Smell your memories: Positive effect of odor exposure on recent and remote autobiographical memories in Alzheimer's disease.

Introduction: There is a burgeoning interest in the effects of odor exposure on autobiographical memory in Alzheimer's disease (AD). We pursued this line of research by assessing the effect of odor exposure on the retrieval of recent and remote memories in AD. Method: Twenty-six patients with mild AD and 28 controls were tested in two conditions: with and without odor exposure. In each condition, participants were invited to retrieve two childhood memories, two adulthood memories, and two recent memories. Results: Analysis showed that AD patients produced a higher number of and more specific childhood memories, adulthood memories, and recent memories after odor exposure than without odor. Discussion: These findings demonstrate how odor exposure may alleviate anterograde and retrograde amnesia, at least when considering the ability of patients with mild AD to retrieve few recent or remote memories.

Speech-language pathologists' perspectives on cognitive communication assessment during post-traumatic amnesia.

PRIMARY OBJECTIVE: There have been few reports of the approaches taken by speech-language pathologists (SLPs) when assessing cognitive communication (CC) during post-traumatic amnesia (PTA) after TBI. This study sought to understand SLPs' rationales for CC assessment during PTA and to examine their perspectives on assessment methods during the early recovery period. METHODS AND PROCEDURES: In this qualitative study, 10 SLPs participated in semi-structured face-to-face or telephone interviews about their rationales and methods for CC assessment during PTA and early recovery. Content analysis was conducted using NVivo software to identify key categories. MAIN OUTCOME AND RESULTS: SLPs reported their reasons for CC assessment as including: (1) Documenting changes and monitoring progress, (2) Feedback to team, family and patient, (3) Diagnosis of communication disorder, (4) Planning and (5) Prognosis. They described conducting ongoing, informal assessment and monitoring of CC, using a combination of standardized and non-standardized measures during PTA, and commenced formal testing after PTA resolution to formulate a baseline level of communication function. CONCLUSIONS: The current study highlighted the importance that SLPs placed on an individualized approach in CC assessment. Findings provided insight into the process of assessment of CC during PTA and the early stage of recovery after TBI.

Postconcussion syndrome and mild head injury: the role of early diagnosis using neuropsychological tests and functional magnetic resonance/spectroscopy.

OBJECTIVE: Postconcussion syndrome (PCS) is usually underestimated in cases of mild head injury (MHI). It is one of the most common causes of physical, cognitive, and psychomotor disturbances that affect the quality of life, work, and social reintegration of individuals. Until now, we did not have evidence of structural abnormalities shown by traditional imaging methods. We describe a series of instruments that confirm PCS with satisfactory evidence. METHODS: We conducted a clinical prospective study of 19 adult patients selected from a pool of 320 adults who had MHI. The cognitive, executive, and memory functions of subjects were examined within the first 72 hours using neuropsychological tests. These results were analyzed with neurological examination and functional MR/spectroscopy. RESULTS: Neurobehavioral alterations were found in 47% of cases, with posttraumatic amnesia. Around 55% of subjects experienced physical disturbances such as headache and postural vertigo due to PCS. The spectroscopy reports revealed neurometabolite disturbances in 54% of cases, particularly N-acetylaspartate (Naa) and the Naa/lactate ratio in the frontal lobe. We observed a relationship between metabolite disturbances in spectroscopy and the digit span backward test (P = .045). CONCLUSIONS: This first diagnostic strategy supports with scientific evidence the presence of PCS in MHI. We identified physical and neuropsychological abnormalities from this group, affecting the areas of memory and learning. Evidence of neurometabolite disturbances were found specifically in the frontal lobe. It is necessary to complete comparative follow-up for an extended period of time. The neuropsychological and spectroscopy tests allow us to confirm the diagnosis of a syndrome that is usually neglected.

