Retrograde amnesia abolishes the self-reference effect in anterograde memory.

Is retrograde amnesia associated with an ability to know who we are and imagine what we will be like in the future? To answer this question, we had S.G., a patient with focal retrograde amnesia following hypoxia, two brain-damaged (control) patients with no retrograde memory deficits, and healthy controls judge whether each of a series of trait adjectives was descriptive of their present self, future self, another person, and that person in the future, and later recognize studied traits among distractors. Healthy controls and control patients were more accurate in recognizing self-related compared to other-related traits, a phenomenon known as the self-reference effect (SRE). This held for both present and future self-views. By contrast, no evidence of (present or future) SRE was observed in SG, who concomitantly showed reduced certainty about his personality traits. These findings indicate that retrograde amnesia can weaken the self-schema and preclude its instantiation during self-related processing.

Terapia de rehabilitación cognitiva en pacientes con trastorno por consumo de alcohol y trastorno neurocognitivo. Estudio piloto / Remediation therapy in patients with alcohol use disorders and neurocognitive disorders: A Pilot Study

El deterioro cognitivo es común en los pacientes alcohólicos. Éste se manifiesta por alteraciones en la memoria anterógrada y retrógrada, el procesamiento visual-espacial, y en las habilidades cognitivas y la atención, siendo algunas reversibles. Las terapias de rehabilitación cognitiva podrían mejorar el rendimiento de los pacientes, siendo una alternativa terapéutica de interés. El objetivo de este estudio piloto fue evaluar la implementación, viabilidad y efectividad de la terapia de rehabilitación cognitiva en pacientes con dependencia al alcohol y deterioro cognitivo asociado. Se trata de un estudio piloto con 16 pacientes (63% hombres, edad media de 59 años) seguidos en la Unidad de Conductas Adictivas de un hospital de tercer nivel. Siendo la abstinencia un requisito para la inclusión, durante 6 meses una enfermera realizó sesiones semanales de una hora (24 sesiones), realizándose ejercicios de psico-estimulación para la mejora del rendimiento cognitivo, funcional y social. Se evaluó a los pacientes al inicio, al final y pasados 6 meses, mediante las escalas MMSE (test Mini-mental de Lobo) y T@M (test de Alteración de Memoria). Sus puntuaciones medias respectivas fueron 26.4 (DE 3,16), 29 (DE 1,67) y 27 (DE 3,1) para MMSE y 38,7 (DE 6,81), 45,7 (DE 5,6) y 41,1 (DE 7,86) para T@M. Los datos se analizaron mediante la prueba de Friedman y se comparon los distintos periodos temporales mediante la prueba de rangos con signo de Wilcoxon, siendo la mayoría de comparaciones significativas (p < 0,05). La asistencia y la satisfacción fueron elevadas. Así pues, la terapia fue viable, ampliamente aceptada y mostró ser efectiva

Many alcohol-dependent patients suffer from cognitive impairment of variable severity, manifested by alterations in retrograde and anterograde memory, visuospatial processing, cognitive abilities and attention, some of which are reversible. In this context, cognitive remediation therapies could significantly improve patients' performance; therefore, these are considered a valuable alternative. The aim of this study was to implement cognitive remediation therapy in patients with alcohol dependence and cognitive impairment and evaluate its viability and effectiveness. The participants were sixteen abstinent, alcohol-dependent patients (mean age of 59 years, 63% males) from the Addictive Behaviours Unit of a tertiary hospital. Over 6 months, a nurse led 1-hour weekly sessions (24 sessions in total) during which exercises for improving functional, social and cognitive performance were completed. Patients were assessed at baseline, at the end of the study and 6 months later, using the Mini-Mental State Examination (MMSE) and the Memory Alteration Test (M@T). Their respective scores were 26.4 (SD 3.16), 29 (SD 1.67) and 27 (SD 3.1) for the MMSE and 38.7 (SD 6.81), 45.7 (SD 5.6) and 41.1 (SD 7.86) for the M@T. Changes were assessed with both Friedman and Wilcoxon signed-rank tests, with mostly statistically significant differences (p < 0.05). Assistance and satisfaction were high. Therefore, the therapy was viable, widely accepted and effective

Psychogenic amnesia: syndromes, outcome, and patterns of retrograde amnesia.

