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PubMed2003

The psychophysiology of anxiety disorder: fear memory imagery.

Psychophysiological response to fear memory imagery was assessed in specific phobia, social anxiety disorder, panic disorder with agoraphobia, post-traumatic stress disorder (PTSD), and healthy controls. Heart rate, skin conductance, and corrugator muscle were recorded as participants responded to tone cues signaling previously memorized descriptor sentences. Image contents included personal fears, social fears, fears of physical danger, and neutral (low arousal) scenes. Reactions to acoustic startle probes (eyeblink) were assessed during recall imagery and nonsignal periods. Participants were significantly more reactive (in physiology and report of affect) to fear than neutral cues. Panic and PTSD patients were, however, less physiologically responsive than specific phobics and the socially anxious. Panic and PTSD patients also reported the most anxiety and mood symptoms, and were most frequently comorbidly depressed. Overall, physiological reactivity to sentence memory cues was greatest in patients with focal fear of specific objects or events, and reduced in patients characterized by generalized, high negative affect.

Acoustic Stimulation↗

PubMed1998

A new protocol for training severely impaired patients in the usage of memory journals.

Although memory disorders are frequently seen in survivors of brain injuries, remediation of patients with severe memory disorders is still relatively neglected in clinical practice due to pessimism by clinicians regarding the efficacy of such remediation. With respect to memory journal training, a further reason for this neglect is likely the lack of readily accessible protocols that therapists can use to work with these patients. The purpose of the present paper is to describe a new memory journal training protocol that was developed to teach brain injury survivors how to compensate for severe memory impairments by using three strengths of most brain injury survivors: immediate attention, procedural memory, and old learning. A training protocol is described that involves baseline testing and a needs assessment, five levels of training exercises, and discharge probe testing. It is concluded that patients with severely impaired memory abilities can learn the present system when care is taken to individualize journals, conduct proper needs assessments, and provide structured training exercises geared to the strengths of memory impaired persons.

Adult↗

PubMed2001

The mind of a failing heart: a systematic review of the association between congestive heart failure and cognitive functioning.

BACKGROUND: Congestive heart failure (CHF) is a frequent complication of most diseases of the heart. CHF is associated with impairment in several aspects of the quality of life of patients, including mood and cognitive performance. Early reports indicated that patients with CHF display deficits in memory and other intellectual abilities, although the clinical relevance of these findings remains unclear. AIM: We reviewed systematically the medical literature with the aim of clarifying the association between CHF and cognitive functioning. METHODS: Systematic review of Medline database for studies published between 1966 and June 2000 using the following key words: congestive heart failure, cognition, cognitive disorders, memory, memory disorders, short-term memory, attention. RESULTS: Thirteen studies reported cognitive information on patients with CHF, but only five met inclusion criteria for systematic review. Three reports described attention (total number of subjects = 369 patients and 882 controls) and memory scores (total number of subjects = 247 patients and 748 controls), two studies reported measures of general cognitive functioning (total number of subjects = 203 patients and 704 controls) and one reported the rate of cognitive impairment (total number of subjects = 88 patients and 987 controls). Pooled analysis indicated that CHF is associated with a pattern of generalized cognitive impairment that includes memory and attention deficits. CONCLUSIONS: The results of the present review highlight the enormous paucity of systematic information about the association between CHF and cognitive functioning, with only five studies reporting data suitable for analysis. We expect that new case-control and cohort studies will be designed to confirm the presence of cognitive impairment in patients with CHF and trust that this information will improve the management of CHF patients and our understanding of the mechanisms associated with cognitive decline in later life.

Attention↗

PubMed2004

Episodic memory impairment in bipolar disorder and obsessive-compulsive disorder: the role of memory strategies.