Rehabilitación neuropsicológica en un caso de amnesia retrógrada aislada / Neuropsychological rehabilitation in an isolated case of retrograde amnesia

La amnesia retrógrada aislada es un déficit neuropsicológico poco común y el empleo de terapia de rehabilitación neuropsicológica no ha sido estudiado ni planteado para estos pacientes. El presente artículo documenta el caso clínico de CE, una paciente de 28 años de edad, residente en Medellín, Colombia, quien posterior a un secuestro, sufre pérdida de la memoria remota. Se le practicó una evaluación neuropsicológica, y estudios de neuroimagen estructural. Posteriormente, se propuso e implementó un plan de rehabilitación neuropsicológica enfocado en la recuperación de la memoria semántica. Al terminar la intervención se encontró mejoría a nivel cognitivo y funcional, con incremento significativo en las habilidades mnésicas y neurolingüísticas, en la comprensión de su entorno y el desempeño en las actividades cotidianas.

Isolated retrograde amnesia is a rare neuropsychological deficit and neuropsychological rehabilitation therapy has not been studied or proposed for these patients. This article documents the case of CE, a 28-year-old female patient, resident in Medellin, Colombia, who suffers remote memory loss after being kidnapped. Neuropsychological assessment and structural neuroimaging studies was performed. Then, a neuropsychological rehabilitation plan focused on semantic memory retrieval was planned and implemented. After the intervention, cognitive and functional improvement was found, with significant increase in mnemonic and neurolinguistic skills, also in understanding of her environment and her performance in daily activities.

[Main interventions for rehabilitation of autobiographical memory in Alzheimer's disease from early to severe stage: a review and new perspectives]. / Prise en charge des troubles de la mémoire autobiographique dans la maladie d'Alzheimer du stade débutant au stade sévère : revue de la littérature et nouvelles perspectives.

Given the limitations of pharmacological treatments in Alzheimer's disease, many non-drug therapies have emerged in recent decades and are often offered in complement of pharmacological treatments. The cognitive rehabilitation interventions focused on memory are usual in Alzheimer's disease. Memory deficits are prominent from the early stages of the disease and cause detriment to patient autonomy in daily life. In particular, problems of identity and autobiographical memory, although still often overlooked in the patients' general neuropsychological profile, appear right away. Because of their more insidious negative influence, specific treatments are still underdeveloped. Rehabilitation of autobiographical memory is complex because it requires taking into account its multiple components, both semantic and episodic, but also understanding its links with personal identity. Thus, this article provides an overview of existing cognitive rehabilitation interventions of anterograde and retrograde autobiographical memory in Alzheimer's disease. We specify the contribution of new technologies to improve the consolidation of recent events memory and of a rehabilitation program of autobiographical memory - REMau -, derived from the TEMPau task, which takes into account the constructive nature of episodic memories via the personal semantic through different periods of life. The main aim is to examine what are the objectives, benefits and limitations of these interventions and to estimate how they can meet the more general problem of deficiency in personal identity. As identity is constructed on the basis of past experience, but is modulated by new experiences, our current challenge is to associate combined treatments of anterograde and retrograde memory based on the interaction between autobiographical memory and the self.

Speech pathologists' current practice with cognitive-communication assessment during post-traumatic amnesia: a survey.

PRIMARY OBJECTIVE: To investigate speech pathologists' current practice with adults who are in post-traumatic amnesia (PTA). METHOD: Speech pathologists with experience of adults in PTA were invited to take part in an online survey through Australian professional email/internet-based interest groups. RESULTS: Forty-five speech pathologists responded to the online survey. The majority of respondents (78%) reported using informal, observational assessment methods commencing at initial contact with people in PTA or when patients' level of alertness allowed and initiating formal assessment on emergence from PTA. Seven respondents (19%) reported undertaking no assessment during PTA. Clinicians described using a range of techniques to monitor cognitive-communication during PTA, including static, dynamic, functional and impairment-based methods. CONCLUSIONS: The study confirmed that speech pathologists have a key role in the multidisciplinary team caring for the person in PTA, especially with family education and facilitating interactions with the rehabilitation team and family. Decision-making around timing and means of assessment of cognitive-communication during PTA appeared primarily reliant on speech pathologists' professional experience and the culture of their workplace. The findings support the need for further research into the nature of cognitive-communication disorder and resolution over this period.