There are very few case series of patients with acute psychogenic memory loss (also known as dissociative/functional amnesia), and still fewer studies of outcome, or comparisons with neurological memory-disordered patients. Consequently, the literature on psychogenic amnesia is somewhat fragmented and offers little prognostic value for individual patients. In the present study, we reviewed the case records and neuropsychological findings in 53 psychogenic amnesia cases (ratio of 3:1, males:females), in comparison with 21 consecutively recruited neurological memory-disordered patients and 14 healthy control subjects. In particular, we examined the pattern of retrograde amnesia on an assessment of autobiographical memory (the Autobiographical Memory Interview). We found that our patients with psychogenic memory loss fell into four distinct groups, which we categorized as: (i) fugue state; (ii) fugue-to-focal retrograde amnesia; (iii) psychogenic focal retrograde amnesia following a minor neurological episode; and (iv) patients with gaps in their memories. While neurological cases were characterized by relevant neurological symptoms, a history of a past head injury was actually more common in our psychogenic cases (P = 0.012), perhaps reflecting a 'learning episode' predisposing to later psychological amnesia. As anticipated, loss of the sense of personal identity was confined to the psychogenic group. However, clinical depression, family/relationship problems, financial/employment problems, and failure to recognize the family were also statistically more common in that group. The pattern of autobiographical memory loss differed between the psychogenic groups: fugue cases showed a severe and uniform loss of memories for both facts and events across all time periods, whereas the two focal retrograde amnesia groups showed a 'reversed' temporal gradient with relative sparing of recent memories. After 3-6 months, the fugue patients had improved to normal scores for facts and near-normal scores for events. By contrast, the two focal retrograde amnesia groups showed less improvement and continued to show a reversed temporal gradient. In conclusion, the outcome in psychogenic amnesia, particularly those characterized by fugue, is better than generally supposed. Findings are interpreted in terms of Markowitsch's and Kopelman's models of psychogenic amnesia, and with respect to Anderson's neuroimaging findings in memory inhibition.

Programa de estimulación cognitiva e inteligencia emocional para mayores (PECI-PM): beneficios en la memoria cotidiana / Cognitive stimulation and emotional intelligence program for seniors (PECI-PM): benefits in daily memory

Fundamento y objetivo: una de las quejas más frecuentes entre la población anciana son los fallos en la memoria cotidiana. El objetivo del presente trabajo es analizar los efectos de un programa de estimulación cognitiva e inteligencia emocional para mayores sobre la memoria cotidiana. Material y método: en un grupo de 28 sujetos, mayores de 55 años, se aplicó el Cuestionario de fallos en la memoria cotidiana (MFE), antes y después de participar en el programa de entrenamiento. Resultados: tras 20 sesiones, se constató una mejora (puntuaciones medias más bajas en fallos de memoria) en cada uno de los factores (recuerdo de actividades, reconocimiento y monitorización de la comunicación), así como en la puntuación global del MFE. Conclusiones: en general, los resultados en quejas subjetivas de memoria son positivos con respecto a las puntuaciones obtenidas antes de las sesiones. No obstante, se espera que con la implementación del resto de sesiones, estas mejoras resulten significativas. Para la segunda fase de implementación del programa, se han incorporado nuevos contenidos y actividades, para seguir trabajando en línea con estos resultados (AU)