BACKGROUND: There is evidence that individuals with bipolar disorder exhibit neuropsychological impairments not only during mood episodes but also when they are euthymic. One of the most consistently reported cognitive problems in euthymic individuals with bipolar disorder is an impairment in verbal episodic memory. Verbal learning and memory depend on individuals' ability to organize verbal information appropriately during learning. The purpose of the present study was (i) to determine whether episodic memory impairment in euthymic individuals with bipolar disorder is mediated by impairments in organization of verbal information during learning and (ii) to compare the characteristics of memory impairment in bipolar disorder with that previously found in obsessive-compulsive disorder (OCD). METHODS: Study participants were 30 individuals with DSM-IV bipolar I disorder (BP-I), 30 individuals with DSM-IV OCD and 30 normal control participants matched for age, gender and education. Participants completed the California Verbal Learning Test (CVLT), a well-established measure of verbal learning and memory that enables assessment of verbal organization strategies during learning. RESULTS: Compared with control subjects, both BP-I and OCD participants showed impaired performance in long-delayed free recall and verbal organization strategies during learning. BP-I participants showed greater long-delay free recall difficulties but not greater verbal organization difficulties during learning than OCD participants. For OCD participants, the long-delay recall impairment was mediated by difficulties using verbal organizational strategies during learning. In contrast, the group difference in long-delayed free recall between BP-I and control participants remained significant even when semantic clustering was introduced as a mediator. This indicated that BP-I participants' long-delayed free recall difficulties were mediated to a lesser extent by difficulties using verbal organizational strategies than for OCD participants. CONCLUSIONS: Verbal episodic memory problems in individuals with bipolar I disorder and OCD are mediated to different degrees by difficulties using semantic clustering encoding strategies compared with control participants.

Adult↗

PubMed1998

Profiles of patients with left prefrontal and left temporal lobe lesions after cerebrovascular infarcations on California Verbal Learning Test-like indices.

We compared memory disorders of three patient groups suffering from brain lesions with a word list corresponding to the California Verbal Learning Test (CVLTgcor). Dependent measures were learning rate and efficiency, retention, and strategic control of the learning process. Compared to a control group of patients with right hemispheric lesions, a left Arteria cerebri posterior (LACP) group showed general memory deficits, an inflated recency effect, and increased serial clustering. A left prefrontal cortex (LPFC) group documented slowed learning and increased recall after semantic cues. Discriminant analysis correctly classified 86.11% of the patients. It is argued that (a) the CVLT helps to cover differences in memory disorders recently discussed in cognitive neuropsychology; (b) differences between PFC and ACP patients become evident only if strategic aspects of learning and increased recall after semantic cueing are taken into account. The results are discussed within the framework of recent cognitive neuropsychological findings and with a distinction between fronto-subcortical and cortical memory disorders.

Attention↗

PubMed1987

Specific effects of cyclandelate on memory.

In an uncontrolled clinical trial of 6 weeks' duration conducted in 20 male patients, aged 49 to 68 years, with memory disorders, cyclandelate 1200 to 1600 mg daily was found to be effective in improving memory as reflected by psychiatric, psychometric and psychophysiological measurements. Treatment with cyclandelate produced clinical effects which were selective for the Wechsler Memory Scale items of visual reproduction and orientation--indicators of the declarative memory. Moreover, the improvements seen in the average auditory reaction and critical flicker fusion frequency demonstrates its effect on procedural memory. Thus, our results indicate that this drug may be therapeutically useful in memory disorders of various aetiology, and that further exploration of the place of cyclandelate in this clinical area is needed.

Aged↗

PubMed2005

Detecting simulated memory impairment: further validation of the Word Completion Memory Test (WCMT).

The Word Completion Memory Test (WCMT) was developed to detect sophisticated attempts at simulating memory impairment. The primary purpose of the present study was to provide additional validity and reliability information about the WCMT. Seventy-one participants were recruited for this study: 30 normal volunteers and 11 memory-disordered patients instructed to perform their best, and 30 normal volunteers instructed to fake memory impairment. Normal volunteers were administered five tests of neuropsychological functioning and five tests of simulation to explore the convergent and divergent validity of the WCMT. Two weeks later, these participants completed all 10 measures a second time. Memory-disordered patients were administered the WCMT and two additional simulation measures as part of a comprehensive neuropsychological evaluation. The WCMT successfully discriminated simulators from nonsimulators with an overall classification accuracy of 97% and demonstrated good psychometric properties. In conclusion, the WCMT continues to show promise as a measure of simulated memory impairment.

Adolescent↗

PubMed1988

Memory impairments: forgetfulness versus amnesia.