Relative contribution of attention and memory toward disorientation or post-traumatic amnesia in an acute brain injury sample.

PRIMARY OBJECTIVE: To examine the relative contribution of attention and memory to orientation/disorientation following moderate-to-severe brain injury. It was hypothesized that attention would be a comparable contributor to orientation, compared to memory; suggesting assessing attention has a role in understanding and estimating duration of post-traumatic amnesia. RESEARCH DESIGN: One hundred and five brain-injured inpatients were divided into three groups of high, moderate or low orientation. ANOVA was run on attention, memory and (as a control) language scores to examine group differences. Correlational analysis was run between orientation items and attention and memory indexes to examine the relative contribution of attention and memory on specific orientation item performance. Multiple regression examined the contribution of memory and attention to being oriented. METHODS AND POCEDURES: Patients' orientation, attention, memory and language were assessed during their inpatient rehabilitation. MAIN OUTCOMES AND RESULTS: Groups differed significantly and attention recovered more sharply between low and moderate orientation states compared to memory and language recovery. Memory contributed most to orientation, followed closely by attention, both surpassing language. Attention most related to temporal estimation, while memory most related to retrieval of well-consolidated memories. CONCLUSIONS: Attention contributes significantly to orientation, although to a slightly lesser degree than memory. Attention should be assessed routinely. The relative 'load' and contribution of attention to orientation and answering orientation-type questions is discussed.

Which on-field signs/symptoms predict protracted recovery from sport-related concussion among high school football players?

BACKGROUND: There has been increasing attention and understanding of sport-related concussions. Recent studies show that neurocognitive testing and symptom clusters may predict protracted recovery in concussed athletes. On-field signs and symptoms have not been examined empirically as possible predictors of protracted recovery. PURPOSE: This study was undertaken to determine which on-field signs and symptoms were predictive of a protracted (≥21 days) versus rapid (≤7 days) recovery after a sports-related concussion. On-field signs and symptoms included confusion, loss of consciousness, posttraumatic amnesia, retrograde amnesia, imbalance, dizziness, visual problems, personality changes, fatigue, sensitivity to light/noise, numbness, and vomiting. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: The sample included 107 male high school football athletes who completed computerized neurocognitive testing within an average 2.4 days after injury, and who were followed until returned to play as determined by neuropsychologists using international clinical concussion management guidelines. Athletes were then grouped into rapid (≤7 days, n = 62) or protracted (≥21 days, n = 36) recovery time groups. The presence of on-field signs and symptoms was determined at the time of injury by trained sports medicine professionals (i.e., ATC [certified athletic trainer], team physician). A series of odds ratios with χ(2) analyses and subsequent logistic regression were used to determine which on-field signs and symptoms were associated with an increased risk for a protracted recovery. RESULTS: Dizziness at the time of injury was associated with a 6.34 odds ratio (95% confidence interval = 1.34-29.91, χ(2) = 5.44, P = .02) of a protracted recovery from concussion. Surprisingly, the remaining on-field signs and symptoms were not associated with an increased risk of protracted recovery in the current study. CONCLUSION: Assessment of on-field dizziness may help identify high school athletes at risk for a protracted recovery. Such information will improve prognostic information and allow clinicians to manage and treat concussion more effectively in these at-risk athletes.

A critical review of the literature on early rehabilitation of patients with post-traumatic amnesia in acute care.