Principles and purpose: One of the most frequent complaints by the older population is failure of their day-to-day memory. The purpose of this study is to analyze the effects of a program for Cognitive Stimulation and Emotional Intelligence for Seniors on day-to-day memory. Materials and method: A group of 28 subjects over 55 years of age were given the Questionnaire on Failure of Day-to-Day Memory, before and after participating in the training program. Results: After 20 sessions, an improvement was shown (lower mean scores in memory failure) in each of the factors (memory of activities, recognition and monitoring of communication), as well as in the overall MFE score. Conclusions: In general, the results in subjective memory complaints are positive with respect to the scores before sessions. However, these improvements are expected to become significant with the implementation of the rest of the sessions. New content and activities have been included in the second stage of program implementation to continue working along the line of these results (AU)

Clinical correlates of retrograde amnesia in mild traumatic brain injury.

PRIMARY OBJECTIVE: The purpose of this study was to examine the clinical significance of retrograde amnesia (RA) in patients with acute mild traumatic brain injuries (MTBI). METHODS AND PROCEDURES: An emergency department sample of patients (n = 75), aged 18-60 years, with no pre-morbid medical or psychiatric conditions, who met the WHO criteria for MTBI were enrolled in this prospective, descriptive, follow-up study. This study examined the presence and duration of RA in relation to socio-demographics, MTBI severity markers including neuroimaging (CT, MRI) and clinical outcomes (Rivermead post-concussion symptoms questionnaire, post-concussion syndrome (PCS) diagnosis and return to work (RTW) status) at 2 weeks, 1 month and 6 months post-injury. MAIN OUTCOMES AND RESULTS: GCS scores and duration of post-traumatic amnesia (PTA) were related to RA. Those with GCS scores of 14 vs. 15 were more likely to have RA (χ(2)(1) = 13.70, p < 0.0001) and a longer duration (Mann-Whitney U = 56.0, p < 0.0001, d = 1.15) of RA. The duration of RA and PTA correlated positively (Spearman ρ(75) = 0.42, p < 0.0001) and those with RA had longer durations of PTA (Mann-Whitney U = 228.5, p = 0.001, d = 1.21). During the follow-up, the presence and duration of RA were not significantly associated with PCS diagnosis or time to RTW. CONCLUSIONS: In this study, the presence and duration of RA was not associated with outcome.

Post-traumatic amnesia predicts intelligence impairment following traumatic brain injury: a meta-analysis.

CONTEXT: Worldwide, millions of patients with traumatic brain injury (TBI) suffer from persistent and disabling intelligence impairment. Post-traumatic amnesia (PTA) duration is a promising predictor of intelligence following TBI. OBJECTIVES: To determine (1) the impact of TBI on intelligence throughout the lifespan and (2) the predictive value of PTA duration for intelligence impairment, using meta-analytic methods. METHODS: Electronic databases were searched for peer reviewed articles, published until February 2012. Studies reporting intelligence following TBI and injury severity by PTA duration were included. Meta-analytic methods generated effect sizes for full scale IQ (FSIQ), performance IQ (PIQ) and verbal IQ (VIQ), following mild TBI (PTA duration 1-24 h) and severe TBI (PTA duration >7 days), during the subacute phase of recovery (≤6 months post-injury) and the chronic phase (>6 months post-injury). Meta-regression elucidated the predictive value of PTA duration for intelligence impairment. RESULTS: Patients with severe TBI exhibited large depressions in FSIQ in the subacute phase of recovery (d = -1.07, 95% CI to 1.52 to -0.62; p<0.001), persisting into the chronic phase (d = -0.78, 95% CI -1.06 to -0.51; p<0.001). PIQ was more severely affected than VIQ in the subacute phase (Q1 =3.85; p<0.05) but not in the chronic phase (Q1 =0.03, p=0.87). Most importantly, longer PTA duration strongly predicted greater depressions of FSIQ and PIQ in the subacute phase (-0.76 ≤ ßs ≤ -0.73, Ps<0.01) and FSIQ, PIQ and VIQ in the chronic phase (-0.80 ≤ ßs ≤ -0.61, Ps<0.05). CONCLUSIONS: PTA duration is a valuable predictor of intelligence impairment following TBI. Results support the routine assessment of PTA duration in clinical settings.