Two varieties of memory disorders can be distinguished--those characterized by the phenomenon of forgetfulness and those characterized by the presence of an amnesic state. Although these two conditions may appear similar, they have different anatomical correlates and functional significance. States of forgetfulness and amnesia arise from different etiologies, have different prognoses and require different therapeutic regimes. The purpose of this article is to distinguish these two varieties of memory disorders and contrast them as to anatomical features, functional differences, etiologies, prognoses and therapeutic management regimes. This should assist the neuroscience nurse to better understand relevant nursing assessment features and plan appropriate therapeutic nursing interventions for the client. Teaching protocols for families and significant others as well as clients with memory impairments should also be enhanced.

Amnesia↗

PubMed1990

Neuropsychological testing for evaluation of brain aging.

The new construct of age-associated memory impairment, designed to describe age-related memory disorders, is grounded on the assumptions that neurobiological brain changes associated with age result in memory performance decline and that memory complaints are the subjective reflection of this decline. The first assumption, although poorly evidenced, seems to be accurate. In contrast, correlation between memory complaints and performance is rather questionable. Most findings favor a psychoaffective nature of the memory complaints more than a close relationship with memory performance. Age-associated memory disorders seem to be a complex syndrome which cannot be correctly understood using a single construct.

Aged↗

PubMed1993

Social service interventions for caregivers of patients with dementia: impact on health care utilization and expenditures.

OBJECTIVES: An intervention, which had as its primary goal the enhancement of compliance to social work recommendations, was shown to produce extremely high rates of compliance. This report addresses the secondary objective of the study: to evaluate the impact of the intervention on short-term (ie, 6-month) health services utilization and expenditures. DESIGN: Randomized controlled trial. SETTING: University-based memory disorders clinic. PARTICIPANTS: Caregivers of patients with progressive memory disorders. MAIN OUTCOME MEASURES: Service utilization and expenditures. RESULTS: The intervention did not have a statistically significant impact on utilization of either health care or community resources. The intervention group had $903 less expenditures during the study period, a difference that did not achieve statistical significance. The results were consistent when controlling for caregiver characteristics that differed at baseline. CONCLUSIONS: Although the intervention was successful in enhancing compliance with recommendations, more intensive interventions may be required to increase subsequent service utilization. Future investigations may wish to target the appropriateness of services used over a period longer than 6 months.

Aged↗

PubMedDate not supplied

[Dementia secondary to thalamic infarct: a case report].

INTRODUCTION: The term dementia refers to the deterioration of the intellectual or cognitive functions, with little or no alteration of consciousness, which is capable of interfering with the activities of daily living and the ability to cope by oneself. One infrequent cause of dementia is its being secondary to a thalamic lesion and is normally due to the involvement of both thalami. CASE REPORT: We report a case of sudden onset dementia caused by lesions affecting only the left thalamus. A 64 year old right handed female patient with chronic arterial hypertension for which she received regular treatment. The patient visited because of difficulty in speaking without any alterations to consciousness, and amnesia of recent anterograde and retrograde events. A CAT scan of the brain revealed a superlacuna in the left thalamus. From then on, the patient presented memory disorders, the most typical being loss of retention memory. CONCLUSIONS: Thalamus injuries that are accompanied by dementia are commonly bilateral and are preferably located in the anterior and medial nuclei. There have been cases of memory disorders secondary to unilateral infarcts of the thalamus and these are related to a thalamocortical deafferentiation. Our case is one of sudden onset thalamic dementia secondary to an infarct affecting only the left thalamus.

Amnesia, Anterograde↗

PubMed2003

[Unawareness of deficits in Alzheimer's disease: a multidimentional approach].

