Effects of magnetic seizure therapy on anterograde and retrograde amnesia in treatment-resistant depression.

BACKGROUND: Electroconvulsive therapy (ECT) is the gold standard for treatment-resistant depression (TRD). However, cognitive side effects, mainly anterograde and retrograde amnesia, frequently occur. Magnetic seizure therapy (MST) is tested using more focal seizure induction. However, the suggestion MST may be more beneficial than ECT because it causes fewer amnesia have not yet been comprehensively investigated using common neuropsychological testing specifically for ECT. We aimed to examine whether MST causes anterograde and retrograde amnesia. METHODS: Ten patients with TRD were treated with MST (8.9 [2] treatments) at 100% machine output, a frequency of 100 Hz and 657.4 (62) pulses per train. The short form of the Autobiographical Memory Inventory was administered to test retrograde amnesia. Furthermore, an extended neuropsychological test battery, including verbal and nonverbal recall as well as recognition tasks, was used. RESULTS: We observed changes in retrograde amnesia, although they were not clinically relevant (mean: -0.42 ± 0.14). Furthermore, no anterograde amnesia as well as no effects on global cognitive status, attention, language, and executive functions after MST were measured. CONCLUSIONS: The cognitive safety and efficacy of MST in patients with TRD were indicated. However, the main limitations of the present study were the small sample and as a consequence, the low statistical power to detect changes after treatment. Therefore, our findings require replication in further studies. In addition, a direct comparison between MST and ECT in a larger sample should be performed before MST can be discussed as an alternative treatment approach to ECT in clinical practice.

Antidepressant and neurocognitive effects of isoflurane anesthesia versus electroconvulsive therapy in refractory depression.

BACKGROUND: Many patients have serious depression that is nonresponsive to medications, but refuse electroconvulsive therapy (ECT). Early research suggested that isoflurane anesthesia may be an effective alternative to ECT. Subsequent studies altered drug, dose or number of treatments, and failed to replicate this success, halting research on isoflurane's antidepressant effects for a decade. Our aim was to re-examine whether isoflurane has antidepressant effects comparable to ECT, with less adverse effects on cognition. METHOD: Patients with medication-refractory depression received an average of 10 treatments of bifrontal ECT (n = 20) or isoflurane (n = 8) over 3 weeks. Depression severity (Hamilton Rating Scale for Depression-24) and neurocognitive responses (anterograde and retrograde memory, processing speed and verbal fluency) were assessed at Pretreatment, Post all treatments and 4-week Follow-up. RESULTS: Both treatments produced significant reductions in depression scores at Post-treatment and 4-week Follow-up; however, ECT had modestly better antidepressant effect at follow-up in severity-matched patients. Immediately Post-treatment, ECT (but not isoflurane) patients showed declines in memory, fluency, and processing speed. At Follow-up, only autobiographical memory remained below Pretreatment level for ECT patients, but isoflurane patients had greater test-retest neurocognitive score improvement. CONCLUSIONS: Our data reconfirm that isoflurane has an antidepressant effect approaching ECT with less adverse neurocognitive effects, and reinforce the need for a larger clinical trial.

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.

Salud percibida, síntomas somáticos y rendimiento mnésico: un estudio de su relación en pacientes con fibromialgia / Perceived health, somatic symptoms and memory performance: a study of their relationship in patients with fibromyalgia

Objetivos: El estudio pretende examinar en pacientes con fibromialgia (FM) si existe: a) relación entre el rendimiento mnésico y el estado de salud percibido, y b) relación entre el rendimiento en la memoria y los síntomas somáticos autoinformados. Métodos: Las participantes (20 mujeres diagnosticadas de FM) de este estudio ex post facto (retrospectivo) completaron diferentes medidas sobre el estado de salud, síntomas somáticos, afectividad negativa y capacidades de memoria. Resultados: Se hallaron correlaciones significativas entre memoria y medidas de salud percibida y síntomas somáticos autoinformados. Los coeficientes de correlación parcial mostraron asociaciones significativas entre el estado de salud percibido y el rendimiento en la memoria de reconocimiento (r = 0,70; p < 0,01), y entre los síntomas somáticos y la capacidad de recuerdo demorado (r = 0,60; p < 0,05). Conclusiones: Los indicadores subjetivos de salud se relacionan con medidas de funcionamiento de la memoria en pacientes con FM. Futuros estudios deberían aumentar la potencia estadística, controlar otras variables de confusión y extrapolar este estudio a otros grupos clínicos con dolor y fatiga crónica(AU)