Amnesia global transitoria en el contexto de una anestesia general / Transient global amnesia after general anaesthesia

La amnesia global transitoria es un síndrome neurológico en el que se produce una pérdida abrupta y pasajera de la capacidad para crear nuevos recuerdos, así como una amnesia retrógrada de intensidad variable, permaneciendo, sin embargo, preservadas la conciencia, la identidad personal y la atención. Se trata de una entidad poco frecuente tras un proceso anestésico. Existen distintas hipótesis etiopatogénicas (base epiléptica, migrañosa o isquémica) y desencadenantes (dolor, la ansiedad, los cambios de temperatura, el ejercicio, las maniobras de Valsalva, las pruebas diagnósticas o determinados medicamentos). Describimos el caso de una paciente con alto grado de ansiedad preoperatoria que sufrió un episodio de amnesia global transitoria tras una intervención quirúrgica otorrinolaringológica. Ante un episodio de amnesia aguda y mantenida tras una anestesia general debemos plantear, en primer lugar, un adecuado diagnóstico diferencial que incluya la amnesia global transitoria, puesto que, en la mayoría de los casos, se trata de un diagnóstico de exclusión. La ansiedad preoperatoria puede ser un desencadenante a tener en cuenta en esta entidad, siendo importante el tratamiento ansiolítico previo a la intervención(AU)

Transient global amnesia is a neurological syndrome in which there is a sudden and brief inability to form new memories, as well as an intense retrograde amnesia. However, awareness, personal identity and attention remain intact. It is an uncommon condition seen after an anaesthetic procedure. There are several aetiopathogenic hypotheses (epileptic, migrainous or ischaemic origin) and triggering factors (pain, anxiety, temperature changes, exercise, Valsalva manoeuvres, diagnostic tests or certain drugs). We describe the case of a patient with a high level of pre-operative anxiety who suffered an episode of transient global amnesia after undergoing otolaryngology surgery. With an acute and continued amnesia after general anaesthesia, the first thing that must be done is to establish a suitable differencial diagnosis, which should include transient global amnesia, as this is mainly an exclusion diagnosis. Preoperative anxiety may be a triggering factor to take into account in this condition, with anxiolytic treatment prior to the surgery being important(AU)

Status epiléptico como complicación de la terapia electroconvulsiva: a propósito de un caso / Epileptic status as a complication of electroconvulsive therapy: a case report

Introducción. La Terapia Electroconvulsiva (TEC) es un tratamiento seguro y eficaz en las indicaciones observadas en múltiples trastornos psiquiátricos. No obstante, pueden aparecer raras complicaciones como compromiso cardiovascular, agitación psicomotriz post-ictal y status epiléptico. Caso clínico. Mujer de 83 años que presenta un cuadro compatible con una depresión psicótica, con intensa angustia, marcada inhibición psicomotriz y negativa a la ingesta global que le conduce a un cuadro de deshidratación Se inicia tratamiento con TEC que resulta extraordinariamente eficaz, pero en la tercera sesión, utilizando la misma intensidad y tratamiento que en las previas, aparece un estatus epiléptico eléctrico no correspondiente con clínica de 700segundos de duración. Se suspende TEC y se realiza seguimiento electroencefalográfico. La recuperación desde entonces es progresiva aunque mucho más lenta. Conclusión. Es fundamental el reconocimiento y tratamiento de convulsiones prolongadas durante la TEC para prevenir la progresión a status epiléptico. Recomendamos la realización de un estudio retrospectivo con el objetivo de identificar factores de riesgo para la aparición de status epiléptico no convulsivo y protocolizar medidas preventivas para evitar dicha complicación (AU)

