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Electroconvulsive therapy related autobiographical amnesia: a review and case report
Abstract
Introduction: While short-term cognitive impairment following electroconvulsive therapy (ECT) is well described and acknowledged, the relationship between ECT and persistent memory impairment, particularly of autobiographical memory, has been controversial.
Methods: We describe the case of a 70-year-old consultant neurophysiologist, AW, who developed prominent, selective autobiographical memory loss following two courses of ECT for treatment-resistant depression.
Results: His performance on standard measures of IQ, semantic and episodic memory, executive function and mood was normal, while he performed significantly below controls on measures of episodic autobiographical memory.
Conclusions: Explanations in terms of mood-related memory loss and somatoform disorder appear unlikely. We relate AW's autobiographical memory impairment, following his ECT, to reports of similar autobiographical memory impairment occurring in the context of epilepsy, and emphasise the importance of using sensitive approaches to AbM assessment.
... 3,4 Despite the considerable amount of literature on the negative effects of ECT on autobiographical memory performance, it appears that this might still be an overlooked or unexpected side effect. A recent case report 5 described the case of a 70-year-old consultant neurophysiologist who developed prominent and permanent autobiographical memory loss following 2 courses of ECT for treatment-resistant depression. The authors emphasize the importance of having sensitive, valid, and reliable autobiographical memory assessments. ...
... Using a Google Form, several descriptive variables were collected (occupation and job setting, number of administrations of the CUAMI-SF, and with which population they worked). In addition, two questions were asked about the difficulty of administration and scoring on a 6-point Likert scale ranging from very difficult (0) or unclear to very easy or clear (5). Similarly, two other questions were asked about the possible redundancy of segments and question categories. ...
Introduction
Assessment of autobiographical memory following electroconvulsive therapy is lacking multilingual options. We therefore developed the Dutch translation of the Columbia University Autobiographical Memory Interview—Short Form (CUAMI-SF). We aimed to assess its practical use and identify segments for potential revision to improve the interview’s applicability.
Methods
The CUAMI-SF comprises 30 questions asking details about 6 segments (eg, last trip, last birthday) and 7 question categories (eg, dates, list of persons present). The interview was translated to Dutch using blind back-translation principles. We evaluated practicality and potential redundancy, through surveying a focus group and quantitative analyses of 60 participants, including depressed patients treated with electroconvulsive therapy (n = 14) or deep brain stimulation (n = 25) and healthy controls (n = 21). For the quantitative analyses, we compared the average percentage of nonanswered questions at baseline between groups. The average consistency scores after a follow-up of approximately 6 weeks were also calculated and compared for each segment between the groups.
Results
The focus group mostly found the CUAMI-SF easy to use and to score, but argued redundancy in specific questions asking for dates, numbers, and addresses. The largest differences in consistency scores between the groups were present for the segments “travel,” “birthdays,” “New Year’s Eve,” and “doctor’s visits,” indicating higher sensitivity compared with “family member” and “job.”
Discussion
The CUAMI-SF was found easy to use by administrators. The segments “family member” and “job” emerged as less sensitive. Therefore, removal might maintain sensitivity while reducing administration time, which could prove beneficial in clinical and research settings.
... Autobiographical memory gaps are of primary concern to patients and their relatives because of the importance of personal memories for patients' identity and sense of a coherent self (Conway and Pleydell-Pearce, 2000;Wilson and Ross, 2003). However, the persistency and severity of autobiographical memory decline with ECT is controversial (Lomas et al., 2021) because of methodological challenges. While most studies have used the Columbia University Autobiographical Memory Interview or its short form (AMI-SF) (McElhiney et al., 2001), the validity and reliability of this interview has been questioned McLoughlin, 2013, 2014). ...
... The differences between EPO and saline groups post-ECT in the secondary behavioural and neuronal measures of autobiographical memory were interesting. Recent research (Landry et al., 2021;Lomas et al., 2021) emphasizes the importance of autobiographical memory as a sensitive indicator of cognitive side effects of ECT. This type of memory is particularly relevant to patients as it shapes their sense of identity and coherence (Conway and Pleydell-Pearce, 2000;Wilson and Ross, 2003). ...
... However, although the short-term cognitive impairment of ECT is well established, the relationship between ECT and persistent memory impairment, especially autobiographical memory, remains controversial. 98 Patients' memory status prior to treatment and the time of assessment after ECT treatment have an impact on the results of the assessment of autobiographical memory. 99 Therefore, the evaluation methods need to be refined to further determine the effect of ECT on autobiographical memory. ...
The prevalence of severe mental disorders has been rising annually. Electroconvulsive therapy (ECT) is considered a valuable treatment option in psychiatry for conditions such as schizophrenia and medication-resistant depression, especially when other treatments have proven insufficient. ECT rapidly improves patients’ mood, alleviates symptoms, and demonstrates significant therapeutic effects. Currently, the form of ECT used in clinical practice is modified electroconvulsive therapy (mECT), which is administered under general anesthesia. Accumulative evidence has confirmed that different anesthetic drugs, anesthetic-ECT time interval, anesthetic depth, and airway management can impact the outcomes of ECT. Therefore, this review aims to summarize the current impact of anesthesia factors on ECT, providing reference for clinical anesthesia during ECT procedures.
... Les donne´es ont montre´une atteinte temporaire de la me´moire ante´rograde et re´trograde mais la plupart des fonctions cognitives s'ame´lioraient au long cours [3]. Certains patients pouvaient pre´senter, ne´anmoins, des de´ficits de la me´moire re´trograde plusieurs mois apre`s l'ECT [14] (Tableau 1). ...
... To achieve accreditation, a team must meet 100% of type 1 standards' (ECTAS, 2020). b In line with those suggested by Robertson and Pryor (2006) and Lomas et al. (2021 ...
Original research discussing acquired communication disorders caused by electrical trauma which pose unique communication barriers due to their evolving symptom manifestation. As the person ages away from the initial injury, communication barriers can become more pronounced with age.