AIMS AND OBJECTIVES: To identify the effect of early rehabilitation of patients with post-traumatic amnesia in patients with traumatic brain injury, to review and critically assess evidence related to the timing of intervention and to identify the effect on outcome of a specific neurological rehabilitation in acute care. BACKGROUND: Up to 70% of patients with traumatic brain injury will experience post-traumatic amnesia. Although duration of post-traumatic amnesia is correlated negatively with outcome for patients with traumatic brain injury, there is limited evidence relating to what influence timing and effect may have on enhancing early rehabilitation patient outcomes. DESIGN: A critical literature review. METHODS: Searches for systematic reviews were undertaken in Medline, CINAHL, Cochrane, PSYC INFO and Neurotraume databases. The efficacy of intervention and timing was classified based on a hierarchy of study designs for questions about health care interventions based on soundness of design. RESULTS: Six reviews and 11 original studies were included and comprised the review. Many studies used weak designs and small sample size, thus limiting their ability to control confusing variables and outcomes. Few studies included papers with the information about timing and effect of early post-traumatic amnesia intervention. Only one study showed an effect of a reality orientation programme in acute care. Although there was no significant detail reported on the possibility of reducing the post-traumatic amnesia period, the study showed clinical relevance. CONCLUSION: This review highlights the limited evidence of the effect of early rehabilitation of patients with post-traumatic amnesia. Future research should be conducted to identify the effectiveness of early intervention. RELEVANCE TO CLINICAL PRACTICE: Although nurses are treating patients with post-traumatic amnesia without systematic assessment, the limited evidence available does little to direct nurses as to the best approach to start early rehabilitation of post-traumatic amnesia to promote good outcomes.

[The pharmacological treatment of abulic posttraumatic state in children-preliminary report]. / Leczenie farmakologiczne pourazowego stanu abulicznego u dzieci--doniesienie wstepne.

UNLABELLED: The aim of the study was the evaluation of clinical condition of the children treated by Gliatilin and Dexamin for posttraumatic abulic state. MATERIAL AND METHOD: The study included 12 children (8 boys, 4 girls) at the age range between 7-16 years (mean age 7.8 years). The evaluation of clinical condition was performed on admission to the Department, and then at 3rd, 6th and 12th month after head injury. The authors analyzed the kind of injury (posttraumatic changes in neuroimaging) and evolution of patients' clinical condition in the follow-up. RESULTS: The most commonly observed reasons of trauma were motor vehicle accidents. The kind of pathology found on the base of neuroimaging did not affect the results of treatment. The patients were treated by Gliatilin, Dexamin or both. In spite of this treatment all children were rehabilitated and their hearing, sight and speech organ were stimulated. Six months after injury only one patient still presented abulic state and six of our patients were in good general condition. None of our patients revealed abulic state after 12 months of head trauma. In two children the Dexamin treatment was given up for seizures. We did not observe any side effects of Gliatilin. CONCLUSIONS: The kind of trauma and posttraumatic intracranial pathology do not determine the prognosis. The evaluation of treatment should be performed after 6-12 months. Gliatilin and Dexamin treatment improves the clinical state of patients with posttraumatic abulic state.

Interpretations of retrograde amnesia: old problems redux.

Recent evidence indicates that an old memory reactivated by cueing becomes labile and vulnerable to an amnesic treatment. Although the 'reconsolidation' concept derived from these findings challenges the traditional consolidation theory, here we argue that the new concept suffers from some of the same limitations as the earlier model. We propose an alternative retrieval-based theory that accommodates the recent data, as well as other puzzling related observations.

The effect of electroconvulsive therapy (ECT) on implicit memory: skill learning and perceptual priming in patients with major depression.

While explicit memory in amnesics is impaired, their implicit memory remains preserved. Memory impairment is one of the side effects of electroconvulsive therapy (ECT). ECT patients are expected to show impairment on explicit but not implicit tasks. The present study examined 17 normal controls and 17 patients with severe major depressive disorder who underwent right unilateral ECT. Patients were tested in three sessions: 24-48 hours prior to, 24-48 hours following the first ECT, and 24-48 hours following the eighth ECT. The controls were tested in three sessions, at time intervals that paralleled those of the patients. Implicit memory was tested by the perceptual priming task - Partial Picture-Identification (PPI). The skill learning task used entailed solving the Tower of Hanoi puzzle (TOHP). Explicit memory was tested by picture recall from the PPI task, verbal recall of information regarding the TOHP, and by the Visual Paired Association (VPA) test. Results showed that explicit questions about the implicit tasks were impaired following ECT treatment. Patients' learning ability, as measured by the VPA task, was only impaired in the first testing session, prior to ECT treatment, reflecting the effect of depression. In addition, groups only differed in the first session on the learning rate of the skill learning task. Perceptual priming was preserved in the patients' group in all sessions, indicating that it is resilient to the effect of depression and ECT. The results are interpreted in terms of the differential effect of depression and ECT on explicit and implicit memory.

