PSYCHIATRY

REPORT ON NEW DEVELOPMENT

AND MANAGEMENT OF AMNESIC
DISORDER

Reporters:
Flores, Beatriz
Ramos, Cristine
Salva, Kristyle
Villafranca, Kiel
Zaldarriaga, Ella
INTRODUCTION
Amnesia is defined as the total or partial loss of memory. There is considerable
heterogeneity regarding amnesic syndromes. Reports of several types of amnesia
can be found in the literature to this date and there is also great diversity in the

neuropsychopathology of amnesia. Amnesic syndrome can be observed in several

pathologies and its onset is progressive or sudden, transient or permanent. In short,
it is important to consider the etiological, organic, progressive and clinical criteria in
amnesia classification.

HOW IS AMNESIA DIAGNOSED?

Initially, the health care professional will need to rule out any other possible causes
of memory loss, including dementia, Alzheimers disease, depression, or a brain
tumor. It will require a detailed medical history - this may be difficult if the patient
does not remember things, so family members or caregivers may also have to be
present. The patients permission to talk about his/her medical details with
somebody else is needed.
The Healthcare Provider will try to cover the following issues:
o
o
o
o
o
o
o
o
o
o
o
o

Can the patient remember recent events, and/or remote events (events
further back in time)?
When did the memory problems start?
How did the memory problems evolve?
Were there any factors which may have caused the memory loss, such as a
head injury, surgery, or stroke?
Is there a family history of any neurological or psychiatric diseases or
conditions?
Details about the patients alcohol intake.
Is the patient currently on any medication?
Has the patient taken illegal drugs, such as cocaine, marijuana, etc.?
Are the patients symptoms undermining his/her ability to look after
himself/herself?
Does the patient have a history of depression?
Has the patient ever had cancer?
Does the patient have a history of seizures?

Physical Assessment:
o
o
o
o

Reflexes
Sensory function
Balance
Some other aspects of the brain and nervous system.

Check Patients:
o
o
o

Judgment
Short-term memory
Long-term memory

DIAGNOSTIC TESTS
In order to find out whether there is any physical damage or brain abnormality, the
doctor may order:
o
o
o
o

An MRI (magnetic resonance imaging) scan - Used in detecting a tumor in the

brain.
A CT (computerized tomography) scan injury).
An EEG (electroencephalogram)
Blood tests may also reveal the presence of any infection, or nutritional
deficiencies.

TREATMENT OF AMNESIA
As of now, there is no known treatment yet for amnesia. However, many forms of
amnesia fix themselves without being treated.
o

Cognitive therapy
Usually through a speech/language therapist, may be helpful for mild to
moderate memory loss.

Psychotherapy
Sometimes it may be effective for some patients. Hypnosis can be an
effective way of recalling memories that have been forgotten.

Occupational therapy
A person with amnesia may work with an occupational therapist to learn new
information to replace what was lost, or to use intact memories as a basis for
taking in new information. Memory training may also include a variety of
strategies for organizing information so that it's easier to remember and for
improving understanding of extended conversation.

MEDICATIONS OR SUPPLEMENTS
No medications are currently available for treating most types of amnesia.
Sometimes it is appropriate to administer a drug called Amytal (sodium
amobarbital) to people suffering from amnesia. The medicine helps some people
recall their lost memories. Wernicke-Korsakoff syndrome involves a lack of thiamine,
treatment includes replacing this vitamin and providing proper nutrition. Although
treatment, which also needs to include alcohol abstinence, can help prevent further
damage, most people won't recover all of their lost memory. If an underlying cause
for the amnesia is identified, there are national organizations that can provide
additional information or support for the individual and their families.

AMNESIA REHABILITATION
Many rehabilitation techniques are actually used to treat amnesic individuals,
especially those who suffer from anterograde amnesia. Interventions may focus on
the use of compensatory techniques, such as computers, beepers, written notes,
diaries or through intensive training programs involving the active participation of
the individual, as well as his/her family and friend circle. In this perspective,
environmental adaptation techniques are used, such as the compensatory
technique education to training (exercise), organizational strategies, visual
imagery and verbal labelling. In addition, other techniques are also used in
rehabilitation, such as implicit tasks, speech, and mnemotechnic methods (Cicerone
et al. 2000). So far, it has been proven that education techniques of compensatory
strategies for memory disorders are effective in individuals with minor traumatic
brain injuries (Gordon et al. 2006). In moderately or severely injured individuals, the
most effective interventions are those appealing to external aids, such as reminders
in order to facilitate particular knowledge or skill acquisition. The purpose of these
external aids is to enhance the individual's functional level rather than the memory
function per se (Cicerone et al. 2000). Reality orientation techniques are also
considered in confused individuals with deficits in the retrograde and anterograde
memory, as well as spatio-temporal disorientation. Their purpose is to enhance
orientation using stimulation and repetition of the basic orientation information
(Corrigan et al. 1985). These techniques are applied on an individual (informal
approach) or a group basis (formal approach) and have been used in populations of
patients primarily presenting with dementia and head-injured patients (Zencius et
al. 1998; de Guise et al. 2005).

