Patients with semantic memory loss: Can they relearn lost concepts?

Abstract

This paper describes a clinical investigation into the learning capacity of a patient with semantic memory loss. With considerable repetition this patient was able to relearn some semantic information. He was more successful at learning semantic information with which he had been familiar prior to his illness than at learning new information. The implications of these observations for the nature of semantic memory impairment, and for rehabilitation of such patients is discussed.     

Memories and reflexions of a psychiatrist of former times]

After 64 years as a psychiatrist, the author relates his experiences in psychiatric centers and in official practice as an expert. In this way, he comments on the evolution of psychiatry spanning three quarters of a century. In particular, he recalls the various methods of treatment used successively, their success and failure and the resulting accidents. He also describes the development of help given and the increasing tendency to reduce obstacles to the freedom of movements of those suffering from mental illness. Mention is also made of the changing working conditions found in psychiatric hospitals and the conception to which has the practicien himself of his role. With regard to the official practice as an expert, different objectives and approaches to the problem have been observed in the past and others are to be hoped in the future.     

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.     

Compulsive repetition of movements in a case of progressive supranuclear palsy]

A 51-year-old right-handed man with an 8-year history of progressive supranuclear palsy developed a peculiar behavior including compulsive repetition of movements. At the age of 47, it was noted that he continuously scratched his trunk with the right hand. He also scratched his thighs until his trousers were torn. On the scalp, posterior neck and forearms, patches of skin were scraped away and the bleeding wounds were scratched over and over again. Although he perceived pain, he could not terminate the strange scratching movement. He could not stop his eating action even after the bowl became empty. He could not leave the bathroom because he continued to wipe the anus after defecation. Yet the patient was not demented. Psychometric assessments including Wechsler adult intelligence scale revised, meaningful and meaningless syllables memory test. Raven's color matrix test, Wisconsin card sorting test (Keio version), and modified Stroop test were within the normal range. When requested to write a letter or a figure, he was always successful, however, he endlessly wrote the same letter or figure until he was told to stop. Although he repeated the behavior and could not terminate the action by himself, he immediately stopped the action on verbal command. When another task was given during the repetitive action, he responded quickly and successfully. His strange behavior was compulsive because he wanted to cease it, but it was not compulsive-obsessive behavior because he did not feel anxiety or pain when his repetitive action was stopped. It was different from stereotypy because he repeated not only meaningless movements but also meaningful complex actions. Unlike perseveration, he changed his activity immediately and successfully when a new task was given. Magnetic resonance imaging findings were remarkable only for mild atrophy of the midbrain tegmentum. Single photon emission computed tomography with ethyl cysteinate dimer demonstrated hypoperfusion in the frontal lobes and the left thalamus. A thalamofrontal disconnection or dysfunction is suggested as the mechanism underlying the compulsive repetifim of moving its based on the SPECT findings in this patient.     

The rewards of pediatric neurosurgery

The author relates how he ended up somewhat unexpectedly as a pediatric neurosurgeon and how fortunate he feels to have become a pediatric neurosurgeon. He reflects on his life and on the importance of trying to do one's best. He comments about the importance of listening, empathizing, and being compassionate as characteristics of the pediatric neurosurgeon and notes that by trying one's best to be a good pediatric neurosurgeon one adopts more of these characteristics by learning from patients and their parents. He discusses the many ways in which the practice of pediatric neurosurgery and his involvement in the International Society for Pediatric Neurosurgery have created meaning in his life, which has led to a feeling of happiness and fulfillment.     

A calendar savant with episodic memory impairments

Patients with memory disorders have severely restricted learning and memory. For instance, patients with anterograde amnesia can learn motor procedures and retain some restricted ability to learn new words and factual information. However, such learning is inflexible and frequently inaccessible to conscious awareness. Here we present a case of patient AC596, a 25-year-old male with severe episodic memory impairments, presumably due to anoxia during a preterm birth. In contrast to his poor episodic memory, he exhibits savant-like memory for calendar information that can be flexibly accessed by day, month, and year cues. He also has the ability to recollect the exact date of a wide range of personal experiences over the past 20 years. The patient appears to supplement his generally poor episodic memory by using memorized calendar information as a retrieval cue for autobiographical events. These findings indicate that islands of preserved memory functioning, such as a highly developed semantic memory system, can exist in individuals with severely impaired episodic memory systems. In this particular case, our patient's memory for dates far outstripped that of normal individuals and served as a keen retrieval cue, allowing him to access information that was otherwise unavailable.     