This presentation provides details explaining how electrical trauma, repeated electrical trauma and lengthy exposure to other forms of non-ionizing radiation can impact speech and communication. Following both UK's National Radiological Protection Board and United States Gulf War Hearing recommendations to study electroconvulsive therapy recipients to better understand the heterogeneity of amyotrophic lateral sclerosis (ALS) and other neurodegenerative diseases. I present four different case studies: Functional NeuroCognitive Imaging results and videos of ECT recipients now living with the neurological sequela of electrical injury which impacts speech and communication. It provides insights into the potential interventions which successfully work for the presenter who lives with speech and communication disorders as a result of chronic electroconvulsive therapy. It identifies strategies to make alternative augmentative communication (AAC) less fatiguing for people who live with a history of chronic exposure to non-ionizing radiation. The presentation concludes with ideas for future research.
-Non-ionizing radiation exposures and subsequent neurodegenerative diseases (Progressive supranuclear palsy and Myoneural Disorders: Amyotrophic Lateral Sclerosis, Motor Neuron Disease and Muscular Sclerosis).
-Immediate and delayed consequences of Electrical Injury/Electromagnetic injury
-Repetitive mild to moderate Traumatic Brain Injuries
-Cognitive communication disorder
-Anoxia/Hypoxia
-Trigeminal, vagal and other cranial nerve dysfunction.
-Electroporation
-Motor Neuron Dysfunction/Motor Neuron Loss
-Demyelination
-Episodic Paroxysmal Neuromuscular Disorders
-Acquired Channelopathies
-Thiols
-Aphasia
-Verbal Apraxia
-Dysarthria, Anarthria
-Preserving residual voice
-Barriers to accessing AAC
-Voice Banking
-AAC Recommendations
The presentation is available with 1.0 CEU through "AAC in the Cloud" website (https://presenters.aacconference.com/videos/UXpVd1FUSXk=)
Cognitive aging research documents reduced access to contextually specific episodic details in older adults, whereas access to semantic or other nonepisodic information is preserved or facilitated. The present study extended this finding to autobiographical memory by using a new measure; the Autobiographical Interview. Younger and older adults recalled events from 5 life periods. Protocols were scored according to a reliable system for categorizing episodic and nonepisodic information. Whereas younger adults were biased toward episodic details reflecting happenings, locations, perceptions, and thoughts, older adults favored semantic details not connected to a particular time and place. This pattern persisted after additional structured probing for contextual details. The Autobiographical Interview is a useful instrument for quantifying episodic and semantic contributions to personal remote memory.
Background:
Electroconvulsive therapy (ECT) is associated with volumetric enlargements of corticolimbic brain regions. However, the pattern of whole-brain structural alterations following ECT remains unresolved. Here, we examined the longitudinal effects of ECT on global and local variations in gray matter, white matter, and ventricle volumes in patients with major depressive disorder as well as predictors of ECT-related clinical response.
Methods:
Longitudinal magnetic resonance imaging and clinical data from the Global ECT-MRI Research Collaboration (GEMRIC) were used to investigate changes in white matter, gray matter, and ventricle volumes before and after ECT in 328 patients experiencing a major depressive episode. In addition, 95 nondepressed control subjects were scanned twice. We performed a mega-analysis of single subject data from 14 independent GEMRIC sites.
Results:
Volumetric increases occurred in 79 of 84 gray matter regions of interest. In total, the cortical volume increased by mean ± SD of 1.04 ± 1.03% (Cohen's d = 1.01, p < .001) and the subcortical gray matter volume increased by 1.47 ± 1.05% (d = 1.40, p < .001) in patients. The subcortical gray matter increase was negatively associated with total ventricle volume (Spearman's rank correlation ρ = -.44, p < .001), while total white matter volume remained unchanged (d = -0.05, p = .41). The changes were modulated by number of ECTs and mode of electrode placements. However, the gray matter volumetric enlargements were not associated with clinical outcome.
Conclusions:
The findings suggest that ECT induces gray matter volumetric increases that are broadly distributed. However, gross volumetric increases of specific anatomically defined regions may not serve as feasible biomarkers of clinical response.
Objectives:
Electroconvulsive therapy (ECT) is the most effective treatment for drugresistant depression. In most studies, cognitive functions including working and semantic memory showed only transient impairment after ECT. However, the deficits of episodic (autobiographical) memory were demonstrated to be long-lasting.
Methods:
We investigated autobiographical memory in 20 patients (8 male, 12 female), aged 21-64 years, with drug-resistant depression, treated with ECT, using the Polish adaptation of the Autobiographical Memory Interview-Short Form (AMI-SF). The assessments were performed before, immediately after 10-12 ECT sessions, and 3 months thereafter.
Results:
Before the ECT, the mean severity of depression was 30 ± 6 points on the 17-item Hamilton Depression Rating Scale and the treatment produced a significant clinical improvement in all patients. The indices of autobiographical memory, as assessed by the AMI-SF, were significantly lower immediately after ECT and 3 months thereafter. The impairment in autobiographical memory did not show correlation with clinical improvement and with any other clinical factors.
Conclusions:
The results obtained in patients with drug-resistant depression confirm that ECT treatment produces a significant impairment of autobiographical memory persisting also three months after the procedure, suggesting that it may be the most important adverse cognitive effect of the ECT.
Objectives:
The aims of the present study were to describe the short-term rate of subjective memory worsening (SMW) and identify factors of importance for SMW in a large clinical sample treated for depression with electroconvulsive therapy (ECT).
Methods:
This register-based study included 1212 patients from the Swedish National Quality Register for ECT. Subjective memory worsening was defined as a 2-point worsening on the memory item of the Comprehensive Psychopathological Rating Scale from before to within 1 week after treatment. Associations between patient characteristics and treatment factors were examined using logistic regression.
Results:
Subjective memory worsening was experienced in 26%. It was more common in women than in men (31% vs 18%; P < 0.001) and more common in patients aged 18 to 39 years than in patients 65 years or older (32% vs 22%; P = 0.008). Patients with less subjective memory disturbances before ECT had a greater risk of SMW. Patients in remission after ECT had a lower risk of SMW. A brief pulse width stimulus gave higher risk of SMW compared with ultrabrief pulse (odds ratio, 1.61; 95% confidence interval, 1.05-2.47).
