AMNESTIC DISORDERS

BY
SHAHIDA AHMED
 DEFINITION

It is a deficit in memory caused by brain damage,

disease or psychological trauma.

Characterized by prominent memory impairment

in the absence of disturbances in the level of
alertness or the other cognitive problems that are
present with Delirium or dementia
 KEY FEATURES
• Memory loss may be sudden or gradual, depending on
etiology.
• Recent memory is disproportionately affected
• False recollections (confabulation), either completely
invented or made up of genuine memories misplaced in
time
• Confusion or disorientation.
• In physical exam, evidence of alcohol abuse can be seen e.g
enlarged liver.
 TYPES
• Main :- • Specific :-
 Anterograde  Transient global  Lacunar amnesia
 Retrograde amnesia  Situation specific
 Transient epileptic amnesia
amnesia  Source amnesia
 Post-traumatic  Childhood amnesia
amnesia  Korsakoff’syndrome
 Dissociative amnesia  Drug induced
o Repressed memory amnesia
o Dissociative fugue
 Prosopamnesia
o Posthypnotic amnesia
Retrograde amnesia – the inability to retrieve
information that was acquired before a particular
date, usually the date of an accident or operation. In
some cases the memory loss can extend back
decades, while in others the person may lose only a
few months of memory.
Anterograde amnesia – the inability to transfer new
information from the short-term store into the long-
term store. People with this type of amnesia cannot
remember things for long periods of time.
Transient Global amnesia – sudden, temporary
memory loss due to problems with blood flow to part
of the brain. Loss of past memories is milder, forming
new memories is harder.
Transient epileptic amnesia – a rare and unrecognized
form of temporal lobe epilepsy, which is typically an
episodic isolated memory loss.
Post-traumatic amnesia – generally due to a head
injury.
Dissociative amnesia –significant episodes in which the individual
is unable to recall important and often emotionally charged
memories.
o Repressed memory – refers to the inability to recall information,
usually about stressful or traumatic events in persons' live. The
memory is stored in long-term memory, but access to it is
impaired because of psychological defense mechanisms.
o Dissociative fugue – caused by psychological trauma and is
usually temporary, unresolved and therefore may return.
o Posthypnotic amnesia – occurs when events during hypnosis are
forgotten, or where past memories are unable to be recalled
which is induced by suggestions made in hypnosis.
Lacunar amnesia – the loss of memory about one
specific event.
Situation specific – can arise in a variety of
circumstances (e.g., committing an offence, child
sexual abuse) resulting in PTSD.
Source amnesia – the inability to remember where,
when or how previously learned information has been
acquired, while retaining the factual knowledge.
Drug induced – - intentionally caused by injection of an
amnesiac drug to help a patient forget surgery or medical
procedures, particularly those not performed under full
anesthesia, or likely to be particularly traumatic.
Prosopamnesia – the inability to remember faces.
Childhood – the common inability to remember events
from one's own childhood.
KORSAKOFF’S SYNDROME
It can result from long-term alcoholism or
malnutrition. It is caused by brain damage due to a
vitamin B1 deficiency and will be progressive if
alcohol intake and nutrition pattern are not modified.
The person’s short-term memory may be normal but
there is difficulty in recalling past event.
It mainly causes vision changes, ataxia and impaired
memory.
 Symptoms
• difficulty in acquiring new information or learning new skills
• change in personality – at one extreme the person may show
apathy (unconcern, lack of emotional reaction), or at the
other, talkative and repetitive behavior
• lack of insight into the condition – even a person with large
gaps in their memory may believe that their memory is
functioning normally
• confabulation – where a person invents events to fill the gaps
in memory. For example, a person who has been in hospital
for several weeks may talk convincingly about having just
visited their aunt earlier that day. This is more common in the
early stages of the illness.
Treatment
• It can be halted if the person is given high doses of
thiamine, abstains from alcohol.
• Adopt a healthy diet with vitamin supplements.
• Needs initial detoxification (removing
the alcohol from their system)
• Will often need long-term treatment for liver
damage or other effects of alcohol misuse.
 CAUSES
• Organic / Neurological :- • Functional / Psychogenic :-
 Head trauma
 Traumatic event
 Stroke
 Severe psychological stress &
 Brain inflammation internal conflict
 Degenerative brain diseases.
 Oxygen deprivation
 Medications / Alcohol
 Subarachnoid hemorrhage
 Tumor
 Seizure disorders
 Physical deficiency
 DIAGNOSIS
Detailed medical & family history from
patient & caregiver.
• When & how memory problems start
• Factors involved – head injury, stroke, surgery, seizures, medication,
alcohol or drug use.
• Physical exam – sensory function, balance etc.
• Doctor may also check patient’s judgment, short-term memory, long-
term memory
• To determine physical damage or brain abnormality – MRI, CT scan,
blood tests
 COMPLICATIONS
• Depends upon severity & scope

• Mild symptoms – difficulty in daily life, problems in

employment, school, social life.