Introduction. Electroconvulsive therapy (ECT) is a safe and effective treatment for multiple indications in psychiatric disorders. However, rare complications, such as cardiovascular compromise, post-stroke agitation and epileptic status, can occur. Case report. The case of an 83-year old female who had clinical symptoms consistent with psychotic depression, intense anguish, pronounced psychomotor retardation and who refused intake with secondary dehydration is presented. Treatment was started with ECT with great improvement of the symptoms, but in the third session of ECT, with the same intensity as the previous ones, electrical epileptic status with no clinical manifestations appeared. It lasted approximately700 seconds. ECT was suspended and the patient was monitored electroencephalographically. Recovery since then has been progressive but much slower. Conclusion. It is essential to recognize and treat prolonged seizures during ECT to prevent progression to epileptic status. We recommend conducting a retrospective study aimed at identifying risk factors for the occurrence of non convulsive status epilepticus in potential patients and to protocolize preventive measures in order to avoid this complication (AU)

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.

Time-course of neurodegeneration and memory impairment following the 4-vessel occlusion/internal carotid artery model of chronic cerebral hypoperfusion in middle-aged rats.

The present work extends previous studies with the aim of developing the 4-vessel occlusion/internal carotid artery (4-VO/ICA) model of chronic cerebral hypoperfusion. The permanent occlusion of the vertebral arteries (VAs) and internal carotid arteries (ICAs) followed the sequence VA→ICA→ICA. The interstage interval (ISI, →), chronicity of 4-VO/ICA, and age of the animals may determine the success of the model with regard to neurohistological and behavioral outcomes. Using middle-aged rats, the present study evaluated (i) how brain damage evolves as the ISI is reduced and duration (i.e., "chronicity") of 4-VO/ICA is prolonged and (ii) how the duration of 4-VO/ICA affects retrograde memory performance. Male Wistar rats (12-15 months of age) were subjected to 4-VO/ICA with an ISI of 7, 5, 4, or 3 days, and hippocampal and cortical damage was examined 7, 30, and 90 days later. Using an ISI of 4 days, retrograde memory performance was assessed in the aversive radial maze after 4-VO/ICA with a duration of 7, 30, and 90 days. The severity of brain neurodegeneration and rate of mortality progressively increased as the ISI length decreased from 7 to 3 days, an effect that was not significantly altered by the chronicity of 4-VO/ICA. Permanent 4-VO/ICA effectively caused retrograde amnesia, an effect that worsened as the chronicity of 4-VO/ICA was prolonged. The findings confirm and expand the notion that permanent, 3-stage 4-VO/ICA effectively produces extensive neurodegeneration and persistent learning/memory impairment in middle-aged rats and that the ISI length, more than the chronicity of 4-VO/ICA, determines the final results.

La fuga disociativa. A propósito de un caso y una breve revisión Bibliográfica / Dissociative fugue. A case report and a brief review of the literature

La fuga disociativa se caracteriza por un viaje repentino lejos del hogar o del trabajo, con incapacidad para recordar el pasado y con confusión acerca de la identidad previa. Presentamos el caso de un paciente con diagnóstico de fuga disociativa derivado a nuestro servicio desde Neurología, por un cuadro de amnesia retrógrada autobiográfica, tras haber desaparecido durante días al salir de su puesto laboral. El paciente tenía conservada la memoria inmediata sin otras alteraciones en las funciones cognitivas. Inicialmente presentaba escasos recuerdos generales y tenía gran dificultad de plantear su situación previa. Posteriormente se aclaran numerosos aspectos conflictivos: consumo de drogas reciente, problemática de pareja crónica, además de dificultades económicas y laborales importantes. En nuestro artículo comentamos aspectos de la etiopatogenia, del diagnostico diferencial y del tratamiento de esta enfermedad, en forma de una breve revisión bibliográfica y se relacionan estos datos con el caso de nuestro paciente en concreto (AU)