RELEARNING AND COMPENSATING

Rehabilitation has two primary components:
1. Relearning forgotten skills
2. Compensating for more enduring impairments
Much of what a survivor has learned in her lifetime still is present in her brain after
the trauma. Severed connections block access to this information and the patient
cant recall how to perform many activities. Through directed training and persistent
practice, rehab reprograms the brain, establishing new connections among these
still-present pockets of information, enabling the patient to reacquire forgotten
skills.
Despite the best efforts of your survivor and her rehab team, serious brain damage
always results in some impairment that cannot be remedied. To lead a full life, your
survivor must learn ways to work around her new deficits. In rehabilitation, she will
be taught to recognize and compensate for her impairments.
Sometimes, compensation means a change in behavior. This is called applying
compensatory strategies. For example, a person with a diminished memory

nearly everyone with a brain injury is taught to keep a detailed, daily schedule to
keep her from aimlessly or inefficiently passing her time.

WHEN SHOULD REHABILITATION BEGIN?

In an ideal world, rehabilitation begins as soon as the survivor is medically stable.
No patient should be kept in an acute hospital setting or a nursing home any longer
than necessary. Combining the brains natural healing process with rehabilitative
therapy is crucial to the success of ones recovery.
Researchers have learned that survivors benefit most from rehabilitation when they
have reached Level 3 or 4 on the Rancho Scale.

References:
http://www.medicalnewstoday.com/articles/9673.php?page=2
http://alz.org
http://www.nhs.uk/conditions/psychotherapy/Pages/Introduction.aspx

FURTHER RESEARCH ABOUT MODERN APPROACH TO AMNESIA

Brain Prosthesis Designed to Help People With Memory Loss

by Bidita Debnath on October 1, 2015 at 1:21 AM Research News - G J E 4
Experts have developed a brain prosthesis that can replace or support a damaged
part of the brain and help people with memory loss problems and form memories as
efficiently as any other person.
The prosthesis, which includes a small array of electrodes implanted into the brain,
has performed well in laboratory testing in animals and is currently being evaluated
in human patients.
The device that relies on a new algorithm was designed originally at University of
Southern California and tested at Wake Forest Baptist Medical Centre in North
Carolina.
The researchers explained that when your brain receives the sensory input, it
creates a memory in the form of a complex electrical signal that travels through
multiple regions of the hippocampus, the memory centre of the brain.
At each region, the signal is re-encoded until it reaches the final region as a wholly
different signal that is sent off for long-term storage.
If there is damage at any region that prevents this translation, then there is the
possibility that long-term memory will not be formed.
That is why an individual with hippocampal damage (for example, due to
Alzheimer's disease) can recall events from a long time ago - things that were
already translated into long-term memories before the brain damage occurred - but
have difficulty forming new long-term memories.
Song and Berger found a way to accurately mimic how a memory is translated from
short-term memory into long-term memory, using data obtained first from animals,
and then from humans.

The prosthesis is designed to bypass a damaged hippocampal section and provide

the next region with the correctly translated memory.
That is despite the fact that there is currently no way of "reading" a memory just by
looking at its electrical signal.
"It is like being able to translate from Spanish to French without being able to
understand either language," said Ted Berger from USC Viterbi School of
Engineering.
In hundreds of trials conducted with nine patients, the new algorithm accurately
predicted how the signals would be translated with about 90 percent accuracy.
The research was presented at the 37th Annual International Conference of the IEEE
Engineering in Medicine and Biology Society in Milan, Italy.

Source: IANS
Read more: Brain Prosthesis Designed to Help People With Memory Loss
http://www.medindia.net/news/brain-prosthesis-designed-to-help-people-withmemory-loss-154086-1.htm#ixzz3xroz06ce

