Psychological factors in retrograde amnesia: self-deception and a broken heart

We explored potential contributing psychological factors in a patient ('XF') with focal retrograde amnesia, within the framework proposed by Kopelman (2000, Cognitive Neuropsychology, 17, 585). In particular, we investigated the psychological trait of self-enhancement. We constructed a self-report questionnaire measure of self-enhancement and compared XF's score on this measure with the scores of 61 control participants. XF was found to have a significantly greater level of self-enhancement than the entire control group, and also than a smaller sample of age- and sex-matched controls. We propose that heightened self-enhancement may reflect a premorbid tendency that potentially predisposes individuals to develop retrograde amnesia.     

Functional retrograde amnesia: a multiple case study

Functional retrograde amnesia (RA) is a rare pathology and has been rarely studied in detail across different patients. We extensively examined five functional RA patients and compared their neuropsychological profile including anterograde and retrograde memory performance, executive functions, emotional processing, and formally assessed psychiatric symptoms. Across patients, neuropsychological deficits beyond RA were most consistently seen in executive functions and attention suggesting that these dysfunctions contribute to the remote memory deficit. In a majority of the patients, problems in social cognition and emotional behaviour were reflected in Theory of Mind deficits and accompanying psychiatric symptoms. Aberrances in a measure of social desirability were detected, pointing to repressive tendencies in three out of the five patients. Future studies of functional RA patients may investigate more specifically which frontal-lobe associated (dys-) functions contribute to the memory retrieval deficit. Moreover, studying more closely the interaction between social cognition, repressive personality style and memory inhibition in this disease seems worthwhile pursuing.     

Focal retrograde amnesia: a long term clinical and neuropsychological follow-up

A patient (E.D.) who had displayed a selective retrograde amnesia in association with transient amnesic episodes (Kapur et al., 1986) was reexamined five years after initial assessment. At the clinical level, his transient amnesic attacks continued, but some of these had clear epileptic features. In addition, EEG investigation indicated temporal lobe abnormality, more prominent in the left temporal region, and supported a clinical diagnosis of temporal lobe epilepsy. Both CT scanning and magnetic resonance imaging were unable to detect the presence of any structural lesion. At the neuropsychological level, there was no evidence of dementia in the form of generalized cognitive dysfunction nor significant deterioration in cognitive functioning since the earlier assessment. Our patient continued to show marked memory loss for public events over the past 20-30 years, in the context of normal or near normal performance on most tests of anterograde memory functioning. While memory for famous scenes and famous faces was markedly impaired, our patient's memory for famous cars was within normal limits and his memory for autobiographical events showed only patchy impairment. Although E.D. performed at an average or above average level on most standard tests of anterograde memory functioning, our patient did show evidence of significant memory loss for public events which had occurred over the past ten years (i.e. since the onset of his illness). The possibility is raised that E.D.'s memory disorder may represent a form of disconnection syndrome.     

Preserved memory in retrograde amnesia: Sparing of a recently acquired skill

Recent work with amnesic patients has revealed a preserved capacity for acquiring and retaining new skills despite otherwise profound anterograde memory impairment. In addition to their anterograde impairment, amnesic patients also have retrograde memory loss for some information acquired prior to the amnestic event. The present experiment addresses for the first time the question of whether preservation of memory for skills is also a feature of retrograde memory impairment. To determine the susceptibility of a recently learned skill to retrograde amnesia, we taught patients to read mirror-reversed words before and during the early part of a prescribed course of electroconvulsive therapy (ECT) and then tested retention of the skill after the course of treatment had been completed. Patients prescribed bilateral or right unilateral ECT and depressed patients not receiving ECT acquired the mirror-reading skill at the same rate and then retained it at the same level. For the patients prescribed ECT, intact learning and retention of the skill occured despite retrograde amnesia for the previous testing sessions and for the words that they had read previously.     

Disproportionate retrograde amnesia in a patient with herpes simplex encephalitis

We describe a patient who developed a severe but temporally limited retrograde amnesia coupled with a relatively mild anterograde amnesia following herpes simplex encephalitis. The patient showed a profound retrograde amnesia for autobiographical events extending for about 10 years prior to the disease onset. Her knowledge about public events and famous persons was also impaired for this period. An MRI and SPECT demonstrated bilateral medial temporal pathology. This case represents a further instance of a relatively focal retrograde amnesia following brain damage. We review other reported cases with focal retrograde amnesia and consider theoretical and neuroanatomical accounts for the present case. Two factors may account for her amnesic patterns: a partial disruption of the store for premorbid binding codes (i.e., information that multimodal feature representations occurred synchronously); along with a relative preservation of the encoding process required to develop new synchronous codes.     