Partial or complete unawareness of deficits in Alzheimer's disease (AD) may result in delaying diagnosis and difficulties for caring. Many theories have been proposed to explain unawareness of neurological or cognitive deficits. Neurological theories use the term of anosognosia to describe unawareness as a consequence of the severity and location of brain lesions. They predict an association between the unawareness of deficits in AD and the severity of dementia or location of the lesions in the right cerebral hemisphere or in the frontal regions. More recent theories have been based on models derived from cognitive neuropsychology. Some models have been designed to explain unawareness of specific deficits such as the memory disorders, others are more extensive based on models of consciousness of the Self. Psychopathological theories postulate that unawareness of deficits is the consequence of a psychological defense mechanism, termed denial. Therefore, unawareness of deficits in AD should be linked to the premorbid personality, abilities to cope with the disease and its consequences more than to the severity and location of brain lesions. The validity of each theory is discussed according to the data from the literature. However, the analysis of the literature is clouded by many methodological difficulties due to the variability of terminology and tools used to assess the unawareness. Moreover, most studies were too narrowly focused on specific points, not taking into account a global model of insight. Nevertheless, some conclusions can be drawn from the available data: 1) the nature of the unawareness of deficits in AD is multidimensional. Terms such anosognosia or denial do not describe single phenomena but correspond to disturbances of various neurological, neuropsychological and psychopathological mechanisms, which can not be explained by a single theory; 2) unawareness should no more be considered as a category but according to a dimensional approach. There is a wide range of levels of unawareness, which can vary from one moment to an other and during the progression of the disease; 3) neurological, neuropsychological and psychopathological mechanisms implicated in unawareness probably coexist in various degrees depending, on one hand, on the disease severity and type of deficits and, on the other hand, on the history and personality of the patient, his(her) familial support, but also on the social perception of the disease. To improve our understanding of the unawareness of deficits in AD, we propose to come back to a detailed clinical description investigating extensively the various aspects of insight.

Aged↗

PubMed2004

Patterns of referring of patients with frontotemporal lobar degeneration to psychiatric in- and out-patient services. Results from a prospective multicentre study.

Dementia with frontotemporal lobar degeneration (FTLD) is clinically characterized by the occurrence of various psychiatric symptoms. In a recent study, the hospital-based prevalence of FTLD and the circumstances of the patients' admission to German psychiatric state hospitals were estimated. On the basis of further continuous assessment, this original FTLD group (n = 33) has been enlarged to 58 patients. The authors here present demographic and clinical data, and reasons for admission to geriatric psychiatry hospitals in comparison with 17 patients, who primarily attended the Memory Disorders Clinic of the University of Regensburg. The results implicate that both institutions see patients with different clinical syndromes: (1) patients were primarily referred to the Memory Disorders Clinic presenting memory and/or speech difficulties as the leading symptoms; (2) major reasons for hospitalisation of patients with FTLD in geriatric psychiatry hospitals were behavioural disturbances; (3) late-onset FTLD (>65 years) was more common than previously assumed in both institutions, and (4) increasing age at admission increased the likelihood to obtain a limited diagnostic approach of brain imaging (only cranial computer tomography) to evaluate the cause of dementia.

Adult↗

PubMed1982

Comparisons between forms of amnesia: some deficits are unique to Korsakoff's syndrome.

Certain features of abnormal memory, which have figured prominently in theoretical treatments of the amnesic syndrome, were assessed in patients with Korsakoff's syndrome, in Case N.A., and in patients receiving electroconvulsive therapy. Patients with Korsakoff's syndrome differed from the other patients by (a) failing to exhibit release from proactive interference, and (b) being disproportionately impaired in the ability to make judgments about the temporal order of recent events. These deficits appear to be related to frontal lobe damage and are superimposed on a more basic memory disorder. Theories of amnesia should be founded on the basic memory disorder and not on deficits such as these, which have no obligatory relationship to amnesia. Dissociations between aspects of memory, revealed by the study of amnesia, can also shed light on the organization of memory in the brain.

Alcohol Amnestic Disorder↗

PubMed2003

Spontaneously hypertensive rats: further evaluation of age-related memory performance and cholinergic marker expression.

OBJECTIVE: The spontaneously hypertensive rat (SHR), often used to study cardiovascular disease processes, may also be utilized to model certain central nervous system changes associated with memory disorders. Previous work in our laboratory indicated that central nicotinic acetylcholine receptors are markedly diminished and that memory-related task performance is impaired in this rodent phenotype. Due to the well-documented importance of the central cholinergic system to memory processes and its vulnerability to the effects of aging, it was of interest to measure other cholinergic markers and to further evaluate memory function in older SHRs. METHOD: Radial arm maze performance was used to assess working memory, quantitative receptor autoradiography with [3H]-pirenzipine, [3H]-AFDX-384 and [3H]-epibatidine (combined with cytisine) was used to determine the densities of muscarinic-M1 and -M2 and nicotinic cholinergic alpha3 receptors, respectively. Immunoblotting experiments were also used to determine the expression of the presynaptic cholinergic markers, choline acetyltransferase and the vesicular acetylcholine transporter. RESULTS: Radial arm maze performance was impaired in hypertensive (compared with normotensive Wistar and Wistar-Kyoto) rats, regardless of age. M1 binding was increased in frontal and prefrontal cortical areas in SHR (p < 0.05), whereas M2 densities were higher in the hypertensive phenotype in the caudate putamen. A lower expression of alpha3-containing nicotinic receptors was observed in the superior colliculus in SHRs. Age-related differences in the expression of the vesicular acetylcholine transporter were noted in the hippocampus. CONCLUSION: The SHR may be useful to model some aspects (particularly hypertension-related) of memory disorders, especially those in which cholinergic function is altered.