EMDR
Eye Movement and Desensitization and Reprocessing (EMDR) (Shapiro, 1995, 2001)
is a method that was developed by Francine Shapiro in the early 1990s. EMDR is a
short term psychodynamic psychotherapy method that focuses on helping the
patient/client to access and process previously forgotten painful traumatic memory.
Amnesia for an event or relationship need not only be traumatic in nature; memory
relating to painful experiences of self in interaction within families is also very
commonly forgotten from mid-adolescence onward. In fact unresolved thoughts of
self in interaction and feelings with regards to a troubling parent-child relationship
often underlies ones later (Bremner et al., 1993) responses to a traumatic event(s),
i.e. earlier stress and trauma set the stage for the later expression of PTSD
symptoms. When painful memory is forgotten, it becomes trapped in the brain and
central nervous system (CNS) (van der Kolk, 1996b), is presented in later
neurobiological alterations of neural circuitry (van der Kolk, 1996b) and is
inadvertently internalized and reenacted in later adult scripts (Goulding & Goulding,
1975; van der Kolk, 1996a). Later stressors and aging allow the expression of
symptoms of chronic psychiatric, affective, or physical illness (van der Kolk, 1996a)
that likely will someday require psychopharmacological intervention according to
todays standard.
The EMDR therapy session helps the patient to recall and process different aspects
of a troubling or painful memory relating to a traumatic event or emotional loss.
What was experienced as painful with recall at the start of therapy, after therapy, is
no longer painful. In addition, the general arousal state of the patient and

experience of uncomfortable symptoms decrease in response to progress in therapy.

Successful processing of each painful memory removes a layer of stress that had
been previously expressed in neurobiological terms and through symptoms prior to
the completion of the EMDR processing. The decreases in arousal and physiological
measures that come with complete processing of painful or traumatic memory
simulates ones sense of well being, similar to that experienced in response to
successfully remitted psychopharmacological therapy. As will be demonstrated in a
future section of this web site, the stress response tends to reduce the functional
integrity of certain corticolimbic regions, e.g. pACC and the hippocampal formation,
and this produces alterations in neural circuitry, in their metabolism as well as in
the synthesis, release and secretion of certain stress neurohormones and
neuroimmune markers. Successful therapies work to improve the function of these
areas to promote the modulation of the stress response.
During the EMDR assessment (Shapiro, 1995, 2001) the therapist completes a
thorough assessment and history with the patient, helps the patient to create and
establish a safe place, and looks to identify the negative cognition that has been
associated with a negative event(s) or relationship(s) that impacts on the patients
current sense of self. The therapist then inquires into the most disturbing sensory
aspect to the traumatic event or relationship (feeling sore with having been beaten
or hearing anger in an aggressors voice), visceral body messages (sinking feeling in
the pit of ones stomach or heart pounding), negative emotion (sadness) which
accompanies the negative cognition (I am not good enough or I am unlovable). The
EMDR therapist monitors the patients sense of disturbance and preferred thought
of self with Subjective Units of Disturbance (SUDS) and Validity of Cognition (VOC)
respectively. The patient is encouraged to reflect on all four areas of experience
while visually guided, bilateral auditory, or somatotopic tapping induced eye
movements are tracked by the EMDR therapist. Holding these different aspects of
experience in mind along with tracked eye movements allows these experiences to
fuse into one memory. This precipitates emotional learning that allows for future
spontaneous memory retrieval without the experience of acute or chronic arousal.
With increasing processing and decreasing discomfort, the patient experiences a
positive cognition (I am good enough).
Many studies have monitored the efficacy of EMDR therapy by providing follow-up
interviews. Reductions in SUDS ratings, basal heart rate, skin temperature, systolic
blood pressure and galvanic skin response to previous traumatic eliciting imagery
were reported (Montgomery & Ayllon, 1994; Wilson et al., 1996) immediately after
the course and completion of EMDR therapy. After three and then fifteen-month
follow-up meetings on three prior EMDR therapy sessions, 66 individuals, 32 of
whom had been diagnosed with PTSD symptoms, experienced an 84% reduction in
assessed PTSD diagnosis and 68% reduction in PTSD symptoms (Wilson et al., 1995,
1997). Two months after three 90-minute EMDR therapy sessions individuals who
had previously experienced a civilian traumatic event no longer reported PTSD
symptoms at the conclusion of therapy (Lazrove et al., 1998). EMDR therapy has
also been reported to be effective at three-month follow-up at alleviating PTSD and
depressive symptoms with 21 rape victims over a course of three 90 minute therapy