Conclusions:
Subjective memory worsening is reported by a minority of patients. However, young women are at risk of experiencing SMW. Ultrabrief pulse width stimulus could be considered for patients treated with unilateral electrode placement who experience SMW. Each patient should be monitored with regard to symptoms and adverse effects, and treatment should be adjusted on an individual basis to maximize the clinical effect and with efforts to minimize the cognitive adverse effects.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
This protocol describes the administration of the 4 Mountains Test (4MT), a short test of spatial memory, in which memory for the topographical layout of four mountains within a computer-generated landscape is tested using a delayed match-to-sample paradigm. Allocentric spatial memory is assessed by altering the viewpoint, colors and textures between the initially presented and target images. Allocentric spatial memory is a key function of the hippocampus, one of the earliest brain regions to be affected in Alzheimer's disease (AD) and impairment of hippocampal function predates the onset of dementia. It was hypothesized that performance on the 4MT would aid the diagnosis of predementia AD, which manifests clinically as Mild Cognitive Impairment (MCI). The 4MT was applied to patients with MCI, stratified further based on cerebrospinal fluid (CSF) AD biomarker status (10 MCI biomarker positive, 9 MCI biomarker negative), and with mild AD dementia, as well as healthy controls. Comparator tests included tests of episodic memory and attention widely accepted as sensitive measures of early AD. Behavioral data were correlated with quantitative MRI measures of the hippocampus, precuneus and posterior cingulate gyrus. 4MT scores were significantly different between the two MCI groups (p = 0.001), with a test score of ≤8/15 associated with 100% sensitivity and 78% specificity for the classification of MCI with positive AD biomarkers, i.e., predementia AD. 4MT test scores correlated with hippocampal volume (r = 0.42) and cortical thickness of the precuneus (r = 0.55). In conclusion, the 4MT is effective in identifying the early stages of AD. The short duration, easy application and scoring, and favorable psychometric properties of the 4MT fulfil the need for a simple but accurate diagnostic test for predementia AD. © 2016 Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Loss of personal memories experienced prior to receiving electroconvulsive therapy (ECT) is common and distressing and in some patients can persist for many months following treatment. Improved understanding of the relationships between individual patient factors, ECT treatment factors and clinical indicators measured early in the ECT course may help clinicians minimise these side effects through better management of the ECT treatment approach. In this study we examined the associations between the above factors for predicting retrograde autobiographical memory changes following ECT treatment.
Seventy four depressed participants with major depressive disorder were administered ECT three times a week using either a right unilateral (RUL) or bitemporal (BT) electrode placement and brief or ultrabrief pulse width ECT. Verbal fluency and retrograde autobiographical memory (assessed using the Columbia Autobiographical Memory Interview - Short Form, AMI-SF) were tested at baseline and after the last ECT treatment. Time to re-orientation was measured immediately following the third and sixth ECT treatments.
Results confirmed the utility of measuring time to re-orientation early during the ECT treatment course as a predictor of greater retrograde amnesia and the importance of assessing baseline cognitive status for identifying patients at greater risk for developing later side effects. With increased number of ECT treatments, older age was associated with increased time to re-orientation. Consistency of verbal fluency performance was moderately correlated with change in AMI-SF scores following RUL ECT.
ECT treatment techniques associated with lesser cognitive side effects should be particularly considered for patients with lower baseline cognitive status or older age.
© The Author 2015. Published by Oxford University Press on behalf of CINP.
Desensitization and blockade of 5-HT2C receptors (5-HT2CR) have long been thought to be central in the therapeutic action of antidepressant drugs. However, besides behavioral pharmacology studies, there is little in vivo data documenting antidepressant-induced 5-HT2CR desensitization in specific brain areas.
Mice lacking the 5-HT reuptake carrier (5-HTT(-/-)) were used to model the consequences of chronic 5-HT reuptake inhibition with antidepressant drugs. The effect of this mutation on 5-HT2CR was evaluated at the behavioral (social interaction, novelty-suppressed feeding and 5-HT2CR-induced hypolocomotion tests), the neurochemical and the cellular (RT-qPCR, mRNA editing and c-fos-induced expression) levels.
Although 5-HTT(-/-) mice had an anxiogenic profile in the novelty-suppressed feeding test, they displayed less 5-HT2CR-mediated anxiety in response to the agonist m-chlorophenylpiperazine in the social interaction test. In addition, 5-HT2CR-mediated inhibition of stress-induced increase in 5-HT turnover, measured in various brain areas, was markedly reduced in 5-HTT(-/-) mutants. These indices of tolerance to 5-HT2CR stimulation were associated neither with altered levels of 5-HT2CR protein and mRNA nor with changes in pre-mRNA editing in the frontal cortex. However, basal c-fos mRNA production in cells expressing 5-HT2CR was higher in 5-HTT(-/-) mutants, suggesting an altered basal activity of these cells following sustained 5-HT reuptake carrier inactivation. Furthermore, the increased c-fos mRNA expression in 5-HT2CR-like immune-positive cortical cells observed in wild-type mice treated acutely with the 5-HT2CR agonist RO-60,0175, was absent in 5-HTT(-/-) mutants.
Such blunted responsiveness of the 5-HT2CR system, observed at the cell signaling level, probably contributes to moderate the anxiety phenotype of 5-HTT(-/-) mice.
© The Author 2014. Published by Oxford University Press on behalf of CINP.
Normative data stratified by three levels of age (16–59, 60–79, and 80–95 years) and three levels of education (0–8, 9–12, and 13–21 years) are presented for phonemic verbal fluency (FAS) and categorical verbal fluency (Animal Naming). The normative sample, aged 16 to 95 years, consisted of 1,300 cognitively intact individuals who resided in the community. Years of education ranged from 0 to 21. The total number of words in 1 minute for each of the letters F, A, and S was correlated r = .52 with the number of animal names generated in 1 minute. Regression analyses showed that FAS was more sensitive to the effects of education (18.6% of the variance) than age (11.0% of the variance). The opposite relationship occurred for Animal Naming, where age accounted for 23.4% of the variance and education accounted only for 13.6%. Gender accounted for less than 1% of variance for FAS and Animal Naming. The clinical utility of these norms is discussed.