Acquisition and transfer of word processing skill by an amnesic patient

Abstract

The present study demonstrates that an amnesic patient was able to acquire a considerable amount of declarative and procedural knowledge about a word processing task and subsequently use it independently in his home environment. He was, however, unable to reflect upon what he had learned or to produce the learned information to changed cues. His learning was thus strongly cue-dependent and may have been achieved through an intact perceptual representation system, semantic memory system, and/or procedural memory system.     

« Hors les lois de la guerre ». À propos du traumatisme psychique chez quatre soldats auteurs de meurtres en situation opérationnelle

Objectives

Following an aggressive situation, can the aggressors, as for the victims, suffer from a traumatic breakdown. As Military Psychiatrists, we have met veteran military murderers. All these patients present with a state of Post-Traumatic Stress Disorder with either severe alcoholism or severe depression (melancholy). We also compared the effects of treatment within the two groups, i.e. murders, and victims.

Patients

We chose four patient observations murderers. Their acts were committed “Except for the laws of war”, that is to say, forbidden by the Geneva Conventions. The alcoholic patients: Guillaume is a 45-year-old veteran from the wars in Indochina and Algeria. He has undergone several unsuccessful detoxification programs. One day, he finally tells the most significant episode of his history. While in Algeria, his lieutenant asked him to execute a prisoner. Since then, he has nightmares where he sees the scene, and calms his anxiety with alcohol. He was hospitalized and commenced psychotherapeutic treatment during which he relived his childhood, adolescence and his military career. Two months later, he is cured from his post-traumatic stress condition and alcoholism. Another veteran from Algeria, who was also a severe alcoholic: whilst there, he was ordered by his chief to execute three prisoners. A few years later, by chance he meets his former boss who tells him that the three victims were brothers. He is very shocked because he comes from a region of “vendettas” where it is said that one does not eliminate a family. These nightmares and his alcoholic career started there. Treatment will prove ineffective. The melancholic patients: Andre is a former veteran of Indochina. There, he participated in the massacre of villagers who had hidden enemies. He returned to France after his time engagement, married, had five children, and resumed his profession as industrial painter. After 5 years, he is assailed by nightmares and cannot stop to tell of the horrors to those around him. His wife eventually threw him out and he became a hobo (tramp) in his small town. Gradually during the night, he has hallucinations: he hears his Vietnamese enemies lurking around him waiting for a day to take revenge. He was hospitalized and fairly gradually, the nightmares disappear and then, slowly, his depressive state. Yanis is a 40-year-old veteran of the French Foreign Legion. He lives in Paris and gradually felt he was the center of a complot by Arab youths in the capital. He became aware of surprised looks and conversations, which indicated that they want to kill him. He took refuge in the Military Hospital, where he recounted the circumstances in which, in Africa, he killed a teenager. This act was the result of a misunderstanding, but he saw himself as a murderer of children. Again, the psychotherapeutic treatment resulted in healing.

Results

In three of our patients, the disappearance of the syndrome of repetition (repetition syndrome) and the alcohol and the melancholic state was achieved quickly. Probably because the “enjoyment” attached to traumatic images when the patient is a victim, here is outweighed by the horror of an act that the person has committed itself. Thus, the patient is willing much faster than when a victim, to get rid of the repetition syndrome.

Conclusion

Patient murderers feel themselves as guilty, which turn them to alcohol and ideas of persecution. Despite the severity of the conditions of post-traumatic stress presented by criminal murderers, do not hesitate to commence psychotherapeutic therapy.     