Dissociative Fugue is characterized by a sudden trip away from home or work, with inability to recall the past and confusion about the previous identity. We report the case of a patient diagnosed to be sufferer from dissociative fugue referred to our department from Neurology. The patient presented with amnesia for autobiographical memories, having disappeared for days after leaving his workplace. mediate recall was preserved, and other alterations in cognitive functions were not identified. Initially general memories were preserved, however the patient had a great difficulty to explain his previous situation. Later, several conflictive aspects were clarified: a recent drug consumption, chronic family problems, as well as important economic and employment difficulties. This paper discusses the pathogenesis, differential diagnosis and treatment of this disease, with a brief literature review relating findings data within the patient’s particular case (AU)

Suppression of neurotoxic lesion-induced seizure activity: evidence for a permanent role for the hippocampus in contextual memory.

Damage to the hippocampus (HPC) using the excitotoxin N-methyl-D-aspartate (NMDA) can cause retrograde amnesia for contextual fear memory. This amnesia is typically attributed to loss of cells in the HPC. However, NMDA is also known to cause intense neuronal discharge (seizure activity) during the hours that follow its injection. These seizures may have detrimental effects on retrieval of memories. Here we evaluate the possibility that retrograde amnesia is due to NMDA-induced seizure activity or cell damage per se. To assess the effects of NMDA induced activity on contextual memory, we developed a lesion technique that utilizes the neurotoxic effects of NMDA while at the same time suppressing possible associated seizure activity. NMDA and tetrodotoxin (TTX), a sodium channel blocker, are simultaneously infused into the rat HPC, resulting in extensive bilateral damage to the HPC. TTX, co-infused with NMDA, suppresses propagation of seizure activity. Rats received pairings of a novel context with foot shock, after which they received NMDA-induced, TTX+NMDA-induced, or no damage to the HPC at a recent (24 hours) or remote (5 weeks) time point. After recovery, the rats were placed into the shock context and freezing was scored as an index of fear memory. Rats with an intact HPC exhibited robust memory for the aversive context at both time points, whereas rats that received NMDA or NMDA+TTX lesions showed a significant reduction in learned fear of equal magnitude at both the recent and remote time points. Therefore, it is unlikely that observed retrograde amnesia in contextual fear conditioning are due to disruption of non-HPC networks by propagated seizure activity. Moreover, the memory deficit observed at both time points offers additional evidence supporting the proposition that the HPC has a continuing role in maintaining contextual memories.

Focal retrograde amnesia: voxel-based morphometry findings in a case without MRI lesions.

Focal retrograde amnesia (FRA) is a rare neurocognitive disorder presenting with an isolated loss of retrograde memory. In the absence of detectable brain lesions, a differentiation of FRA from psychogenic causes is difficult. Here we report a case study of persisting FRA after an epileptic seizure. A thorough neuropsychological assessment confirmed severe retrograde memory deficits while anterograde memory abilities were completely normal. Neurological and psychiatric examination were unremarkable and high-resolution MRI showed no neuroradiologically apparent lesion. However, voxel-based morphometry (VBM)-comparing the MRI to an education-, age-and sex-matched control group (n = 20) disclosed distinct gray matter decreases in left temporopolar cortex and a region between right posterior parahippocampal and lingual cortex. Although the results of VBM-based comparisons between a single case and a healthy control group are generally susceptible to differences unrelated to the specific symptoms of the case, we believe that our data suggest a causal role of the cortical areas detected since the retrograde memory deficit is the preeminent neuropsychological difference between patient and controls. This was paralleled by grey matter differences in central nodes of the retrograde memory network. We therefore suggest that these subtle alterations represent structural correlates of the focal retrograde amnesia in our patient. Beyond the implications for the diagnosis and etiology of FRA, our results advocate the use of VBM in conditions that do not show abnormalities in clinical radiological assessment, but show distinct neuropsychological deficits.

A multicentre study on the clinical utility of post-traumatic amnesia duration in predicting global outcome after moderate-severe traumatic brain injury.