To date, electroconvulsive therapy (ECT) is the most potent treatment in severe depression. Although ECT has been successfully applied in clinical practice for over 70 years, the underlying mechanisms of action remain unclear. We used functional MRI and a unique data-driven analysis approach to examine functional connectivity in the brain before and after ECT treatment. Our results show that ECT has lasting effects on the functional architecture of the brain. A comparison of pre- and posttreatment functional connectivity data in a group of nine patients revealed a significant cluster of voxels in and around the left dorsolateral prefrontal cortical region (Brodmann areas 44, 45, and 46), where the average global functional connectivity was considerably decreased after ECT treatment (P < 0.05, family-wise error-corrected). This decrease in functional connectivity was accompanied by a significant improvement (P < 0.001) in depressive symptoms; the patients' mean scores on the Montgomery Asberg Depression Rating Scale pre- and posttreatment were 36.4 (SD = 4.9) and 10.7 (SD = 9.6), respectively. The findings reported here add weight to the emerging "hyperconnectivity hypothesis" in depression and support the proposal that increased connectivity may constitute both a biomarker for mood disorder and a potential therapeutic target.
Transient epileptic amnesia is a form of temporal lobe epilepsy in which sufferers often complain of irretrievable loss of remote memories. We used a broad range of memory tests to clarify the extent and nature of the remote memory deficits in patients with transient epileptic amnesia. Performance on standard tests of anterograde memory was normal. In contrast, there was a severe impairment of memory for autobiographical events extending across the entire lifespan, providing evidence for the occurrence of 'focal retrograde amnesia' in transient epileptic amnesia. There was a milder impairment of personal semantic memory, most pronounced for midlife years. There were limited deficits of public semantic memory for recent decades. These results may reflect subtle structural pathology in the medial temporal lobes or the effects of the propagation of epileptiform activity through the network of brain regions responsible for long-term memory, or a combination of these two mechanisms.
An important goal in electroconvulsive therapy (ECT) research is to minimize associated cognitive side-effects while maintaining its high efficacy. This study explored the use of a novel approach, right unilateral (RUL) ECT with an ultrabrief pulsewidth (0.3 ms) (RUL-UB), in comparison with standard RUL ECT. Seventy-four depressed in-patients received RUL-UB ECT at six times seizure threshold, and 22 patients received standard RUL ECT (1.0 ms pulsewidth) at five times seizure threshold. Formal, prospective evaluations of mood and cognitive functioning over the treatment course were done by a rater blinded to treatment condition. Efficacy was maintained using the ultrabrief pulsewidth, with equivalent numbers of responders and remitters to the standard RUL ECT group, although the speed of response was slower. Cognitive outcomes were superior in the RUL-UB ECT group, particularly in the retention of verbal and visual information, as well as in retrograde autobiographical memory.
Complaints of memory difficulties are common among patients with epilepsy, particularly with temporal lobe epilepsy where memory-related brain structures are directly involved by seizure activity. However, the reason for these complaints is often unclear and patients frequently perform normally on standard neuropsychological tests of memory. In this article, we review the literature on three recently described and interrelated forms of memory impairment associated with epilepsy: (i) transient epileptic amnesia, in which the sole or main manifestation of seizures is recurrent episodes of amnesia; (ii) accelerated long-term forgetting, in which newly acquired memories fade over days to weeks and (iii) remote memory impairment, in which there is loss of memories for personal or public facts or events from the distant past. Accelerated long-term forgetting and remote memory impairment are common amongst patients with transient epileptic amnesia, but have been reported in other forms of epilepsy. Their presence goes undetected by standard memory tests and yet they can have a profound impact on patients' lives. They pose challenges to current theoretical models of memory. We discuss the evidence for each of these phenomena, as well as their possible pathophysiological bases, methodological difficulties in their investigation and their theoretical implications.
The internal consistency reliability (ICR) of the 40-item University of Pennsylvania Smell Identification Test (UPSIT) and its 10-, 20-, and 30-item fractions was explored, as well as the relationships between the fractions and the entire 40-item test. Pearson correlation coefficients (rs) were computed among all independent combinations and permutations of the four 10-item UPSIT booklets using data from 774 subjects. The median r values of the 10- and 20-item combinations were used to establish the ICRs of the 10- and 20-item tests. The ICRs of the 30- and 40-item tests were estimated using the Spearman-Brown formula and the median rs of the 20-item combinations. Additional ICR estimates of the 40-item UPSIT were obtained from nonsymmetrical fractions using the Horst formula. The ICRs for the UPSIT and its 10-, 20-, and 30-item fractions were 0.922, 0.752, 0.855 and 0.898, respectively. No major sex differences emerged. Estimates of correlations between (1) single booklets and two-booklet combinations and (2) the 40-item UPSIT using Guilford's (1953) correction for nonindependence ranged from 0.812 to 0.871. Overall, these results indicate that (1) the UPSIT and its 10-, 20-, and 30-item fragments have very high ICRs and (2) individual UPSIT booklets or their combinations can be used to assess smell function in a reliable manner where extreme time constraints are present (e.g., in surveys and in brief neuropsychological test batteries).
The field of autobiographical memory has made dramatic advances since the first collection of papers in the area was published in 1986. Now, over 25 years on, this book reviews and integrates the many theories, perspectives, and approaches that have evolved over the last decades. A truly eminent collection of editors and contributors appraise the basic neural systems of autobiographical memory; its underlying cognitive structures and retrieval processes; how it develops in infancy and childhood, and then breaks down in aging; its social and cultural aspects; and its relation to personality and the self. Autobiographical memory has demonstrated a strong ability to establish clear empirical generalizations, and has shown its practical relevance by deepening our understanding of several clinical disorders - as well as the induction of false memories in the legal system. It has also become an important topic for brain studies, and helped to enlarge our general understanding of the brain.
Temporal lobe epilepsy (TLE) can be associated with a marked impairment of autobiographical memory. This is occasionally its presenting feature. We describe two individuals with severe epilepsy-associated autobiographical memory loss. Both MB and PT were reassured initially that their memory was intact on the basis of standard neuropsychological tests. Both have written detailed accounts of their symptoms. The key neuropsychological features of their cases are the relative normality of performance on standard memory tests, with preservation of semantic memory for impersonal information, in contrast to a profound amnesia for salient autobiographical episodes and an impoverishment of imaginative scene construction. First person accounts from these individuals illustrate the importance of autobiographical memory in sustaining a coherent sense of self, informing interpersonal relationships and supporting future thinking and problem-solving. These cases contribute to the growing evidence for a distinctive pattern of autobiographical memory loss associated with TLE, and indicate that it can take a severe form affecting both personal semantics and episodic recollection. Defining the phase of memory processing most relevant to this form of amnesia, and the roles of physiological and structural pathology, requires further research. The paper's title refers to the introspective ‘void’ highlighted by both MB and PT in their reports – in PT's words: ‘My primary symptom is the void that is my past’.
