer memory performance and also predicted lower performance levels than did younger subjects. The LISREL models suggested (a) direct effects of memory self-efficacy (MSE) on initial predictions; (b) upgrading of prediction–performance correlations across trials, determined by direct effects of performance on subsequent predictions; (c) significant effects of a higher order verbal memory factor on MSE; and (d) an independent relationship of text recall ability to initial text recall performance predictions. These results lend support to the theoretical treatment of predictions as task-specific MSE judgments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

TraceLink: a model of amnesia and consolidation of memory

This investigation examined the feasibility of applying the conductance catheter technique for measurement of absolute aortic segmental volume. Aortic segment volume was estimated simultaneously in vitro by using the conductance catheter technique and sonomicrometer crystals. Experiments were performed in five isolated canine aortas. Vessel diameter and pressure were altered, as were the conductive properties of the surrounding medium. In addition, a three-dimensional finite-element model of the vessel and apparatus was developed to examine the electric field and parallel conductance volume under different experimental conditions. The results indicated that in the absence of parallel conductance volume, the conductance catheter technique predicted absolute changes in segmental volumes and segmental pressure-volume relationships that agreed closely with those determined by sonomicrometry. The introduction of parallel conductance volume added a significant offset error to measurements of volume made with the conductance catheter that were nonlinearly related to the conductive properties of the surrounding medium. The finite-element model was able to predict measured resistance and parallel conductance volume, which correlated strongly with those measured in vitro. The results imply that absolute segmental volume and distensibility may be determined only if the parallel conductance volume is known. If the offset volume is not known precisely, the conductance catheter technique may still be applied to measure absolute changes in aortic segmental volume and compliance.     

Drugs, memory, and metamemory: A dose-effect study with lorazepam and scopolamine.

This experiment was designed to use the graded dose-related amnesia produced by the benzodiazepine lorazepam (1.0, 2.0 mg/70 kg, oral) and the anticholinergic scopolamine (0.3, 0.6 mg/70 kg, subcutaneous) as a tool to explore the cognitive and neurochemical mechanisms underlying metamemory in the judgment of learning paradigm, with a placebo-controlled independent groups design in healthy volunteers (n=12/group). Results provide evidence for a pharmacological dissociation between effects on memory versus metamemory (relative accuracy of item-by-item monitoring) across a range of levels of memory performance and suggest that the drugs selectively impair those aspects of metamnemonic monitoring that require participants' awareness of their overall current state of functioning (absolute accuracy of prospective item-by-item monitoring, prospective global monitoring) but not those that rely solely on assessment of individual item characteristics (relative accuracy of item-by-item monitoring). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional perception and memory in amnesia.

The authors examined whether perception of emotional stimuli is normal in amnesia and whether emotional arousal has the same enhancing effect on memory in amnesic patients as it has in healthy controls. Forty standardized color pictures were presented while participants rated each picture according to emotional intensity (arousal) and pleasantness (valence). An immediate free-recall test was given for the pictures, followed by a yes-no recognition test. Arousal and valence ratings were highly similar among the amnesic patients and controls. Emotional arousal (regardless of valence) enhanced both recall and recognition of the pictures, and this enhancement was proportional for amnesic patients and controls. Results suggest that emotional perception and the enhancing effect of emotional arousal on memory are intact in amnesia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recovery of memory after posthypnotic amnesia

Notes that documentation of the reversibility of posthypnotic amnesia has been hampered by the correlation of hypnotizability with the initial level of response to amnesia suggestions. 691 college students were placed in groups differing in hypnotic susceptibility that could be matched for initial amnesia recall, thereby eliminating the ceiling effect. At virtually every point along the distribution of initial amnesia response, hypnotizable Ss were significantly better able than insusceptible Ss to recapture the previously blocked memories after the amnesia suggestion was lifted. Conversely, those Ss who showed reversibility of amnesia were more responsive overall to hypnosis than those who did not. It is concluded that reversibility is of value in distinguishing between amnesia and pseudoamnesia and between partial amnesia and nonamnesia. Furthermore, reversibility helps define posthypnotic amnesia as a process involving the disruption of retrieval processes in memory. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term memory in amnesia: Cued recall, recognition memory, and confidence ratings.

We explored what kind of information is acquired when amnesic patients are able to exhibit significant retention on tests of cued recall and recognition memory. Amnesic patients and control subjects attempted to learn sets of sentences. Memory for the last word in each sentence was tested after 1 hr in the case of the amnesic patients, or after 1 to 2 weeks in the case of (delayed) control subjects. Amnesic patients and (delayed) control subjects performed at similar levels on tests of cued recall and recognition memory. Amnesic patients were just as confident of their correct answers as were control subjects. Moreover, amnesic patients were no more disadvantaged than control subjects when they were cued indirectly by presenting paraphrases of the original sentences. These findings demonstrate that the residual knowledge retained by amnesic patients can be as flexible, as accessible to indirect cues, and as available to awareness as the knowledge retained by (delayed) control subjects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)