Objectives: The study aims to examine in patients with fibromyalgia (FM) if exists: a) relationship between memory performance and perceived health status, and b) relationship between memory performance and self-reported somatic symptoms. Methods: The participants (20 women diagnosed with FM) of this ex post facto study (retrospective) completed several measures of health status, somatic symptoms, negative affect and different memory skills. Results: We found significant correlations between memory and measures of perceived health and self-reported somatic symptoms. The partial correlation coefficients showed significant associations between perceived health status and performance on recognition memory (r = 0,70; p < 0,01) and between somatic symptoms and delayed memory capacity (r = 0,60; p < 0,05). Conclusions: The subjective health indicators are related to memory performance measures in patients with FM. Future studies should increase statistical power, to control other confounding variables and to extrapolate this study to other clinical groups with pain and chronic fatigue(AU)

Autobiographic memory: phenomenological aspects, personal semantic knowledge, generic events and characters (one case of pure retrograde memory recovery).

Tulving et al. [Brain Cogn 8 (1988) 3-20] proposed an operational distinction concerning memory between a semantic component consisting of general information about the individual's past and an episodic component, containing memories of specific events that can be situated in space and time. After a mild head trauma and in the context of professional troubles, patient FF displayed a pure retrograde amnesia concerning both his biographical identity and semantic memories. The patient could no longer access his memories. However, these did not seem completely lost since his answers to tests concerning historical events were better than random, his answers to a television quiz were automatic, he showed temporal transfer phenomena (ecmnesia) and since he retrieved the entirety of his memories within nine months. The patient FF illustrates the loss of retrograde autobiographic memory and the recovery of episodic memories, which requires three elements: a sense of subjective time, an autonoetic awareness (the ability to be aware of subjective time) and a "self" that can travel in subjective time.

Prolonged retrograde amnesia following sedation with propofol in a 12-year-old boy.

Propofol is commonly used for sedation in a variety of clinical settings, as well as for induction and maintenance of anesthesia. The ease with which propofol can be administered and titrated to clinical effect, in addition to its accepted safety profile, has made it the drug of choice for sedation in outpatient procedures, such as gastrointestinal endoscopy. While short-term amnesia is a well-known side-effect of propofol, we present the first documented case of prolonged retrograde amnesia following propofol administration in a pediatric patient. Possible mechanisms and clinical management strategies related to this unique event are discussed.

A retrospective controlled study into memory complaints reported by depressed patients after treatment with electroconvulsive therapy and pharmacotherapy or pharmacotherapy only.

Few studies have been conducted comparing complaints of memory problems using objective and subjective memory scales in depressed patients who received electroconvulsive therapy (ECT) + pharmacotherapy or treatment with pharmacotherapy only. Patients who suffer from depression according to the Diagnostic and Statistical Manual of Mental Disorder (Fourth Edition) criteria and who were admitted within the past 5 years before this study in a general psychiatric hospital were screened for inclusion. Objective retrograde amnesia was assessed using the Autobiographical Memory Interview and the Amsterdam Media Questionnaire (AMQ). Subjective retrograde amnesia was assessed using the Squire Subjective Memory Questionnaire and the ECT Retrograde Amnesia and Perception Scale (ERAPS), a newly developed scale. Twenty of the 84 patients who received ECT + pharmacotherapy and 30 of the 196 patients who received pharmacotherapy only participated in the study. Patients' ERAPS memory scores were compared with proxies' ERAPS memory scores of the patients to assess the reliability of memory complaints. The ECT + pharmacotherapy group was found to suffer more from memory problems using the AMQ 1990 test. There was also a difference for the proxy's ERAPS memory score, reflecting the conviction of proxies from the ECT + pharmacotherapy patients that these patients suffer more memory problems due to the illness, treatment with pharmacotherapy, or ECT. The differences could not be explained by the influence of determinants for retrograde amnesia. ECT + pharmacotherapy patients did not attribute their memory problems mainly to ECT but put equal "blame" on the depressive illness, treatment with pharmacotherapy, and ECT. The analyses suggest that the AMQ 1990s test is (more) sensitive in registering retrograde amnesia than the other scales used in the study.

Forgetting, reminding, and remembering: the retrieval of lost spatial memory.