Transient amnesia can be the principal manifestation of epilepsy. This diagnosis, however, is seldom suspected by clinicians and remains controversial. The amnestic attacks are often associated with persistent memory complaints. This study was designed to provide the first description of transient epileptic amnesia in a substantial series of patients.
Fifty patients were recruited over 18 months using the following diagnostic criteria: (1) recurrent, witnessed episodes of amnesia; (2) other cognitive functions intact during attacks; and (3) compelling evidence of epilepsy. We assessed clinical features and performed neuropsychological evaluation in cases and 24 matched control subjects.
Transient epileptic amnesia develops in later life (mean onset, 62 years). Amnestic episodes are frequent (median, 12/year), brief (median duration, 30-60 minutes), and often occur on waking (37/50 cases). Epilepsy was the initial specialist diagnosis in only 12 of 50 cases. Attacks ceased on anticonvulsant medication in 44 of 47 treated patients. A total of 40 of 50 cases described persistent memory difficulties. Despite normal performance on standard memory tests, patients exhibited accelerated forgetting of verbal and visual material over 3 weeks by comparison with matched control subjects (p < 0.001). They also showed loss of autobiographical memories for events extending back over 40 years (p < 0.05).
We propose that transient epileptic amnesia is a distinctive epilepsy syndrome, typically misdiagnosed at presentation and associated with accelerated long-term forgetting and autobiographical amnesia. The syndrome is of clinical and theoretic importance.
Introduction:
Reduced hippocampal volume is one of the most consistent morphological findings in Major Depressive Disorder (MDD). Electroconvulsive therapy (ECT) is the most effective therapy for MDD, yet its mechanism of action remains poorly understood. Animal models show that ECT induces several neuroplastic processes, which lead to hippocampal volume increases. We conducted a meta-analysis of ECT studies in humans to investigate its effects on hippocampal volume.
Methods:
PubMed was searched for studies examining hippocampal volume before and after ECT. A random-effects model was used for meta-analysis with standardized mean difference (SMD) of the change in hippocampal volume before and after ECT as the primary outcome. Nine studies involving 174 participants were included.
Results:
Total hippocampal volumes increased significantly following ECT compared to pre-treatment values (SMD=1.10; 95% CI 0.80-1.39; z=7.34; p<0.001; k=9). Both right (SMD=1.01; 95% CI 0.72-1.30; z=6.76; p<0.001; k=7) and left (SMD=0.87; 95% CI 0.51-1.23; z=4.69; p<0.001; k=7) hippocampal volumes were also similarly increased significantly following ECT. We demonstrated no correlation between improvement in depression symptoms with ECT and change in total hippocampal volume (beta=-1.28, 95% CI -4.51-1.95, z=-0.78, p=0.44).
Conclusion:
We demonstrate fairly consistent increases in hippocampal volume bilaterally following ECT treatment. The relationship among these volumetric changes and clinical improvement and cognitive side effects of ECT should be explored by larger, multisite studies with harmonized imaging methods.
The Addenbrooke’s Cognitive Examination (ACE) was originally developed as a theoretically motivated extension of the Mini-Mental State Examination (MMSE) which attempted to address the neuropsychological omissions and improve the screening performance of the latter. Though taking longer to administer than the MMSE, and therefore best suited to specialist settings, ACE and its subsequent iterations, ACE-R and ACE-III, have proved easy to use, acceptable to patients, and have shown excellent diagnostic utility in identifying dementia and cognitive impairment in a variety of clinical situations (Alzheimer’s disease, frontotemporal lobar degenerations, Parkinsonian syndromes, stroke and vascular dementia, brain injury). The most recent development, the Mini-Addenbrooke’s Cognitive Examination (M-ACE), takes no more time to administer than the MMSE but, like the longer versions, is superior to MMSE in diagnostic utility. The utility of ACE/ACE-R has prompted translation into various languages, and this trend is anticipated to continue for ACE-III and M-ACE.
Maintenance electroconvulsive therapy (ECT) is sometimes prescribed for refractory psychiatric conditions. We describe five patients who received maintenance ECT and developed florid temporal epileptiform abnormalities on electroencephalography (EEG) despite no history of epilepsy and normal neuroimaging. All patients had received regular ECT for at least 8 months. Three patients had clinical events consistent with epileptic seizures, and video-EEG monitoring captured electrographic seizures in two patients. After cessation of ECT the EEGs normalized in all patients, and no further clinical seizures occurred. Maintenance ECT may predispose to epilepsy with a seizure focus in the temporal lobe.
Objective:
ECT is the most effective treatment for severe depression. Previous efficacy studies, using thrice-weekly brief-pulse ECT, reported that high-dose (6× seizure threshold) right unilateral ECT is similar to bitemporal ECT but may have fewer cognitive side effects. The authors aimed to assess the effectiveness and cognitive side effects of twice-weekly moderate-dose (1.5× seizure threshold) bitemporal ECT with high-dose unilateral ECT in real-world practice.
Method:
This was a pragmatic, patient- and rater-blinded, noninferiority trial of patients with major depression (N=138; 63% female; age=56.7 years [SD=14.8]) in a national ECT service with a 6-month follow-up. Participants were independently randomly assigned to bitemporal or high-dose unilateral ECT. The primary outcome was change in the 24-item Hamilton Depression Rating Scale (HAM-D) score after the ECT course; the prespecified noninferiority margin was 4.0 points. Secondary outcomes included response and remission rates, relapse status after 6 months, and cognition.