BACKGROUND: Past research shows that post-traumatic amnesia (PTA) duration is a particularly robust traumatic brain injury (TBI) outcome predictor, but low specificity limits its clinical utility. OBJECTIVES: The current study assessed the relationship between PTA duration and probability thresholds for Glasgow Outcome Scale (GOS) levels. METHODS: Data were prospectively collected in this multicentre observational study. The cohort was a consecutive sample of rehabilitation patients enrolled in the National Institute on Disability and Rehabilitation Research funded TBI Model Systems (n = 1332) that had documented finite PTA duration greater than 24 h, and 1-year and 2-year GOS. RESULTS: The cohort had proportionally more Good Recovery (44% vs 39%) and less Severe Disability (19% vs 23%) at year 2 than at year 1. Longer PTA resulted in an incremental decline in probability of Good Recovery and a corresponding increase in probability of Severe Disability. When PTA ended within 4 weeks, Severe Disability was unlikely (<15% chance) at year 1, and Good Recovery was the most likely GOS at year 2. When PTA lasted beyond 8 weeks, Good Recovery was highly unlikely (<10% chance) at year 1, and Severe Disability was equal to or more likely than Moderate Disability at year 2. CONCLUSIONS: Two PTA durations, 4 weeks and 8 weeks, emerged as particularly salient GOS probability thresholds that may aid prognostication after TBI.

Retrograde amnesia and malingering.

PURPOSE OF REVIEW: Malingered anterograde amnesia is a phenomenon that has been exhaustively studied, whereas research on retrograde amnesia has tended to focus upon functional and organic accounts of impairment. The present review explores studies relevant to extending the malingering paradigm to retrograde amnesia. RECENT FINDINGS: In the period reviewed, very little work has directly addressed the area of malingered retrograde amnesia. Researchers have tended to explain apparent 'anomalies' in memory performance or individual presentation, as manifestations of unconscious or psychological distress-mediated behaviour. In contrast, research with offenders claiming amnesia for their crimes has emphasized that malingered retrograde amnesia can be identified with relevant assessment methods. Brain imaging work too has begun to clearly describe the associated neural processes that underlie deception. It appears that the necessary coalescence of insights from clinical neuropsychology, brain imaging and neurology has reached a critical moment. SUMMARY: Current and previous studies are reviewed that addresses the assessment of malingered retrograde amnesia and evidences that a critical moment has been reached.

Neumomediastino espontáneo tras accidente de motocicleta. Caso clínico y revisión de la literatura / Spontaneous pneumomediastinum following a motorcycle accident. Report on a case and review of the literature

Introducción: el neumomediastino espontáneo es una entidad muy rara. Presentamos un caso de esta enfermedad. Caso clínico: varón de 17 años de edad que, tras sufrir un accidente de motocicleta de baja energía, acudió a urgencias por cefalea relacionada con dolor en el cuello. En la exploración física se apreciaba ecolalia, así como amnesia retrógrada del episodio. Destacaba una crepitación a la palpación en la región anterior y lateral derecha del cuello. El resto de la exploración física por aparatos fue normal. Las pruebas de imagen realizadas mostraron aire en el trayecto de la vena yugular derecha. Con el diagnóstico de neumomediastino espontáneo, el paciente quedó ingresado en observación. Con el reposo y la medicación analgésica mejoró en las horas siguientes y se pudo darle el alta sin incidencias. Se presenta el caso y se hace una revisión de la literatura. Conclusiones: el neumomediastino espontáneo normalmente es una enfermedad benigna que suele resolverse favorablemente sin tratamiento(AU)

Introduction: The spontaneous pneumomediastinum is an extremely rare condition. We hereby present a case of this pathology.Clinical case17 year-old man who suffered a low-energy motorcycle accident and came into the emergency department complaining of headache and neck pain. Physical examination showed echolalia and retrograde amnesia and crepitation on the anterior and right lateral part of the neck. No other physical signs were found. Plain radiographs and a CT-scan showed air in the right jugular vein. With the diagnosis of spontaneous pneumomediastinum, the patient remained under observation. With rest and analgesia the patient improved within the next hours and was discharged without any complication. The case is presented and the literature is reviewed.ConclusionsSpontaneous pneumomediastinum is a normally benign pathology that tends to resolve favourably without any treatment (AU)

Dual task performance in early Alzheimer's disease, amnestic mild cognitive impairment and depression.

