AMNESIA

Amnesia is the general term for a condition in which memory (either stored
memories or the process of committing something to memory) is disturbed or lost, to a
greater extent than simple everyday forgetting or absent-mindedness. Amnesia may result
either from organic or neurological causes (damage to the brain through physical injury,
neurological disease or the use of certain drugs), or from functional or psychogenic
causes (psychological factors, such as mental disorder, post-traumatic stress or
psychological defence mechanisms).
There are two main types of amnesia: anterograde amnesia (where the ability to
memorize new things is impaired or lost because data does not transfer successfully from
the conscious short-term memory into permanent long-term memory); and retrograde
amnesia (where a person's pre-existing memories are lost to conscious recollection,
beyond an ordinary degree of forgetfulness, even though they may be able to memorize
new things that occur after the onset of amnesia). Anterograde amnesia is the more
common of the two. Sometimes both these types of amnesia may occur together,
sometimes called total or global amnesia. Another type of amnesia is post-traumatic
amnesia, a state of confusion and memory loss that occurs after a traumatic brain injury.
Amnesia which occurs due to psychological factors is usually referred to as psychogenic
amnesia.
Many kinds of amnesia are associated with damage to the hippocampus and
related areas of the brain which are used in the encoding, storage and retrieval of
memories. If there is a blockage in the pathways along which information travels during the
processes of memory encoding or retrieval, or if whole regions of the brain are missing or
damaged, then the brain may not be able to form new memories or retrieve some old ones.
The usual causes of amnesia are lesions to the brain from an accident or neurological
disease, but intense stress, alcohol abuse, loss of oxygen or blood flow to the brain, etc,
can all also cause amnesia, as sometimes can treatments such as electro-convulsive
therapy. For example, intense stress can cause the sympathetic nervous system to activate
the adrenal glands, which then secrete certain hormones into the bloodstream which can
significantly affect the plasticity of the brain’s neurons (i.e. their ability to change and
strengthen connections), especially those in the hippocampus.
In most cases, amnesia is a temporary condition, lasting from a few seconds to a
few hours, but the duration can be longer depending on the severity of the disease or
trauma, up to a few weeks or even months. Although it is very rare for anyone to experience
total (permanent) amnesia, one well-known case of long-lasting and acute total (retrograde
and anterograde) amnesia, perhaps the worst case of amnesia ever recorded, is that of the
British musician Clive Wearing, who suffered damage to his brain as a result of an
encephalitis virus in 1985. Because the damage was to an area of his brain required to
transfer memories from working memory to long-term memory, he is completely unable to
form lasting new long-term memories, and his memory is therefore limited to a short-term
memory of between 7 and 30 seconds, to the extent that he will greet his wife like a long-
lost friend even if she only left to go into the kitchen 30 seconds ago. However, Wearing still
recalls how to play the piano and conduct a choir, despite having no recollection of having
received a musical education, because his procedural memory was not damaged by the
virus. In general, memories of habits (procedural memory) are usually better preserved
than memories of facts and events (declarative memory), and the most distant long-term
memories, such as those of childhood, are more likely to be preserved. When memories
return, older memories are usually recalled first, and then more recent memories, until
almost all memory is recovered.

ANTEROGRADE AMNESIA

Anterograde amnesia is the loss of the ability to create new memories, leading to a partial
or complete inability to recall the recent past, even though long-term memories from before
the event which caused the amnesia remain intact. Sufferers may therefore repeat
comments or questions several times, for example, or fail to recognize people they met just
minutes before.

Anterograde amnesia may be drug-induced (several benzodiazepines are known to have

powerful amnesic effects, and alcohol intoxication also has a similar effect) or it follows a
traumatic brain injury or surgery in which there is damage to the hippocampus or medial
temporal lobe of the brain, or an acute event such as a concussion, a heart attack, oxygen
deprivation or an epileptic attack. Less commonly, it can also be caused by shock or an
emotional disorder.

Research shows that anterograde amnesia results from a failure of memory encoding and
storage. New information is processed normally, but almost immediately forgotten, never
making it into the regions of the brain where long-term memories are stored. More
specifically, in normal use, neurons in the mammillary bodies of the hypothalamus make
connections with the thalamus, which in turn makes connections with the cortex of the
brain, where long-term memories are stored. Anterograde amnesia can therefore result from
damage to the hypothalamus and thalamus and the surrounding cortical structures, so
that encoded memories are never stored since connections between hippocampus and
cortex are disrupted.

Usually, sufferers from anterograde amnesia lose declarative memory (the recollection of
facts), but they retain non-declarative, or procedural, memory (the learning of skills and
habits). For instance, they may be able to remember or learn how to do things, such as
talking on the phone or riding a bicycle, but they may not remember what they had eaten for
lunch earlier that day. This is because procedural memory does not rely on the
hippocampus and medial temporal lobe memory system in the same way as declarative
memory. There have, however, been cases where anterograde amnesia patients lose only
the episodic part of their declarative memory (that part which relates to autobiographical
information with a temporal and/or spatial context), and not the semantic part (factual
information, such as language, history, geography, etc, with autobiographical association).
When there is damage to just one side of the medial temporal lobe, the neuroplasticity of
the brain (its ability to re-map its neural connections when necessary) can often allow the
opportunity for normal, or near-normal, functioning for memories with time.
RETROGRADE AMNESIA
Retrograde amnesia is a form of amnesia where someone is unable to recall events that
occurred before the development of the amnesia, even though they may be able to encode
and memorize new things that occur after the onset.