Confabulation in A Dysexecutive Patient: Implication for Models of Retrieval

A confabulating patient MM is described who, despite clear evidence of a dysexecutive syndrome, showed normal prospective and retrospective memory in everyday life and preserved autobiographical memory. He also performed well on many, but not all laboratory-based measures of learning and memory that were given. His confabulation typically involved going well beyond the information he could genuinely recall, and was attributed to a defect in memory monitoring resulting from his frontal lobe damage. Implications for the role of “stop rules” in memory retrieval are discussed.     

A 68-year-old man with speech disturbance as the initial symptom followed by bradykinesia and dementia. Clinical conference]

We report a 68-year-old man with progressive speech disturbance and dementia. He was well until 1995, when he noted an onset of difficulty in speech. He was able to name simple objects and understand language, however, he showed great difficulty in spontaneous speech. In 1998, he visited our service. He was alert and oriented, but he showed moderate degree of dementia. He did not appear to have aphasia but he showed marked dysarthria and slurred speech. He showed limb-kinetic apraxia in his right hand. He showed moderate restriction in his vertical gaze, masked face, and dysphagia. He walked normally. No rigidity, ataxia, or abnormal involuntary movement was noted. He showed grasp response and he was bradykinetic. He was treated with levodopa without effect. His condition deteriorated slowly and he was admitted to our service because of fever on February 13, 1999. He was alert but almost mute. He was unable to look upward or downward. Oculocephalic response was preserved. Axial rigidity was noted but no limb rigidity was present. He walked with small steps. Retropulsion was present. Deep tendon reflexes were diminished and the plantar response was flexor bilaterally. Laboratory examinations were unremarkable and his fever went down within a few days by supportive treatment. He was discharged to his home, where his condition deteriorated further. He developed cardiopulmonary arrest on May 3, 1999 and was brought into ER again. Cardiopulmonary resuscitation was unsuccessful and he was pronounced dead at 7:30 in the morning on the same day. The patient was discussed in a neurological CPC. The chief discussant arrived at the conclusion that this patient had corticobasal degeneration. But he felt that the differential diagnosis from atypical progressive supranuclear palsy, in which cortical pathology and symptoms predominated as in corticobasal degeneration, would be extremely difficult. Most of the participants felt that this patient had corticobasal degeneration, but a few thought that he had atypical PSP. Post-mortem examination revealed asymmetric cortical atrophy, which was accentuated in the left motor cortical area. Microscopic examination of the precentral cortex revealed neuronal loss and gliosis. Ballooned neurons and astrocytic plaques were also seen. The substantia nigra showed marked neuronal loss. Neuropil threads were observed in the nigra. Those threads were positive for anti-tau immunohistochemistry. The internal segment of the globus pallidus, the subthalamic nucleus, and the cerebellar dentate nucleus showed mild to moderate neuronal loss. A few neurofibrillary tangle-positive neurons were seen in these structures. Neuropil threads were also seen throughout. Pathologic changes were consistent with the diagnosis of corticobasal degeneration. One of the participants pointed out that he was able to walk at the time when he was showing marked speech disturbance and limb-kinetic apraxia, which was rather unusual for PSP suggesting corticobasal degeneration.     

Reversible dementia: a case of cryptococcal meningitis masquerading as Alzheimer's disease

A 70-year-old man presented to us in 1994 with a three-year history of worsening dementia. With the exceptions of a Mini-Mental State exam score of 20 and an inability to tandem walk, his physical and neurological examinations were normal. His past medical history revealed that in 1992 he had been evaluated at another institution for memory impairment and bifrontal headaches. A spinal tap had been done in 1992 showing elevated protein, reduced glucose, and a pleocytosis; his CSF fungal culture and cryptococcal antigen test were negative. He subsequently was lost to follow-up, and although his headaches had resolved, his mental status had continued to worsen. In 1994 his CSF cryptococcal antigen was positive, and his CSF fungal culture grew C. neoformans. He gradually improved with treatment for cryptococcal meningitis (CM). With the exception of mild memory impairment, in 2003 he and his family thought that his mental status had returned to normal. This case emphasizes that: 1) CM should always be kept in the differential diagnosis of dementia; 2) CM may be extremely insidious and difficult to diagnose; and 3) if one is to rule out unequivocally all possible reversible causes of dementia, one should perform a spinal tap.     