Results:
Of the eligible patients, 69 were assigned to bitemporal ECT and 69 to unilateral ECT. High-dose unilateral ECT was noninferior to bitemporal ECT regarding the 24-item HAM-D scores after the ECT course (mean difference=1.08 points in favor of unilateral ECT [95% CI=-1.67 to 3.84]). There were no significant differences for response and remission or 6-month relapse status. Recovery of orientation was quicker following unilateral ECT (median=19.1 minutes versus 26.4 minutes). Bitemporal ECT was associated with a lower percent recall of autobiographical information (odds ratio=0.66) that persisted for 6 months.
Conclusions:
Twice-weekly high-dose unilateral ECT is not inferior to bitemporal ECT for depression and may be preferable because of its better cognitive side-effect profile.
Epilepsy is one of the most common disorders of the brain, and these patients often suffer from memory problems. There are a number of reasons for this: seizures can directly affect the brain in ways that disturb memory; epilepsy often results from trouble in brain regions closely linked to memory; the treatment of epilepsy can affect memory; epilepsy can cause psychological problems, like depression, which interfere with memory. This book reviews all aspects of the relationship between this common and potentially serious neurological disorder and memory, one of the core functions of the human mind. The chapters review the history of the subject; the clinical features of memory disorder in epilepsy; neuropsychological, neuroradiological, neuropathological, and electrophysiological findings; the roles of anticonvulsant side effects and psychiatric disorder; and the scope for memory support and rehabilitation. The study of patients with epilepsy has revealed much about the workings of memory, yet there has been no recent review of this field of research. This book aims to this gap.
Electroconvulsive therapy (ECT) is used to treat otherwise treatmentresistant depression. Despite clear mood-enhancing effects, it is associated with complaints of memory loss. This chapter outlines a brief history of ECT, its effects on the brain and on memory, and why subjective memory loss may surpass the objectively measured loss. It also presents results from an ongoing study assessing autobiographical memory following ECT using the Autobiographical Interview, which separates episodic from semantic autobiographical memory. Initial analyses suggest a disproportional impairment of episodic memory, although semantic memory to some extent is also affected. In spite of some recovery, this impairment persists three months after treatment. This research validates the subjective impairments reported by ECT patients, and supports theoretical constructs of memory that assume a behavioural and neural separation between episodic and semantic autobiographical memory.
Research over the past decade has firmly established that the ability to retrieve remote information, particularly personally experienced autobiographical memories, is impaired in patients with temporal lobe epilepsy or excisions (TLE). Despite a long-held model of memory consolidation that suggested only recent memories would be impacted by medial temporal damage, clinical neuropsychologists working with TLE patients are readily impressed by their assertions of poor recollection of personal events such as family vacations; even when prompted by descriptions and reminders they report that it simply doesn't 'feel' like a lived experience. This type of memory has been found to be particularly sensitive to disruption in patients with TLE and, based on lesion and functional imaging data, it is hypothesized that it reflects damage to the medial temporal lobe (MTL) and most prominently the hippocampus, which serves as a critical 'hub' of a network that supports autobiographical recall. This chapter presents evidence in support of that hypothesis, and discusses questions regarding retrieval of semantic versus experiential remote memory, specification of the processes compromised in MTL damage that gives rise to autobiographical memory deficits, and the relationship between damage and patterns of functional activation in autobiographical memory networks of healthy individuals and patients with TLE.
Although problems with remembering significant events from the past (e.g. holidays, weddings, etc.) have been reported previously in patients with transient epileptic amnesia (TEA), to date there have been no detailed studies of autobiographical memory in patients with this disorder. To investigate this issue, a 68-year-old right-handed man (R.G.) who suffered from TEA and reported significant autobiographical memory problems was tested on a battery of neuropsychological tests of anterograde and remote memory. Tests of autobiographical memory revealed that R.G. was unable to evoke detailed autobiographical recollections from a substantial part of his life. By contrast, he performed well on tests of new learning and general knowledge and possessed good personal semantic information about his past. In summary, a distinct form of autobiographical amnesia, which is characterized by loss of experiential remembering of significant events, may be associated with TEA. It is proposed that the autobiographical memory deficit seen in the disorder may result from the progressive erasure of cortically based memory representations. This case adds to growing evidence for a dissociation between mechanisms subserving anterograde memory and those required to evoke remote episodic memories.
Depression is characterized by distinct profiles of disturbance in ways autobiographical memories are represented, recalled, and maintained. We review four core domains of difficulty: systematic biases in favor of negative material; impoverished access and responses to positive memories; reduced access to the specific details of the personal past; and dysfunctional processes of rumination and avoidance around personal autobiographical material. These difficulties drive the onset and maintenance of depression; consequently, interventions targeted at these maladaptive processes have clinical potential. Memory therapeutics is the development of novel clinical techniques, translated from basic research, that target memory difficulties in those with emotional disorders. We discuss prototypical examples from this clinical domain including MEmory Specificity Training, positive memory elaboration, memory rescripting, and the method-of-loci (MoL).
Shortening the pulse width to 0.3 millisecond holds neurophysiological and clinical promise of making electroconvulsive therapy (ECT) safer by reducing cognitive adverse effects. The exclusive effects of pulse width on autobiographical and subjective memory are largely unstudied. The aim was to principally investigate during the acute ECT course and at 3 months after ECT autobiographical and subjective memory effects of 0.3-millisecond ultrabrief and 1-millisecond brief-pulse ECT.
Patient with severe depression were randomized to 1-millisecond brief-pulse (n = 20) or 0.3-millisecond ultrabrief-pulse (n = 20) right unilateral ECT, both at 6 times the threshold stimulus dose given thrice weekly. Autobiographical Memory Interview (Kopelman) and Squire Subjective Memory Questionnaire were administered at baseline, after 8 sessions, end of the acute course, and 3 months later.
Early adult semantic memory worsened significantly over time with brief-pulse compared with ultrabrief ECT: F3,88 = 2.60, P = 0.05. There was a significant decline in brief-pulse treatment vis-à-vis a significant improvement with ultrabrief-pulse treatment with childhood semantic memory (P = 0.022), early adult semantic (P = 0.03), and recent semantic memory (P = 0.018) only at 24 hours after the eighth ECT treatment.