Recovery of function processes in human amnesia: evidence from transient global amnesia.

There are few clues as to the processes that underlie recovery of function from human amnesia. Evidence is offered from the perspective of a study of recovery of function during an episode of transient global amnesia (TGA) that occurred as a complication of a cerebral angiographic procedure being carried out in a neurosciences centre, and where there was therefore a unique opportunity to examine acute changes in memory function. This allowed us to conduct the first quantitative study where shrinkage of anterograde and retrograde memory loss was plotted at four separate intervals throughout the acute recovery process, and also 24 hr later. Recovery of retrograde amnesia preceded recovery from anterograde amnesia. Resolution of a naming deficit more closely paralleled recovery from retrograde amnesia rather than anterograde amnesia. Within retrograde amnesia for public events, there was a temporal gradient of memory loss, with more recent events affected to a greater degree than earlier events. Within anterograde amnesia, picture recognition memory preceded recovery of story recall memory. On the basis of these findings, and related observations in the published literature, it is proposed that recovery from some types of human amnesia, such as that associated with TGA, follows a 'lateral-to-medial' rule--lateral inferotemporal areas that play a major role in retrograde amnesia recover first from hypometabolism related to the TGA attack, followed by 'interface' areas such as the rhinal and parahippocampal cortices that are considered to have a role in both anterograde and retrograde memory functioning, with the last areas to recover physiological integrity being discrete limbic-diencephalic structures such as the hippocampus.

A new case of retrograde amnesia with abnormal forgetting rate.

The classic amnesic syndrome is characterised by a severe anterograde amnesia and a less important retrograde amnesia with sparing of the semantic component. We report the case of a patient who showed a global amnesic syndrome following a mild head injury. Initially, amnesia was both anterograde and retrograde, and also involved semantic knowledge. Two years later the picture had changed remarkably. The retrograde deficit for autobiographical events was still total, while semantic memory had recovered to a large extent. Learning had also greatly improved, but only if assessed after a short delay; abnormally rapid forgetting rate were found at longer intervals. This pattern of impairment does not lend itself to an easy interpretation. However, the hypothesis of a consolidation deficit may be advanced.

Acquisition of generic memory in amnesia.

Amnesic patients' ability to acquire generic, semantic information was assessed relative to their own level of episodic memory. Patients studied a list of words in which some items were presented twice and others once. Upon each presentation, the words were tagged episodically by presenting them in a unique color. Recall of the colors in which words were presented suggested that individual presentations of repeated items were less likely to be recalled than presentations of nonrepeated items; however, actual recall of repeated items exceeded that of nonrepeated items. This outcome demonstrated that amnesics can recall some items generically without recalling either of their individual presentations. However, amnesics' recall of twice-presented items remained far below that of the control group, even when their recall of once-presented items was matched by testing the control group after a delay. This finding suggests that amnesic patients can acquire new generic knowledge but do so much less efficiently than do normal individuals. Furthermore, this deficit occurs independently of the amnesics' episodic memory impairments, reflecting instead a disruption in semantic learning per se.

[Disordered retrograde memory: diagnostic procedures in brain damage]. / Das gestörte Altgedächtnis: Diagnoseverfahren bei Hirngeschädigten.

The maintenance of old memories subsequent to brain damage is discussed with the particular aim of pointing out problems and possibilities of measuring them post-injury. Relationships between forms of brain damage and retrograde amnesia are outlined, and various recent tests designed to measure old memories are specified and assessed. From this survey it is concluded that tests and test batteries are rather heterogenous so far and at best only crudely comparable between studies, and that a clinically practicable (i.e., short), yet valid and reliable test still has to be created.