sessions (Rothbaum, 1997). After three months of EMDR therapy and a three month
follow-up, combat veterans with post-traumatic stress disorder reported reductions
in symptoms of memory intrusion, avoidance, and arousal, and reported overall
improvements when compared with veterans receiving routine care (Carlson et al.,
1998).
The studies noted above document EMDRs efficacy at reducing symptoms and
physiological measures in response to the processing of a single traumatic event,
but another noted after two sessions of EMDR, that more sessions were needed to
resolve a trauma (Scheck et al., 1998). The population of 21 individuals in this study
presented many dysfunctional behaviors, such as substance abuse, incarceration,
friendships with individuals who had engaged in prostitution, and relationships with
partners who were in current incarceration with histories of substance abuse. In
clinical practice such patient populations tend to present chronic stress histories of
multiple traumas (physical and/or sexual abuses) and emotional losses throughout
their lives. Another study did a five-year follow-up of previous EMDR therapy and
found that therapeutic benefits experienced immediately after EMDR therapy were
lost at follow-up (Macklin et al., 2000). This study like the one noted above used a
sample population of veterans who were described as entrenched and chronically
ill. The fact that both sample populations were noted to be severely dysfunctional
and chronically ill suggest that they presented histories of multiple traumas in their
lifetime and/or unresolved feelings with regards to emotional losses. The individuals
cumulative stress responses to these other traumas were not accounted for in the
processing of one single traumatic event. This dynamic would make the method
appear ineffectual, because several sessions were actually needed to process
numerous traumas to produce long-term effective results.
After successful EMDR threrapy, posttreatment salivary cortisol levels were
significantly reduced in response to dexamethasone challenge and were also
associated with reductions in perceived sensitivity to the impact of prior aversive
life events and in anxiety symptoms (Heber et al., 2002). In a SPECT neuroimaging
study post-treatment activations of the perigenual anterior cingulate were strongly
correlated with post-treatment decreases in sensitivity to reliving trauma and rated
distress values as well as reductions of anxiety symptoms that met previously
assigned PTSD diagnosis (Levin et al., 1999).
In summary, EMDR, a short term psychodynamic therapy method has been tested
by many researchers for its short-term and long term effectiveness. With individuals
with limited traumas in their histories the EMDR therapy method has been found to
be short, direct, and proven to be quite effective. However, with individuals with
multiple traumas and many emotional losses in their histories, the processing of a
single traumatic event is not sufficient by itself to offset the neurobiological cascade
precipitated by a lifetime of chronic, cumulative responses to stressful interactions
with the environment. A plan needs to be developed with these individuals to
address and target each trauma with each succeeding EMDR session.

A novel therapeutic approach for an existing drug reverses a condition in

elderly patients who are at high risk for dementia due to Alzheimer's
disease, researchers at Johns Hopkins University found.
The drug, commonly used to treat epilepsy, calms hyperactivity in the brain of
patients with amnestic mild cognitive impairment (aMCI), a clinically recognized
condition in which memory impairment is greater than expected for a person's age
and which greatly increases risk for Alzheimer's dementia, according to the study
published this week in NeuroImage: Clinical.
The findings validate the Johns Hopkins team's initial conclusions, published three
years ago in the journal Neuron. They also closely match the results in animal
studies performed by the team and scientists elsewhere. Next, neuroscientist
Michela Gallagher, the lead investigator, hopes the therapy will be tested in a largescale, longer-term clinical trial.
Hippocampal over-activity is well-documented in patients with aMCI and its
occurrence predicts further cognitive decline and progression to Alzheimer's
dementia, Gallagher said.
"What we've shown is that very low doses of the atypical antiepileptic levetiracetam
reduces this over-activity," Gallagher said. "At the same time, it improves memory
performance on a task that depends on the hippocampus."
The team studied 84 subjects; 17 of them were normal healthy participants and the
rest had the symptoms of pre-dementia memory loss defined as aMCI. Everyone
was over 55 years old, with an average age of about 70.
The subjects were given varying doses of the drug and also a placebo in a doubleblind randomized trial. Researchers found low doses both improved memory
performance and normalized the over-activity detected by functional magnetic
resonance imaging that measures brain activity during a memory task. The ideal
dosing found in this clinical study matched earlier preclinical studies in animal
models.
"What we want to discover now, is whether treatment over a longer time will
prevent further cognitive decline and delay or stop progression to Alzheimer's
dementia," Gallagher said.
Other team members from Johns Hopkins included Arnold Bakker, assistant
professor of psychiatry and behavioral sciences; Marilyn S. Albert, director of the
Division of Cognitive Neuroscience in the Department of Neurology; professor of
neurology Gregory Krauss and the clinical study coordinator, Caroline L. Speck.
Gallagher, the Krieger-Eisenhower Professor of Psychology and Neuroscience, is the
founder of, and a member of the scientific board of, AgeneBio, a biotechnology
company focused on developing treatments for diseases that affect brain function.
The company is headquartered in Baltimore.
Gallagher owns AgeneBio stock, which is subject to certain restrictions under Johns
Hopkins policy. She is entitled to shares of any royalties received by the university

on sales of products related to her inventorship of intellectual property. The terms of

these arrangements are managed by the university in accordance with its conflictof-interest policies.

Journal Reference:
Arnold Bakker, Marilyn S. Albert, Gregory Krauss, Caroline L. Speck, Michela
Gallagher. Response of the medial temporal lobe network in amnestic mild cognitive
impairment to therapeutic intervention assessed by fMRI and memory task
performance. NeuroImage: Clinical, 2015; 7: 688 DOI: 10.1016/j.nicl.2015.02.009