Clinically meaningful and significant improvement in semantic autobiographical memory occurred in ultrabrief treatment vis-à-vis brief-pulse ECT after 8 treatments. Ultrabrief treatment offered a small but significant advantage over 1-millisecond brief-pulse high-dose right unilateral ECT with early adult semantic autobiographical memory, which persisted up to 3 months.
This study was undertaken to identify the relationship between the raw scores obtained on the Rey Complex Figure Test (CFT) under four different administration procedures; additionally, the effects of the administration procedures on the Recognition Trial (Meyers & Meyers, 1994) were examined. The Recognition Trial is a new instrument, developed to assess recognition of various parts of the CFT. Many authors have presented a variety of administration procedures; however, there are no studies that examine the relationship of the various administration procedures. The administration procedures used were as follows: (1) Copy, Immediate recall, 30-min recall, and Recognition Trial; (2) Copy, 3-min recall, 30-min recall, Recognition Trial; (3) Copy, Immediate recall, 3-min recall, 30-min recall, Recognition Trial; (4) Copy, 30-min recall, Recognition Trial. The results of the study indicate no significant difference in the 30-min recall score or on the Recognition Trial if an immediate/short-term recall was given; however, if no immediate/short-term recall was given, there was a difference in the 30-min recall score and the Recognition Trial. There was no significant difference in a time period from immediate to 3 min on the 30-min recall score.
Reviewed published work for the efficacy and safety of electroconvulsive therapy (ECT) vs simulated ECT, ECT vs pharmacotherapy, and different forms of ECT for patients with depressive illness. The authors designed a systematic overview and meta-analysis of randomised controlled trials and observational studies. They obtained data from the Cochrane Collaboration Depressive Anxiety and Neurosis and Schizophrenia Group Controlled trial registers, Cochrane Controlled Trials register, Biological Abstracts, CINAHL, EMBASE, LILACS, MEDLINE, PsycINFO, and SIGLE, reference lists, and specialist textbooks. The main outcome measures were depressive symptoms, measures of cognitive function, and mortality. Meta-analysis of data of short-term efficacy from randomised controlled trials was possible. Real ECT was significantly more effective than simulated ECT (6 trials, 256 Ss). Treatment with ECT was significantly more effective than pharmacotherapy (18 trials, 1144 Ss). Bilateral ECT was more effective than unipolar ECT (22 trials, 1408 Ss). It is concluded that ECT is an effective short-term treatment for depression, and is probably more effective than drug therapy. Bilateral ECT is moderately more effective than unilateral ECT, and high dose ECT is more effective than low dose. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Introduction:
Functional amnesia refers to various forms of amnesia, which have no direct organic brain basis. Psychological stress and trauma were etiologically linked to its development across various cultures.
Methods:
We have studied several patients with functional amnesia, employing neuropsychological and neuroimaging methods. Herein we provide a review of the current understanding of the phenomenology, neuropsychology and neurobiology of functional amnesia, which we illustrate by reference to five own case descriptions and other cases presented in the literature.
Results:
Functional amnesia is mostly of retrograde nature and presents in the form of a memory blockade or repression to recollect episodic-autobiographical events, which may cover the whole past life. Sometimes, the recollection impairment is localized to certain time epochs. In comparison to functional retrograde amnesia, functional isolated anterograde amnesia is much rarer and data on its neurobiology are scant. In patients with functional amnesia with pronounced retrograde episodic-autobiographical memory impairments, we identified changes in brain metabolism, above all reductions in the temporo-frontal regions of the right hemisphere. Recently, even subtle structural changes in the white matter of the (right) frontal cortex were described in functional retrograde amnesia by other researchers.
Conclusions:
The disruption in recollection in functional amnesia is often accompanied by changes in personality dimensions, pertaining to cognition (self-related processing, theory of mind), autonoetic consciousness and affectivity. This suggests that functional amnesia is a multifaceted condition. We hypothesize that the recollection deficit in functional retrograde amnesia primarily reflects a desynchronization between a frontal lobe system, important for autonoetic consciousness, and a temporo-amygdalar system, important for evaluation and emotions. Despite assumptions that functional amnesia can always be reversed, several cases of functional amnesia were found to follow a chronic course, suggesting a need for longitudinal prospective studies to quantify possible global cognitive deterioration over time and its neural underpinnings.
ABSTRACT– A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
Neurocognitive functioning is well known to be affected after ECT. However quantified data about the severity of the cognitive impairment after ultrabrief pulse and brief pulse ECT are limited, which makes it hard to judge its clinical relevance.
To review all prospective studies using right unilateral (ultra) brief pulse index electroconvulsive therapy published up until February 2011 which used at least one instrument for cognitive assessment before and after ECT. The severity and persistence of neurocognitive side effects immediately (one to seven days post ECT), between one and six months and after six months post ECT were assessed by calculating effect sizes using Cohen's d.
Ten studies fulfilled the inclusion criteria and provided detailed information to compute effect sizes. The results indicate loss of autobiographical memory and impairment of verbal fluency, anterograde verbal and non-verbal memory immediately after brief pulse RUL ECT. To a lesser extent impairment of working memory and reduced speed of processing is found. Autobiographical memory is the only domain still being impaired between one and six months post ECT, but improved in this period. Verbal fluency normalized to baseline performance between one and six months post ECT whereas anterograde verbal and non-verbal memory normalized or even improved. Speed of processing improved within six months after ECT. Long-term data on these cognitive domains were not available. Based on two of the ten included studies the results suggest that ultrabrief pulse RUL ECT causes less decline in autobiographical and anterograde memory after ECT than brief pulse RUL ECT.
This review may be limited because of the small number of included studies and due to unreliable effect sizes. Furthermore, few data were available for non-memory domains and cognitive functioning after six months.
Loss of autobiographical memory is still present between one and six months after unilateral brief pulse ECT. Ultrabrief pulse RUL ECT shows less decline in autobiographical memory. Other neurocognitive impairments after brief pulse RUL ECT seem to be transient.