Pure retrograde amnesia following a mild head trauma: a neuropsychological and metabolic study

After a minor closed head injury, a 33-year-old man acquired extensive retrograde amnesia (RA) covering the previous ten years and concerning autobiographical, semantic and procedural memories. The patient's learning abilities remained excellent and he recovered considerable information from his wife, the media and personal documents. This relearned information did not, however, provide a sense of personal experience in the first weeks. CT and MRI failed to show brain damage, but EEG and SPECT examination showed a marked right temporal dysfunction. After three months the patient had almost completely recovered from RA. Interestingly, a parallel recovery was observed in the second SPECT obtained at this period. There was clearly a blockade of retrieval, while the stored engrams were probably intact. The mechanisms underlying such a functional amnesia are discussed in the light of previous reports of amnesia without brain lesions.     

Hippocampal contributions to recollection in retrograde and anterograde amnesia

Lesions restricted to the hippocampal formation and/or extended hippocampal system (hippocampal formation, fornix, mammillary bodies, and anterior thalamic nuclei) can disrupt conscious recollection in anterograde amnesia, while leaving familiarity-based memory relatively intact. Familiarity may be supported by extra-hippocampal medial temporal lobe (MTL) structures. Within-task dissociations in recognition memory best exemplify this distinction in anterograde amnesia. The authors report for the first time comparable dissociations within recognition memory in retrograde amnesia. An amnesic patient (A.D.) with bilateral fornix and septal nuclei lesions failed to recognize details pertaining to personal past events only when recollection was required, during recognition of episodic details. His intact recognition of generic and semantic details pertaining to the same events was ascribed to intact familiarity processes. Recollective processes in the controls were reflected by asymmetrical Receiver's Operating Characteristic curves, whereas the patient's Receiver's Operating Characteristic was symmetrical, suggesting that his inferior recognition performance on episodic details was reliant on familiarity processes. Anterograde and retrograde memories were equally affected, with no temporal gradient for retrograde memories. By comparison, another amnesic person (K.C.) with extensive MTL damage (involving extra-hippocampal MTL structures in addition to hippocampal and fornix lesions) had very poor recognition and no recollection of either episodic or generic/semantic details. These data suggest that the extended hippocampal system is required to support recollection for both anterograde and retrograde memories, regardless of their age.     

Psychological factors affecting a medical condition: ischemic coronary heart disease

The criteria for scientific validation of the entities currently subsumed under the DSM-IV category of "Psychological Factors Affecting a Medical Condition" have never been clearly enumerated. Historically, its precursor category ("Psychophysiological Disorder") was rarely used, and predicated upon clinical observation of personality styles among patients with specific physical illnesses, or clinical observations relating psychosocial events and symptom exacerbation. Because of logical flaws with either of these methods, clarification of the most rigorous criteria for demonstrating a cause-effect relationship is necessary. With the increase in well-designed and carefully executed epidemiological and treatment studies, this diagnostic category has evolved into an arena where cutting-edge insights and therapies are becoming available for a growing variety of medical conditions, especially ischemic coronary heart disease. The present article reviews the nature of the scientific evidence necessary to accept an etiological or aggravating role for psychological events.     

Delusion of inanimate doubles: Description of a case of focal retrograde amnesia

This paper reports the case of a patient, M.P., who developed delusion of inanimate doubles, without Capgras syndrome, after traumatic brain injury. His delusional symptoms were studied longitudinally and the cognitive impairments associated with delusion were investigated. Data suggest that M.P. did ‘perceive’ the actual differences between doubles and originals rather than ‘confabulate’ them. The cognitive profile, characterized by retrograde episodic amnesia, but neither object processing impairment nor confabulations, supports this hypothesis. The study examines the nature of object misidentification based on Ellis’ and Staton's account and proposes a new account based on concurrent unbiased retrieval of semantic memory traces and biased recollection of episodic memory traces.     