BACKGROUND: The dual task paradigm (Baddeley et al. 1986; Della Sala et al. 1995) has been proposed as a sensitive measure of Alzheimer's dementia, early in the disease process. METHOD: We investigated this claim by administering the modified dual task paradigm (utilising a pencil-and-paper version of a tracking task) to 33 patients with amnestic mild cognitive impairment (aMCI) and 10 with very early Alzheimer's disease, as well as 21 healthy elderly subjects and 17 controls with depressive symptoms. All groups were closely matched for age and pre-morbid intellectual ability. RESULTS: There were no group differences in dual task performance, despite poor performance in episodic memory tests of the aMCI and early Alzheimer's disease groups. In contrast, the Alzheimer patients were specifically impaired in the trail-making test B, another commonly used test of divided attention. CONCLUSIONS: The dual task paradigm lacks sensitivity for use in the early differential diagnosis of Alzheimer's disease.

Mild cognitive impairment does entail retrograde amnesia for public events.

In this study memory for public events was evaluated in 15 amnesic mild cognitive impairment (aMCI) patients, whose clinical diagnosis was refined through a stringent selection procedure. A total of 9 patients were longitudinally reassessed over an 18-month period. About half of the participants were impaired at baseline and nearly 80% at the end of the 18-month follow-up. Moreover, retrograde memory declined significantly over time. Evidence of a pathological Ribot-type temporal gradient was found in about half of the aMCI patients. This is the first report of a remote memory deficit in aMCI. It highlights amnesia for public events as a frequent accompaniment of this condition. The findings tie in with the hypothesized role of the hippocampal complex in long-term memory.

A case of anti-aquaporin-4 and anti-glutamate receptor antibodies positive myelitis presented with modest clinical signs.

We present a case of anti-aquaporin-4 antibody-positive myelitis, which suggests the high-risk syndrome of neuromyelitis optica, whose modest clinical signs were in conspicuous contrast to the extensive spinal cord lesions demonstrated on magnetic resonance (MR) imaging. Follow-up MR imaging showed marked improvement of lesions. Interestingly, an anti-glutamate receptor antibody, which has been suggested to cause dysfunction of N-methy-D-aspartate receptor on neuron, was detected in the cerebrospinal fluid of the patient. We discuss the case and related literature.

Undifferentiation of somatic responses to emotions in a case of functional amnesia.

The term functional amnesia (FA) has been proposed for cases of memory impairment presenting with severe retrograde amnesia in the absence of cerebral injury or history of psychiatric disturbance. Emotional flattening has often been reported alongside FA, however the mechanism of such a modification is unknown. This study aimed to explore the emotional processing in a rare case of a patient with FA complaining of severe emotional flattening. We presented ecological dynamic video stimuli conveying strong peaceful and fearful emotions to the patient and 13 controls. We then explored their emotional responses considering both conscious emotional judgements and automatic psychophysiological responses (skin conductance) and facial muscular activity (corrugator supercilii). Both patient P.P. and controls perfectly recognized the emotions conveyed by the films. However, P.P. failed to show an increased skin conductance and corrugator activity as found in controls during fearful film extracts compared with peaceful extracts. Taken together, these finding demonstrate the presence of an emotional deficit, characterized by a failure to generate appropriate somatic responses to positive and negative stimuli. Although this altered somatic processing did not interfere with PP's explicit recognition of emotion, it modified his emotional experience, thereby constituting a possible explanation for his emotional flattening. This study therefore suggests that FA is not limited to a mnemonic impairment, but is a more complex disorder, involving also the processing of emotionally loaded experiences.