Retrograde amnesia usually follows damage to areas of the brain other than the
hippocampus (the part of the brain involved in encoding new memories), because already
existing long-term memories are stored in the neurons and synapses of various different
brain regions. For example, damage to Broca’s or Wernicke’s areas of the brain, which are
specifically linked to speech production and language information, would probably cause
language-related memory loss. It usually results from damage to the brain regions most
closely associated with declarative (and particularly episodic) memory, such as the
temporal lobe and prefrontal cortex. The damage may result from a cranial trauma (a
blow to the head), a cerebrovascular accident or stroke (a burst artery in the brain), a
tumour (if it presses against part of the brain), hypoxia (lack of oxygen in the brain), certain
kinds of encephalitis, chronic alcoholism, etc.

Typically, episodic memory is more severely affected than semantic memory, so that the
patient may remember words and general knowledge (such as who their country’s leader is,
how everyday objects work, colours, etc) but not specific events in their lives. Procedural
memories (memory of skills, habits and how to perform everyday functions) are typically not
affected at all.

Retrograde amnesia is often temporally graded, meaning that remote memories are more
easily accessible than events occurring just prior to the trauma (sometimes known as
Ribot's Law after the 19th Century psychologist Théodule-Armand Ribot), and the events
nearest in time to the event that caused the memory loss may never be recovered. This is
because the neural pathways of newer memories are not as strong as older ones that have
been strengthened by years of retrieval and re-consolidation. While there is no actual cure
for retrograde amnesia, “jogging” the victim’s memory by exposing them to significant
articles from their past will often speed the rate of recall.

PSYCHOGENIC AMNESIA
Psychogenic amnesia, also known as functional amnesia or dissociative amnesia, is a
disorder characterized by abnormal memory functioning in the absence of structural brain
damage or a known neurobiological cause. It results from the effects of severe stress or
psychological trauma on the brain, rather than from any physical or physiological cause. It
is often considered to be equivalent to the clinical condition known as repressed memory
syndrome.

There are two main types of psychogenic amnesia: global amnesia and situation-specific
amnesia. Global amnesia, also known as fugue state, refers to a sudden loss of personal
identity lasting a few hours or days, often accompanied by severe stress or depression and
often involving extended periods of wandering and confusion. It is very rare, and usually
resolves over time (although memory of the fugue episode itself may remain lost), often
helped by therapy. Situation-specific amnesia is a type of psychogenic amnesia that
occurs as a result of a severely stressful event, as part of post-traumatic stress disorder.
Post-traumatic stress disorder (PTSD) is a severe anxiety disorder that can develop after
exposure to any event that results in psychological trauma, which manifests itself in
constant re-experiencing of the original trauma through flashbacks or nightmares and
avoidance of any stimuli associated with the trauma, as well as increased arousal (such as
difficulty falling or staying asleep, anger and hypervigilance).

It is most commonly associated with traumatic events or violent experiences involving

emotional shock, such as being mugged or raped or involved in car crash. Those at
increased risk include those sexually or physically abused during childhood, those who
have experienced domestic violence, natural disasters, terrorist acts, etc, soldiers who have
experienced combat, and essentially anyone who has experienced any sufficiently severe
psychological stress, internal conflict or intolerable life situation.

Freudian psychology suggests that psychogenic amnesia is an act of self-preservation,

where the alternative might be overwhelming anxiety or even suicide. Unpleasant, unwanted
or psychologically dangerous memories are repressed or blocked from entering the
consciousness as a kind of subconscious self-censorship, but they remain in the
unconscious. Neurologically, normal autobiographical memory processing is blocked by an
imbalance of stress hormones such as glucocorticoids and mineralocorticoids in the
brain, particularly in the regions of the limbic system involved in memory processing.
Such repressed memories may be recovered spontaneously, years or decades after the
event, triggered by a particular smell, taste or other identifier. Because it is due to
psychological rather than physiological causes, psychogenic amnesia can also sometimes
be helped by therapy. Repressed memories may be accessed by psychotherapy,
hypnotism or other techniques, although it is often difficult to distinguish a true repressed
memory from a false one without corroborating evidence.

Those who suffer from psychogenic amnesia tend to lose their biographical or episodic
memories, (to the extent of not even being able to remember their own names and
addresses), particularly of the events leading up to the trigger event, but usually preserve
their semantic and procedural memories, and the ability to create new memories. Episodes
of psychogenic amnesia can last from a few hours to several days, or sometimes even
months, although severe cases are very rare. Because it is due to psychological rather than
physiological causes, it can sometimes be helped by therapy.