Retrograde amnesia can occur after brain damage because this disrupts sites of storage, interrupts memory consolidation, or interferes with memory retrieval. While the retrieval failure account has been considered in several animal studies, recent work has focused mainly on memory consolidation, and the neural mechanisms responsible for reactivating memory from stored traces remain poorly understood. We now describe a new retrieval phenomenon in which rats' memory for a spatial location in a watermaze was first weakened by partial lesions of the hippocampus to a level at which it could not be detected. The animals were then reminded by the provision of incomplete and potentially misleading information-an escape platform in a novel location. Paradoxically, both incorrect and correct place information reactivated dormant memory traces equally, such that the previously trained spatial memory was now expressed. It was also established that the reminding procedure could not itself generate new learning in either the original environment, or in a new training situation. The key finding is the development of a protocol that definitively distinguishes reminding from new place learning and thereby reveals that a failure of memory during watermaze testing can arise, at least in part, from a disruption of memory retrieval.

The effects of pretraining and reminder treatments on retrograde amnesia in rats: comparison of lesions to the fornix or perirhinal and entorhinal cortices.

The present experiment examined the effects of pretraining and reminder treatments on the retention of a nonrelational odor-guided digging task following lesions to the hippocampal formation (i.e., fornix) or parahippocampal region (i.e., perirhinal and entorhinal cortices). The results showed that fornix-lesioned rats and control rats had good retention of the task and did not differ from each other; however, perirhinal- and entorhinal-lesioned rats were severely impaired and differed from fornix and control rats. The present experiment found no attenuation of amnesia following pretraining, which may be due to the lesion technique employed and the size of the resulting lesions. However, the experiment found a significant difference in performance following a reminder treatment, even in the severely impaired perirhinal- and entorhinal-lesioned group.

Dense retrograde amnesia, intact learning capability and abnormal forgetting rate: a consolidation deficit?

Following a thoracic trauma, which caused brain hypoxia, a 24-year-old man presented with a dense retrograde amnesia for events, persons and environments that spanned his whole life before injury. Knowledge acquired at school or through the media were equally lost, with the exception of arithmetical skills and some geographical knowledge. No deficit was apparent in language, object recognition, motor skills and intellectual tests. Anterograde memory was marked by very efficient learning capacity, an almost perfect retention of information at delay interval of 4 hours and pathologically rapid forgetting at longer delays. Informal observations agreed with test performance in showing that he could relearn facts of the past and easily acquire new information, but tended to lose these memories if the information was not frequently rehearsed. PET showed a hypometabolism of the posterior temporal lobes. Though some points remain obscure, we propose that a consolidation deficit hypothesis provides the most sensible interpretation of this peculiar pattern of memory deficit.

The use of flumazenil in reversing the midazolam and diazepam sedation in outpatients undergoing gastroscopy.

A prospective double blind randomized study was conducted to assess the efficacy and safety of flumazenil in patients for upper gastrointestinal endoscopy, sedated with midazolam or diazepam. Flumazenil significantly reduced the degree of sedation in both treatment groups without significant intergroup differences. There was no evidence of rebound sedation during the observation period of 4 hours. Anterograde amnesia was effectively antagonized in both groups. Flumazenil was a well tolerated safe and effective benzodiazepine antagonist. The combination of benzodiazepine with flumazenil makes it possible to reduce the recovery period and may be useful in outpatients undergoing endoscopy.

A method for the recovery of mishap related events lost to amnesia.

The author describes a non-hypnotic, non-pharmacologic method employed in the recovery of memories blocked by amnesia following an aircraft accident. A detailed account of the method used during the investigation of two mishaps is provided. Memories were fully recovered. In addition, a description of the use of this technique in enhancing the recall of a witness to a fatal aircraft accident is provided.

Somatostatin and (D-Trp8, D-Cys14)-somatostatin delay extinction and reverse electroconvulsive shock induced amnesia in rats.

In the present study the effects of somatostatin and its analogs on active avoidance behavior, electroconvulsive shock (ECS)-induced retrograde amnesia, and spatial-discrimination learning were compared in rats. (D-Trp8, D-Cys14)-somatostatin (as did the somatostatin molecule itself) delayed the extinction of active avoidance behavior, antagonized ECS-induced amnesia, and did not modify spatial-discrimination learning. Des-Asn5-(D-Trp8, D-Ser13) somatostatin and des-AA1,2,4,5,12,13,-(D-Trp8) somatostatin did not influence these behaviors. The data suggest that certain parts of the somatostatin molecule are important for its behavioral actions.