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Clinical and experimental approaches to varieties of memory.

Memory is described as a complex aspect of cognitive functioning. Memory is dependent upon input from the sensory modalities; it relies upon the passage of time; and it requires intervening processes for initial acquisition and subsequent access. Based upon questions posed concerning the relationship between clinical and experimental advances in memory and memory disorders, an example is given to illustrate the influence of research upon techniques for diagnosis and rehabilitation. Suggestions are provided about how to approach answering other related questions in neuropsychology. An integrated program is suggested with the aim of bringing together findings from neuroanatomy, neurochemistry, and neurobehavior. Emphasis is placed upon integrating results of research based upon human and nonhuman models of disordered memory and other cognitive functions. Neuroanatomical systems important for performing delayed-reaction tasks are reviewed, as are results of delayed response and delayed alternation testing in several human populations with neurological dysfunction suggestive of frontal lobe damage.

Adult↗

Sleep, memory maintenance, and mental disorders.

Memory circuits of the brain are activated by self-generated brain waves, primarily during sleep. These activations refresh the efficacies (strengths) of synapses in affected circuits, maintaining the efficacies at the "dedicated" values that support circuit functions. The neural pathologies underlying many mental disorders appear to exert their deleterious influences by inducing abnormalities in brain waves. The abnormal waves, in turn, fail to sustain dedicated synaptic efficacies in memory circuits, leading to mental malfunction. Dreaming is an "unconscious" awareness of circuit reinforcement during sleep, with dream contents being derived from the activated circuits. When synaptic efficacies are degraded, the dreams are illusory.

Humans↗

Long-term assessment of neuropsychiatric adverse reactions associated with efavirenz.

OBJECTIVES: The Sensio study objectives were to assess the outcome of neuropsychiatric adverse reactions (NPAR) that develop after initiation of efavirenz (EFV) therapy, to ascertain the late NPAR after a 3-month treatment period, to evaluate the impact of NPAR on patients' quality of life (QoL) in a real-life population. METHODS: During a 6-month period, consecutive HIV-infected adult outpatients receiving an ongoing EFV therapy for at least 3 months were asked to fill in a specifically designed self-administered questionnaire addressing sleep disturbances, behavioural changes, mood disturbances, anxiety, cognitive disorders, hallucinations, dizziness and the general impact on patients' QoL. RESULTS: A total of 174 questionnaires were analyzed. The main late emergent NPAR were sleep disorders: abnormal dreams 24.7%, nocturnal waking 19.6%, trouble falling asleep 17.8%; cognitive disorders: memory disorders 23.0%, impaired concentration 18.9%; anxiety 15.5%; mood disorders: sadness 19.3%, suicidal ideations 9.2%. Global neuropsychic discomfort was moderate to severe in 23% of patients after a 3-month treatment period. CONCLUSION: NPAR occur mainly during the first month of EFV therapy but often persist thereafter. A significant percentage of patients reported suicidal ideations at the time of the study. Our results suggest the need for routine screening for NPAR among patients receiving EFV therapy and better management.

Adolescent↗

The outcome, working ability and psychic changes after traumatic brain injury.

INTRODUCTION: Severe traumatic brain injury belongs to diagnoses with unfavourable outcome. Almost half of patients die due to this diagnose and many survivals remain severely disabled. MATERIAL AND METHODS: In our follow-up file we evaluated 52 patients treated at neurosurgical department due to this diagnosis. The survivals were subsequently examined in order to determine the severity of their objective neurological and cognitive problems. RESULTS: Mortality rate in our group reached 56 %. The overall results show cognitive disorders (memory disorders, prolonged latency and concentration disorders). Out of 92 % of surviving patients, it was neurological impairment that was most frequently (65 %) involved. CONCLUSION: Both cognitive disorders and neurological impairments are responsible for complicated resocialising including working ability which is very low after severe traumatic brain injury--in our group 26 %. Major obstacle can be seen in the psychological component of their over-all impaired quality of life (Tab. 5, Ref. 6).

Adolescent↗

Everyday memory functioning in obsessive- compulsive disorder.

Memory performance in obsessive-compulsive disorder (OCD) is discussed as a pathogenetic risk factor for the emergence of OCD, particularly checking compulsions. At present, however, findings are mixed and little is known about memory performance in tasks relevant to everyday functioning in patients with OCD. For the present study, memory performance was assessed in 31 patients diagnosed with OCD and 33 healthy controls with the Rivermead Behavioural Memory Test (RBMT), which covers a wide range of verbal and nonverbal memory components as well as prospective memory. OCD patients performed comparably to healthy controls on the memory task for verbal, nonverbal, and prospective memory (p > .1). According to norm values, memory performance was unimpaired in most OCD patients. The present findings further challenge a broad account of the "memory deficit" hypothesis of OCD and compulsive checking, respectively.

Activities of Daily Living↗

Disruption of classical conditioning in patients with Alzheimer's disease.