Malingering and retrograde amnesia: the historic case of the Collegno amnesic

Assessment of feigned cognitive disorders is an important field of neuropsychology because of its applications to forensic settings. Strategies for detecting malingering in amnesia are available for anterograde amnesia. Less attention has been given to malingering in retrograde amnesia. The case of the 'Smemorato di Collegno' (The Collegno Amnesic) is probably the most famous case of malingered retrograde amnesia ever known in Italy. In 1926, a man who appeared to have lost all his autobiographical memories and identity spent nearly a year in the Collegno asylum of Turin without a name. He was later initially identified as Giulio Canella, Director of the 'Scuola Normale di Verona' who had disappeared during the war in 1916. He was suspected of later identified as being Mario Bruneri, a petty crook from Turin who played the part of an amnesic whose retrograde memory gradually returned. A lengthy investigation was required before this conclusion was reached. Several clinicians and renowned academics evaluated the case, but only Alfredo Coppola, diagnosed "malingered retrograde amnesia" using a method that was extremely innovative for the times. The aim of the present paper is to review the original cognitive evaluation and the strategies used for malingering detection in the "Collegno case". The outcome of the case is then discussed in the light of present-day forensic neuropsychology and the level of advancement of mental examination achieved in the 1920s in Europe is highlighted.     

Psychological therapy for psychogenic amnesia: Successful treatment in a single case study

Psychogenic amnesia is widely understood to be a memory impairment of psychological origin that occurs as a response to severe stress. However, there is a paucity of evidence regarding the effectiveness of psychological therapy approaches in the treatment of this disorder. The current article describes a single case, “Ben”, who was treated with formulation-driven psychological therapy using techniques drawn from cognitive behavioural therapy (CBT) and acceptance and commitment therapy (ACT) for psychogenic amnesia. Before treatment, Ben exhibited isolated retrograde and anterograde memory impairments. He received 12 therapy sessions that targeted experiential avoidance followed by two review sessions, six weeks and five months later. Ben's retrograde and anterograde memory impairments improved following therapy to return to within the “average” to “superior” ranges, which were maintained at follow-up. Further experimental single case study designs and larger group studies are required to advance the understanding of the effectiveness and efficacy of psychological therapy for psychogenic amnesia.     

The dissociation of anterograde and retrograde amnesia in a patient with herpes encephalitis.

Establishing the precise relationship between anterograde amnesia (AA) and retrograde amnesia (RA) has implications for psychological and neuroanatomical models of memory. Many patients have been described who demonstrate AA in conjunction with RA or who demonstrate AA with little, or no apparent, RA. Intact anterograde memory in conjunction with deficits on tasks of retrograde memory is rarely encountered. In this paper, we describe a young female patient (LD) whose RA is extremely severe when contrasted with her mild to moderate deficits on tasks of verbal anterograde memory. In addition, on tests of episodic and semantic autobiographical memory, LD appeared more impaired in her recall of specific episodes than of factual information about her past. The importance of this dissociation in RA for the episodic-semantic distinction and the possible role of visual imagery in recalling remote episodic events are discussed.     

A dissociation between anterograde and retrograde amnesia after treatment with electroconvulsive therapy: a naturalistic investigation

OBJECTIVE: The aim of the present study is to investigate the cumulative effects of a clinically determined course of electroconvulsive therapy (ECT) on anterograde and retrograde amnesia. In this study, mood and memory were examined in the context of a protocol driven by therapeutic response, rather than by preordained research criteria. METHODS: Twenty-two patients with major depressive disorder and 18 nondepressed controls were taught a series of faces and names before the initiation of ECT, and their retention of this information was examined after the end of treatment. Anterograde (ie, new learning) and retrograde memory (ie, recall of information learned before ECT) were assessed. Eleven ECT patients underwent unilateral (UL) stimulation, and 11 had a combination of UL and bilateral stimulation. Major depressive disorder patients and nondepressed controls participants were matched according to baseline memory abilities. Unilateral and unilateral/bilateral (UB) ECT patients were matched according to baseline depression and memory abilities. RESULTS: Treatment with ECT resulted in a dissociation between anterograde and retrograde memory; after treatment, major depressive disorder patients demonstrated significant retrograde amnesia, whereas there was no change in their anterograde memory. Unilateral and UB ECT patients performed equally well on tasks of anterograde memory. Contrary to our expectation, UB ECT was not associated with greater retrograde memory loss than was UL ECT treatment. However, a trend toward a group difference was present on 1 memory measure. CONCLUSIONS: Results of the study suggest that a clinical course of ECT is associated with isolated impairment for information learned before treatment (ie, retrograde memory), whereas there was no effect of ECT on posttreatment learning abilities (ie, anterograde memory).     