• Probability of no recovery of lost memories.

• Severe symptoms – supervision or extended care facility

may be required.
RISK FACTORS
• Bilateral damage to • Local infection
diencephalic and • Seizures
mediotemporal • Alcohol.
structures
• Thiamine deficiency
• Head trauma
• Cerebrovascular
disease
• Hyproxia
 TREATMENT

Although improvements occur when patients receive

certain treatments, there is still no actual cure remedy
for amnesia so far.
To what extent the patient recovers and how long the
amnesia will continue depends on the type and
severity.
Addressing both emotional and cognitive difficulties
• Cognitive therapy & Occupational therapy – strategies
to develop memory skills, create new retrieval paths
• Psychotherapy & Hypnosis.
• Family support involving ‘reality oriented aids’ –
environment having familiar objects, photographs,
smells & sounds.
• Treating underlying medical conditions e.g for
Korsakoff’s syndrome, consuming thiamin rich foods
like beans, , whole-grain cereals etc.
 External Aids
• Technological assistance – memory aids to keep track of
day-to-day tasks, set reminders, pictures etc
• A pocket diary and an address book ( note choose a few
specific places in which to write notes and a few specific places in
which to keep them)
• Write all future engagements in the diary
• Look at the diary frequently, and at least every day
• Alarm e.g electronic wristwatch or kitchen timers
• Beware of safe places; These places are likely to be out
of sight and out of mind too
Internal Aids
• The amount one remember is strongly correlated with
the amount of time one spend learning
• To learn most efficiently one need to concentrate
without being anxious: attention without tension
• A little and often will keep memory shining
Six aspects of organising thinking
• Chunking to break the information into chunks of a
maximum of seven items
• Using cues to remind one’s of what one’s want to
remember
• Relating the new information to what one’s already
know
• Making sense of the new information
• It is easier to recognise things than to recall
• Revise soon after the original learning, and then space
out additional revision periods further and further apart
 • Researchers are investigating several
neurotransmitters involved in memory formation,
which may one day lead to new treatments for
memory disorders. But the complexity of the brain
processes involved makes it unlikely that a single
medication will be able to resolve memory problems.
 MEDICATION
• There is no cure for amnesia but amnesic drugs can
be used as a premedicants for inducing sedation and
amnesia before medical procedures.
• For such purpose benzodiaepines like midazolam,
lorazepam, propofol etc. are given before carrying
out surgery or other medical procedures to reduce
anxiety and inhibit unpleasant memories.
• Of these midazolam is most commonly used due to
its fast recovery time.
 Mechanism of action of Midazolam
• Midazolam comes under the umbrella of
benzodiazepines.
• The targets for benzodiazepines actions are GABAA
receptors. {GABA is the major inhibitory
neurotransmitter in the central nervous system
(CNS)}
• Binding of GABA to its receptor triggers an opening of
the central ion channel, allowing chloride through the
pore.
• The influx of chloride ions causes hyperpolarization
of the neuron and decreases neurotransmission by
inhibiting the formation of action potentials.
• Benzodiazepines modulate GABA effects by binding
to a specific high-affinity site (distinct from the
GABA-binding site).
• It increases frequency of channel opening produced
by GABA.
 ADVERSE EFFECTS

• DEPENDENCY
▫ Psychological and physical dependence on midazolam
can develop if high doses of the drugs ate given for a
prolong period. Abrupt discontinuation results in
withdrawal symptoms, including confusion, anxiety,
agitation, restlessness, insomnia, tension and (rarely)
seizures.
 Less common side effects
• Anxiety • nausea
• chest pain or discomfort • nervousness
• choking • noisy breathing
• confusion • pale or blue lips, fingernails, or
• difficult or troubled breathing skin
• restlessness
• drowsiness
• shaking
• dry mouth
• shortness of breath
• fast heartbeat
• slow or irregular heartbeat
• hyperventilation • tightness in the chest
• irregular heartbeats • trouble sleeping
• irregular, fast or slow, or shallow • unable to speak
breathing • unusual tiredness
• irritability • weakness
• lightheadedness, dizziness, or • wheezing
fainting
 Rare side effects
• changes in patterns and • seeing, hearing, or feeling
rhythms of speech things that are not there
• feeling of constant • sensation of spinning
movement of self or • shakiness and unsteady
walk
surroundings
• sleepiness
• headache • slow to respond
• lack or loss of self-control • slurred speech
• loss of balance • trouble in speaking
• mood swings • unconsciousness
• noisy breathing • unsteadiness, trembling, or
• not breathing other problems with muscle
control or coordination
• restlessness
 Special consideration
• This drug should be avoided in patients with acute
narrow-angle glaucoma, severe mental problems (e.g.
psychosis) or severe liver disease
• It should also be avoided if the patient has alcohol
intoxication with abnormal vital signs.
• Interaction with other drugs like carbamazapine,
barbiturates, disulfiram, valproic acid, narcotic pain
medicines e.t.c. should also be noted.