One of the primary features of Alzheimer's disease (AD) is a disorder of memory. Although considerable effort has been devoted to characterizing this memory disorder, simple forms of memory such as classical (Pavlovian) conditioning have not been studied. The prevailing view has been that these simple forms of memory are not affected in AD. These forms of memory, however, may be of particular interest because they are beginning to be well understood at the neurobiological level. Because of this, when memory disorders are detected, it may be possible to specify their neurobiological substrate. We now report that classical conditioning of the eyeblink response is disrupted in AD patients compared to age-matched controls. This deficit in conditioning is not due to nonassociative factors such as changes in sensitivity to stimuli or disruption of the motor response. The results are considered in terms of using simple forms of memory to help generate hypotheses regarding the neurobiology of age-related memory disorders.

Aged↗

Disorders of memory.

This paper reviews disorders of memory. After a brief survey of the clinical varieties of the amnesic syndrome, transient and persistent, selected theoretical issues will be considered by posing a series of questions. (i) What is impaired and what is spared in anterograde amnesia? (ii) Do temporal lobe, diencephalic and frontal lobe amnesias differ? (iii) How independently semantic is semantic memory? (iv) What determines the pattern and extent of retrograde memory loss? (v) Can retrograde amnesia ever be "isolated"? (vi) Does psychogenic amnesia involve the same mechanisms as organic amnesia? (vii) How and when do false memories arise? Commonalities as well as differences across separate literatures will be emphasized, and the case for a more "dynamic" (interactionist) approach to the investigation of amnesia will be advocated.

Amnesia↗

[Amnesic presentations of the compulsive obsessional confusions (about 3 patients appearing in a consultation of memory)].

Disorders or complaints of memory are a frequent cause of consultation in depression, major anxiety and psychiatry disease with personality disorders. We report 3 patients with obsessive compulsive disorder (OCD), without diagnosis and treatment, examined in a specialized memory consultation. They always had OCD with cognitive checking. Diagnosis of transient global amnesia and temporal complex seizure were discussed in 2 cases. Psychometric impairment only was observed in first free recall of a verbal memory task and was no specific. Behavioural during testing seemed to be very important to analyse. First, a 49-year-old man consulted because he had stereotyped transient amnesia lasted one minute, 2 or 3 times a week, since 6 months. He was a teacher. Transient amnesia always occurred during lessons. Suddenly he didn't know where he was or what he was speaking about. Episodes lasted one minute. After them, he had no confusion and no difficulty in concentration but intense anxiety. In an another hand, when he was in his car, after lessons, he could forget where he was during some minutes. CT scan and EEG were normal. Neuropsychological tests only objectived impairment in first free recall of Grober and Buschke's words. Patient explained that he could not prevent to check responses. He told us checking obsessive compulsive disorder during since long time ago. We discussed clear differences which existed between seizure and ruminations or preoccupations. Secondly, a 55-year-old woman was afraid of her memory performances. She was medical secretary and had no problem in her work but she would like a memory consultation to reassure herself. She was neither depressed nor anxious. She presented curious production in fluency task. She had to produce as many animals's names as possible: she could say 35 names which was an excellent performance but only in alphabetic order! Neuropsychological tests objectived impairment in her first free recall of Grober and Buschke's words. She tried in her first free recall to remember words in alphabetic order. She explained how she was bound to range everything in alphabetic order! She had a lot of rituals. She thought that she had an obsessive compulsive disorder but never consulted about this. The observation illustrated suspiscions about memory operations which could be observed in patients group with obsessive compulsive disorders. Finally, a 62-year-old man told us that he had presented a transient global amnesia during 4 hours. He had an important appointment and was upset about that. He didn't go to it and wandered in his flat. He always asked the same questions and forgot everything. He had no neurological deficit. He was anxious, sad and cried several times. He perfectly remembered the episod and thought that he had a panic attack! Verbal memory tests only objectived difficulties in his first free recall of Grober and Buschke words as the two others patients. He had a story of obsessive compulsive disorder with checking and rituals. In this observation, we discussed clear differences which existed between panic attacks and global transient amnesia. We analyzed patterns of neuropsychological performances which illustrated clinical features of obsessive compulsive disorder. These three patients impaired in their first free recall of verbal memory task. It is not a specific result. We observed during psychometric evaluation, strategic processing which impaired episodic memory: patients tried to check their performances. Memory complaints only were observed in checking obsessive compulsive disorder. It is a difficulty or a doubt about memory capacities. Difficulties could be due to particular cognitive processes who pertubate normal memory capacities.

Female↗

[Disorders of concentration and memory in young adults and middle-aged persons].

Four patients, two women aged 29 and 52 and two men aged 46 and 25, respectively, consulted a neurologist for attention and memory disorders. Further investigation revealed that the symptoms were caused by metachromatic leucodystrophy, Graves' disease, Huntington's disease, and a psychological background, respectively. The first patient became dependent in 1.5 years, the second recovered after treatment, the third was independent with slowly progressive symptoms after 1 year, and the fourth was advised to consult a psychologist. Disorders of attention and memory in relatively young people deserve a detailed evaluation at the very first visit, involving the elaboration of an initially extensive differential diagnosis. Too early a separation between a psychic and an organic pathogenesis should be avoided. Indications for the presence of a neurological condition include: consultation at the initiative of others, a relatively brief duration of symptoms without a clear provoking factor, the absence of a psychiatric history or life event, cognitive dysfunction in several areas, abnormal behaviour and an incriminating family history.