Searching for lost memory: memory loss and recovery mechanisms observed in a patient with pure retrograde amnesia

We describe a patient who developed acute reversible amnesia characterized by impaired recollection of past events with preserved anterograde memory. This occurred after a mild head trauma and in the context of occupational stress. Isolated retrograde amnesia affected autobiographical memory (with lost of identity lasting a few days) and semantic knowledge. Isolated retrograde amnesia subsided for nine months. The patient was no longer able to access to his memories, which did not seem completely lost. Some answers to tests concerning historical events were better than those given at random; his answers to a TV quiz were automatic or he exhibited temporal transfer phenomena (ecmnesia). Gradual, progressive, irregular and spontaneous or "flash" recovery, which was also facilitated by dreams, associations or contextual clues. The persistent and vivid familiarity of the retrieved memories are reported here together with the organization of long-term memory and the clinical and neuropsychological traits of functional isolated retrograde amnesia.     

The impact of disrupted cortico-cortico connectivity: a long-term follow-up of a case of focal retrograde amnesia

We report a long-term follow-up study of case JM, who demonstrated a focal retrograde amnesia (FRA) as a consequence of cerebral vasculitis. The present study showed that, several years post-onset, JM experienced considerable impairment in episodic retrograde memory, with normal anterograde autobiographical memory. Further investigations demonstrated that she showed no evidence of accelerated forgetting, unlike some other cases of FRA. Knowledge of people, pre- and post-illness, was also normal. Her ability to recall details of famous public events was good (though weaker for pre-illness events). JM's pattern of impairment is discussed in the context of other recent cases of FRA and developments in models of normal memory function.     

The anterograde and retrograde retrieval ability of a patient with amnesia due to encephalitis

A patient with amnesia due to encephalitis was previously described in 1976 as having normal short-term memory and an intact ability to perform semantic analysis. Despite this ability, his retention beyond the limits of short-term memory was nearly nil. The present investigation sought to evaluate more completely the nature of this patient's retrieval deficit using a series of paradigms developed subsequent to his initial testing. Once again it was discovered that while his intact analytic abilities allowed retention of material in working memory, as soon as that working capacity was exceeded, retrieval of information became nearly impossible. It became apparent that the patient could not discriminate between a cue's most recently analyzed associate and the strongest existing associate to that cue in his semantic hierarchy. An analysis of his retrograde memory ability showed that he could retrieve almost no real episodes of either a public or private nature from his past. Instead, he seemed to rely on generalizations from his semantic memory to reconstruct “probable” events.     

Anterograde and retrograde amnesia in a person with bilateral fornix lesions following removal of a colloid cyst

AD, a 45-year-old man, presented with a severe and global anterograde amnesia following surgery for removal of a colloid cyst. Structural neuroimaging confirmed bilateral lesions to the fornix and a small lesion in the basal forebrain. Testing for remote episodic memory of autobiographical events, and for remote semantic memory of personal and public events, and of famous people, revealed that AD had a severe retrograde amnesia for autobiographical episodes that covered his entire lifetime, and a time-limited retrograde amnesia for semantic memory. Because the fornix and basal forebrain lesions disrupted major afferent and efferent pathways of the hippocampus, it was concluded that the integrity of the hippocampus and its projections are needed to retain and/or recover autobiographical memories no matter how old they are. By contrast, hippocampal contribution to semantic memory is time-limited. These findings were interpreted as consistent with Multiple Trace Theory, which holds that the hippocampal system is essential for recovering contextually rich memories no matter how old they are, but is not needed for recovering semantic memories.     

Actors but not scripts: the dissociation of people and events in retrograde amnesia.

We describe our further investigations of the retrograde amnesia in a single case. R.F.R. became globally amnesic following an attack of Herpes Simplex Encephalitis. He could generate and recognize superordinate level information about the vast majority of proper names including the names of people but he was very impaired at giving information about what had "happened" to these same individuals. He could also provide detailed information about family friends but he could not recall salient major personal episodes in which these same individuals had been involved. Knowledge of people appears to be represented in a different way to that of events, even when a singular event has provided the main or only opportunity for learning about the individual.     

A brief taxonomy of tactile illusions and demonstrations that can be done in a hardware store

This paper surveys more than twenty types of tactile illusions and discusses several of their aspects. These aspects include the ease with which they can be demonstrated and whether they have clear visual analogs. The paper also shows how to construct equipment made of simple supplies able to deliver well-controlled tactile signals in order to conveniently demonstrate four different tactile illusions.