The constant remembering and re-imagining of traumatic events causes them to be

reinforced and re-consolidated time after time, and the memory is so strong and realistic
that it is encoded almost as a new current event each time, rather than as an old memory.
Thus, the memories need to be “re-filed” in their proper place (in the past), and recent
advances in the understanding of neuroplasticity (the brain's ability to rewire and
reconfigure itself) have led to some promising treatments. One example is the use of beta
blockers, such as propanolol, while repeatedly reading a detailed account of the traumatic
event, thus chemically blocking neurons so that, over time, the account becomes just
another story without the old traumatic personal associations.
POST-TRAUMATIC AMNESIA
Post-traumatic amnesia is a state of confusion or memory loss that occurs immediately
following a traumatic brain injury. The injured person is disoriented and unable to
remember events that occur after the injury, and may be unable to state their name, where
they are, and what time it is, etc.

The amnesia resulting from a trauma may be retrograde amnesia (loss of memories that
were formed shortly before the injury, particularly where there is damage to the frontal or
anterior temporal regions) or anterograde amnesia (problems with creating new memories
after the injury has taken place), or both. In some cases, anterograde amnesia may not
develop until several hours after the injury

Post-traumatic amnesia may be either short term, or longer lasting (often over a month -
see box at right), but is hardly ever permanent. When continuous memory returns, the
person can usually function normally. Retrograde amnesia sufferers may partially regain
memory later, but memories are never regained with anterograde amnesia because they
were not encoded properly.

Memories from just before the trauma are often completely lost, partly due to the
psychological repression of unpleasant memories (psychogenic amnesia), and partly
because memories may be incompletely encoded if the event interrupts the normal process
of transfer from short-term to long-term memory.

DEMENTIA
Dementia is a general term for a large class of disorders characterized by the progressive
deterioration of thinking ability and memory as the brain becomes damaged. Essentially,
when memory loss is so severe that it interferes with normal daily functioning, it is called
dementia. Less severe memory loss is usually referred to as mild cognitive impairment.
It is sometimes estimated that dementia doubles in frequency about every 5 years from the
age of 65, which suggests that around 5% of those age 65 have dementia, and over 50%
for those in the 85 to 90 year range.

Dementia is usually characterized by severe memory loss in conjunction with one or more
of aphasia (loss of the ability to produce or understand language), apraxia (the inability to
make certain movements, despite a healthy body), agnosia (problems recognizing familiar
persons and objects, even though the senses are functioning) or executive dysfunction
(inability to plan, organize or reason). Sufferers exhibit serious loss of cognitive ability,
beyond what might be expected from normal ageing, and particularly in the areas of
memory, attention, language and problem solving.

The best known and most common type of dementia is Alzheimer’s disease, which
accounts for 50-75% of all dementias. The second most common type, accounting for up to
20% of dementia cases, is vascular dementia, which has symptoms similar to Alzheimer’s
but usually results from damage done to the brain by a blood clot or a haemorrhage cutting
off the brain's blood supply due to a stroke or succession of strokes. Other types of
dementia include Lewy body dementia, frontotemporal dementia, Huntington's disease
and Creutzfeldt-Jakob disease. Some types of dementia are reversible (such as those
caused by thyroid disease), while some (such as Alzheimer's disease) are irreversible.
Dementia may be caused by specific events such as traumatic brain injury (also see post-
traumatic amnesia) or stroke, or it may develop gradually as a result of neurodegenerative
disease affecting the neurons of the brain (thereby causing gradual but irreversible loss of
function of these cells) or as a secondary symptom of other disorders like Parkinson’s
disease.

STROKE
Stroke (sometimes called a cerebrovascular accident) is the rapidly developing loss of
brain function due to disturbance in the blood supply to the brain, caused by a blocked or
burst blood vessel. This can be due to thrombosis or arterial embolism or due to a
haemorrhage. As a result, the affected area of the brain is unable to function, leading to the
inability to move one or more limbs on one side of the body, inability to understand or
formulate speech, or inability to see one side of the visual field. It is one of the leading
cause of adult disability worldwide, and risk factors include advanced age, hypertension
(high blood pressure), previous stroke or transient ischemic attack, diabetes, high
cholesterol, cigarette smoking and atrial fibrillation.

A stroke causes brain injury as the resulting lack of oxygen damages particular parts of the
brain. If the temporal lobe of the brain is affected, the effects may include short-term
memory impairment and difficulty acquiring and retaining new information, as well as
problems with perception and attention, and may lead to full-blown dementia, often
referred to as vascular dementia (an overall decline in thinking abilities, with symptoms
similar to Alzheimer's).

Studies have shown that elderly people with mild cognitive impairment (defined as where
memory problems due to old age are mild and do not generally interfere with normal daily
activities) who also have a stroke have a much greater chance of developing dementia.
Approximately one third of stroke victims will develop memory problems and experience
serious difficulties in other aspects of performing daily activities.

After a less severe stroke, memory often returns gradually over a period of weeks or
months. Even after a severe stroke, improvement in memory may continue for up to two
years, although it may be unrealistic to expect further progress after this time.