Adult↗

Disorders of memory of motor sequences in cerebral palsied children.

In 74 children (32 boys, 42 girls) between 7 and 14 years of age with different forms of cerebral palsy (mainly spastic ones) the motor memory was tested with a sequence of movements which had to be remembered at once, after 24 hours and after 5 days. The normal levels were determined by testing 21 healthy children matched as to age as control as (10 boys, 11 girls). Each exercise was evaluated separately as follows: the movement is performed correctly in the right sequence, 2 points; the movement is performed in a wrong sequence, but in the correct group of three exercises, 1 point; the sequence of movements is entirely wrong or the child does not perform the movements at all, 0 points. Thus for each testing a child can get a maximum of 12 points and for all three testings a maximal 36 points. In 48.5% of the CP children a disorder of memory was found, more frequently in left-sided hemiparesis than in right-sided, and more frequently in paucospastic diparesis (without adductor or flexor spasms and without flexor spastic signs in the toes) than in the classical form. Thus a motor memory disorder is part of the natural history of CP.

Adolescent↗

[Involvement of central nervous system disclosing Waldenstrom's disease: demonstration of intrathecal secretion of immunoglobulin M].

We report the case of a 68-year old woman complaining of disorders of memory and persistent headaches in whom the diagnosis of Waldenström's macroglobulinaemia (WM) was made. Computerized tomography of the brain showed a butterfly-shaped hyperdensity in the splenium of the corpus callosum, with ventricular dilatation. Magnetic resonance imaging displayed high-intensity signals on T2-weighted sequences. Protein immunoelectrophoresis elicited an IgM kappa peak. The CSF was found to contain proteins and lymphocytes in excess, and immunohistochemical staining confirmed the predominance of anti-kappa and the presence of intrathecal IgM secretion. Chemotherapy was temporarily effective on the memory disorders, but the patient died 26 months after the beginning of treatment. Central nervous system manifestations are seldom observed in WM, and they are now grouped under the name of Bing-Neel syndrome. Psychic disorders are rarely reported. It is suggested that IgM secretion plays a predominant role in the pathogenesis of leucoencephalitis, and this is supported by the finding of intrathecal IgM synthesis.

Aged↗

A multi-center blinded prospective study of urine neural thread protein measurements in patients with suspected Alzheimer's disease.

OBJECTIVE: To investigate the utility of a clinical laboratory ELISA format assay that measures neural thread protein (NTP) in urine in the assessment of patients presenting with cognitive symptoms. DESIGN: A prospective blinded multicentered study. SETTING: Eight US specialty clinics for the evaluation of cognitive or memory disorder or dementia, including memory disorder and dementia clinics, neurology clinics, and psychiatry clinics, in 8 states. PARTICIPANTS: Prospectively enrolled consecutive patients who were newly referred to a specialty clinic for assessment of cognitive or memory disorder symptoms or dementia to rule out or rule in Alzheimer's disease (AD). MEASUREMENTS: Participants provided a first morning urine sample for UNTP measurement for testing at a central core laboratory and subsequently went through specialized diagnostic evaluations in accordance with established clinical criteria. Urine NTP measurement was compared to the diagnostic categorization of the patients as probable or possible AD (according to National Institute of Neurological Communicative Disorders and Stroke and the Alzheimer Disease and Related Disorders Association [NINCDS-ADRDA] criteria), mild cognitive impairment (MCI) (according to Quality Standards Subcommittee of the American Academy of Neurology [AAN] criteria) or definite non-AD. Clinical diagnoses were made without reference to UNTP measurement; the testing laboratory was blinded to both patient identity and clinical diagnoses. RESULTS: A total of 168 enrolled and consented patients provided qualifying urine samples and completed specialized diagnostic workups. There were 91.4% of subjects with probable AD, 37.7% of subjects categorized as possible AD, and 48.6% of subjects with MCI who had an elevated NTP measurement (>22 microg/mL). There were 90.7% of subjects diagnosed as definite non-AD who had a normal NTP measurement (< or =22 microg/mL). CONCLUSION: Noninvasive UNTP test results are potentially helpful as part of the workup of dementia for the nonspecialist to help in the decision as to whether referral and/or more detailed investigation is advisable.

Age Distribution↗

11: disorders of memory and intellect.

The clinical approach to the patient with a suspected disorder of memory and intellect is to establish whether it is dementia, which parts of the brain are affected, what is the cause, what is the prognosis, and what can be done about it. The diagnosis of dementia usually requires the involvement of memory and at least one other cognitive system. Delirium and depression are important differential diagnoses. Patients with dementia should usually have some simple investigations after a careful history-taking and examination to identify "reversible" causes. The commonest cause of dementia is Alzheimer's disease, in which short-term memory disturbance is usually prominent. Other causes of dementia include cerebrovascular disease, Lewy-body disease and Pick's disease. There is now hope for patients with Alzheimer's disease (which can be treated with some success with cholinesterase inhibitors) and patients with vascular dementia, in whom aggressive control of causal risk factors may retard progression.

Aged↗