Intrasellar syndrome. Analysis of 506 cases of transsphenoidal surgery

The author has performed 506 transsphenoidal surgeries but has analyzed in this study only 404 cases. There were 396 hypophyseal tumors, 4 intrasellar cysts and 4 empty sellas. Based in the symptoms presented by the patients he describes an "intrasellar syndrome", characterized by headache, visual disorders and hormonal abnormalities. He calls attention for intrasellar tumors with normal sella, as seen by x-ray. The diagnosis of these tumors were made only by endocrinological studies. At last he shows the advantages of transsphenoidal surgery in this pathology and the excellent results obtained. The mortality of his cases was only 0.2%.     

Posttraumatic stress disorder caused by the misattribution of seizure-related experiential responses

Patients with temporal lobe seizures sometimes experience what John Hughlings Jackson described as "dreamy states" during seizure onset. These phenomena may be characterized by a re-experiencing of past events, feelings of familiarity (déjà vu), and hallucinations. In previous reports, patients have been aware of the illusory nature of their experiences. Here, however, the case of a patient with a documented 37-year history of temporal lobe epilepsy who is not aware is described. Fifteen years ago, the patient saw visions of traumatic autobiographical events that he had never previously recalled. He believed them to be veridical memories from his childhood, although evidence from his family suggests that they were not. The patient's psychological reaction to the "recovery" of these traumatic "memories" was severe enough to qualify as posttraumatic stress disorder (PTSD). To our knowledge, this is the first report of PTSD caused by the misattribution of mental states that accompany a seizure.     

Later developments: molecular keys to age-related memory impairment

Age-related memory impairment, a cognitive decline not clearly related to any gross pathology, is progressive and widespread in the population, although not universal. While the mechanisms of learning and memory remain incompletely understood, the study of their molecular mechanisms is already yielding promising approaches toward therapy for such "normal" declines in the efficiency of learning. This review presents the rationale and results for two such approaches. One approach, partial inhibition of the type IV cAMP specific phosphodiesterase, appears to act indirectly. Although little evidence supports an age-related decline in this system, considerable evidence indicates that this approach can facilitate the transition from short-term to long-term memory and thus counterbalance defects in long-term memory, which may be due to other causes. A second approach, inhibition of l-type voltage gated calcium channels (LVGCCs) may be a specific corrective for a molecular pathology of aging, as substantial evidence indicates that an ongoing increase occurs throughout the lifespan in the density of these channels in hippocampal pyramidal cells, with a concomitant reduction in cellular excitability. Because LVGCCs are also crucial to extinction, a paradigm of inhibitory learning, age-related memory impairment may be an unfortunate side effect of a developmental process necessary to the maturation of the ability to suppress inappropriate behavior, an interpretation consistent with the antagonistic pleiotropy theory of aging.     

A case of left internal capsular infarction with auditory hallucination and peculiar amnesia and dysgraphia

A 46-year-old businessman suddenly became to behave curiously on the morning, September 1, 1988. He forgot how to go through an automatic ticket gate, which he used every day. In his company, he also forgot how to open the cash box, and he wrote a meaningless report for his business. From the night on that day, he had experienced auditory hallucination in which whispering words of some criticism to his performance for a few days. On the next day, he was admitted to a psychiatric hospital because he was suggested to have schizophrenia. By day 6 after the onset, his curious symptoms completely disappeared. However, slight verbal memory disturbance and cognitive dysfunction still remained. Because the brain CT on day 6 showed a small localized subcortical infarction in the left hemisphere he was transferred to our clinic on day 20 to elucidate the relation between the abnormal behavior and the infarction. His blood pressure was 116/64 mmHg and pulse was regular 63/min. He was clear and did not have any neurological deficit. He kept his episodic memory regarding the events at the onset and could almost recall them precisely. Results of standard blood tests, electrocardiogram, ultrasound cardiogram, electroencephalogram as well as cerebral angiography were normal. Computed tomography and magnetic resonance imaging showed an infarcted lesion in the genu of the left caudate nucleus, adjacent to the anterior part of the thalamus.(ABSTRACT TRUNCATED AT 250 WORDS)     