Aging↗

PubMedDate not supplied

Specificity of the memory deficits associated with basal ganglia dysfunction.

Recent studies comparing the explicit and implicit memory disorders of Huntington's disease (HD) and Alzheimer's disease (AD) patients have yielded new insights into the specificity of the memory disorders associated with basal ganglia dysfunction. Patients with HD have severe deficiencies in retrieving information from either episodic or semantic explicit memory. This retrieval deficit is not confounded by impairments in storage, rapid forgetting, intrusion errors and a deterioration of the structure of semantic knowledge. While HD patients perform normally on implicit memory tasks involving lexical, semantic and pictorial priming, they are impaired on implicit tests which require the initiation and/or modification of central motor programs. It is concluded that the basal ganglia play a specific but important role in memory although the processes they mediate are different from those dependent on the integrity of the hippocampus and diencephalon.

Basal Ganglia Diseases↗

PubMed1993

[Cerebellar syndrome after carbon monoxide poisoning. Magnetic resonance imaging and single photon emission tomography].

A 19-year-old woman presented with severe carbon monoxide poisoning resulting in coma, brain stem signs, cerebellar syndrome, anterograde memory disorder and some frontal signs. Nine years later, generalized seizures appeared. At the age of 31, the cerebellar syndrome and memory disorders persisted. MRI showed cerebellar and internal temporal atrophy with high-intensity signals, and hippocampal and callosal atrophy. SPECT (Xe133) showed a low cerebellar blood flow.

Adult↗

PubMed1997

Amnesia and neglect: beyond the Delay-Brion system and the Hebb synapse.

Hippocampal damage in people causes impairments of episodic memory, but in rats it causes impairments of spatial learning. Experiments in macaque monkeys show that these two kinds of impairment are functionally similar to each other. After any lesion that interrupts the Delay-Brion system (hippocampus, fornix, mamillary bodies and anterior thalamus) monkeys are impaired in scene-specific memory, where an event takes place against a background that is specific to that event. Scene-specific memory in the monkey corresponds to human episodic memory, which is the memory of a unique event set in a particular scene, as opposed to scene-independent human knowledge, which is abstracted from many different scenes. However, interruption of the Delay-Brion system is not sufficient to explain all of the memory impairments that are seen in amnesic patients. To explain amnesia the specialized function of the hippocampus in scene memory needs to be considered alongside the other, qualitatively different functional specializations of other memory systems of the temporal lobe, including the perirhinal cortex and the amygdala. In all these specialized areas, however, including the hippocampus, there is no fundamental distinction between memory systems and perceptual systems. In explaining memory disorders in amnesia it is also important to consider them alongside the memory disorders of neglect patients. Neglect patients fail to represent in memory the side of the world that is contralateral to the current fixation point, in both short- and long-term memory retrieval. Neglect was produced experimentally by unilateral visual disconnection in the monkey, confirming the idea that visual memory retrieval is retinotopically organized; patients with unilateral medial temporal-lobe removals showed lateralized memory impairments for half-scenes in the visual hemifield contralateral to the removal. Thus, in scene-memory retrieval the Delay-Brion system contributes to the retrieval of visual memories into the retinotopically organized visual cortex. This scene memory interpretation of hippocampal function needs to be contrasted with the cognitive-map hypothesis. The cognitive-map model of hippocampal function shares some common assumptions with the Hebb-synapse model of association formation, and the Hebb-synapse model can be rejected on the basis of recent evidence that monkeys can form direct associations in memory between temporally discontiguous events. Our general conclusion is that the primate brain encompasses widespread and powerful memory mechanisms which will continue to be poorly understood if theory and experimentation continue to concentrate too much, as they have in the past, on the hippocampus and the Hebb synapse.

Amnesia↗