Transvestism in a person with learning disabilities presenting with behavioural problems

A case of transvestism is reported in a 47-year-old man with learning disabilities. He had developed encephalitis in childhood, which had resulted in moderate learning disabilities and epilepsy, and had been living in institutions from the age of six. He did not have any chance to express his sexual desire and this frustration manifested as aggressive behaviour. Recently, he moved to a community home and his deviant sexual behaviour became apparent. Management of his problems Involves organizing a behavioural programme linking his cross dressing with aggressive behaviour.     

Freud and the mighty warrior

This essay traces a prominent facet of Freud's personality, his being a "mighty warrior" throughout his life. This aspect of his character evolved as a reaction formation against his submissive father and as an identification with his more aggressive mother. He first tried it out in his highly ambivalent relationship to his nephew John, who was one year older. In his childhood play, Freud identified with certain military heroes, such mighty warriors as Napoleon, Hannibal, Alexander the Great, and Massena. As he grew older he shifted from military heroes to other great men including Goethe, Shakespeare, and finally Moses. He substituted these men as ego ideals in place of his father about whose stature he felt disillusioned. He far surpassed his father in his life achievements and yet managed to maintain an even-handed, respectable relationship with him until he died in 1896. His mother all but worshipped Sigmund but also demanded that he achieved the maximum in whatever he did. He had to earn her love by an outstanding performance but always wanted to feel unconditionally loved. His mighty warrior attitude developed into an important part of its personality. It protected him from feelings of helplessness and inadequacy and made him into an outstanding leader of the psychoanalytic movement.     

Bilateral hippocampal pathology impairs topographical and episodic memory but not visual pattern matching.

A virtual reality environment was used to test memory performance for simulated "real-world" spatial and episodic information in a 22-year-old male, Jon, who has selective bilateral hippocampal pathology caused by perinatal anoxia. He was allowed to explore a large-scale virtual reality town and was then tested on his memory for spatial layout and for episodes experienced. Topographical memory was tested by assessing his ability to navigate, recognize previously visited locations, and draw maps of the town. Episodic memory was assessed by testing the retrieval of simulated events which consisted of collecting objects from characters while following a route through the virtual town. Memory for the identity of objects, as well as for where they were collected, from whom, and in what order, was also tested. While the first task tapped simple recognition memory, the latter three tested memory for context. Jon was impaired on all topographical tasks and on his recall of the context-dependent questions. However, his recognition of objects from the virtual town, and of "topographical" scenes (as evaluated by standard neuropsychological tests), was not impaired. These findings are consistent with the view that the hippocampus is involved in navigation, recall of long term allocentric spatial information and context-dependent episodic memory, but not visual pattern matching.     

Posttraumatic stress disorder caused by the misattribution of seizure-related experiential responses

Patients with temporal lobe seizures sometimes experience what John Hughlings Jackson described as “dreamy states” during seizure onset. These phenomena may be characterized by a re-experiencing of past events, feelings of familiarity (déjà vu), and hallucinations. In previous reports, patients have been aware of the illusory nature of their experiences. Here, however, the case of a patient with a documented 37-year history of temporal lobe epilepsy who is not aware is described. Fifteen years ago, the patient saw visions of traumatic autobiographical events that he had never previously recalled. He believed them to be veridical memories from his childhood, although evidence from his family suggests that they were not. The patient's psychological reaction to the “recovery” of these traumatic “memories” was severe enough to qualify as posttraumatic stress disorder (PTSD). To our knowledge, this is the first report of PTSD caused by the misattribution of mental states that accompany a seizure.