Autobiographical amnesia assessments in depression need to account for normal changes in consistency over time, contribution of mood and type of memories measured. We report herein validation studies of the Columbia Autobiographical Memory Interview - Short Form (CAMI-SF), exclusively used in depressed patients receiving electroconvulsive therapy (ECT) but without previous published report of normative data. The CAMI-SF was administered twice with a 6-month interval to 44 healthy volunteers to obtain normative data for retrieval consistency of its Semantic, Episodic-Extended and Episodic-Specific components and assess their reliability and validity. Healthy volunteers showed significant large decreases in retrieval consistency on all components. The Semantic and Episodic-Specific components demonstrated substantial construct validity. We then assessed CAMI-SF retrieval consistencies over a 2-month interval in 30 severely depressed patients never treated with ECT compared with healthy controls (n=19). On initial assessment, depressed patients produced less episodic-specific memories than controls. Both groups showed equivalent amounts of consistency loss over a 2-month interval on all components. At reassessment, only patients with persisting depressive symptoms were distinguishable from controls on episodic-specific memories retrieved. Research quantifying retrograde amnesia following ECT for depression needs to control for normal loss in consistency over time and contribution of persisting depressive symptoms.
Objective:
Although electroconvulsive therapy (ECT) is generally considered effective against depression, it remains controversial because of its association with retrograde memory loss. Here, we assessed memory after ECT in circumstances most likely to yield strong retrograde amnesia.
Method:
A cohort of patients undergoing ECT for major depression was tested before and after ECT, and again at 3-months follow-up. Included were 21 patients scheduled to undergo bilateral ECT for severe major depression and 135 controls matched for gender, age, education, and media consumption. Two memory tests were used: a verbal learning test to assess anterograde memory function, and a remote memory test that assessed memory for news during the course of one year.
Results:
Before ECT the patients' scores were lower than those of controls. They were lower again after treatment, suggesting retrograde amnesia. At follow-up, however, memory for events before treatment had returned to the pre-ECT level. Memory for events in the months after treatment was as good as that of controls.
Limitations:
The sample size in this study was not large. Moreover, memory impairment did not correlate with level of depression, which may be due to restriction of range.
Conclusions:
Our results are consistent with the possibility that ECT as currently practiced does not cause significant lasting retrograde amnesia, but that amnesia is mostly temporary and related to the period of impairment immediately following ECT.
Several experiments carried out with a subset of patients with temporal lobe epilepsy have demonstrated normal memory performance at standard delays of recall (i.e. minutes to hours) but impaired performance over longer delays (i.e. days or weeks), suggesting altered long-term consolidation mechanisms. These mechanisms were specifically investigated in a group of five adult-onset pharmaco-sensitive patients with temporal lobe epilepsy, exhibiting severe episodic memory complaints despite normal performance at standardized memory assessment. In a first experiment, the magnitude of autobiographical memory loss was evaluated using retrograde personal memory tasks based on verbal and visual cues. In both conditions, results showed an unusual U-shaped pattern of personal memory impairment, encompassing most of the patients' life, sparing however, periods of the childhood, early adulthood and past several weeks. This profile was suggestive of a long-term consolidation impairment of personal episodes, adequately consolidated over 'short-term' delays but gradually forgotten thereafter. Therefore, in a subsequent experiment, patients were submitted to a protocol specifically devised to investigate short and long-term consolidation of contextually-bound experiences (episodic memory) and context-free information (semantic knowledge and single-items). In the short term (1 h), performance at both contextually-free and contextually-bound memory tasks was intact. After a 6-week delay, however, contextually-bound memory performance was impaired while contextually-free memory performance remained preserved. This effect was independent of task difficulty and the modality of retrieval (recall and recognition). Neuroimaging studies revealed the presence of mild metabolic changes within medial temporal lobe structures. Taken together, these results show the existence of different consolidation systems within declarative memory. They suggest that mild medial temporal lobe dysfunction can impede the building and stabilization of episodic memories but leaves long-term semantic and single-items mnemonic traces intact.
to examine racial differences in (a) the prevalence of financial exploitation and psychological mistreatment since turning 60 and in the past 6 months and (b) the experience-perpetrator, frequency, and degree of upset-of psychological mistreatment in the past 6 months.
random digit dial telephone recruitment and population-based survey (telephone and in-person) of 903 adults aged 60 years and older in Allegheny County (Pittsburgh), Pennsylvania (693 non-African American and 210 African American). Covariates included sex, age, education, marital status, household composition, cognitive function, instrumental activities of daily living/activities of daily living difficulties, and depression symptoms.
prevalence rates were significantly higher for African Americans than for non-African Americans for financial exploitation since turning 60 (23.0% vs. 8.4%) and in the past 6 months (12.9% vs. 2.4%) and for psychological mistreatment since turning 60 (24.4% vs. 13.2%) and in the past 6 months (16.1% vs. 7.2%). These differences remained once all covariates were controlled in logistic regression models. There were also racial differences in the experience of psychological mistreatment in the past 6 months. Risk for clinical depression was also a consistent predictor of financial exploitation and psychological mistreatment.
although the results will need to be replicated in national surveys, the study suggests that racial differences in elder mistreatment are a potentially serious issue deserving of continued attention from researchers, health providers, and social service professionals.
Methods used to evaluate subjective effects of electroconvulsive therapy (ECT) have relied on self-report about discrete aspects of memory. Although objective deficits are demonstrable, patients generally report improved memory after ECT. Patients have not been asked to evaluate the global impact of ECT on mood or memory. This study was undertaken to compare patients' evaluations of ECT outcomes using direct questioning about global impact compared with standard methods.
A prospective, naturalistic study was conducted in seven hospitals. Patients completed clinical and neurocognitive assessments before ECT, including the Cognitive Failures Questionnaire (CFQ), the Autobiographical Memory Interview-Short Form, and a novel interview assessing expectations about the impact of ECT on mood and memory (Global Self-Evaluation-Mood [GSE-Md], GSE-memory [GSE-My]). Follow-ups were conducted one and 24 weeks after ECT, and the GSE-Md and GSE-My evaluated perceived global impact at these time points.
Patients reported marked improvement after ECT on the CFQ, a traditional instrument assessing specific cognitive complaints. CFQ and depression severity scores were strongly correlated. On the GSE-My, patients reported a deleterious memory effect both one and 24 weeks after ECT. GSE-My, but not CFQ, scores were associated with treatment technique and long-term retrograde amnesia.
Characterization of patients' experience of cognitive side effects after ECT differs markedly depending on assessment method. Direct questioning about global impact revealed more negative views and associations with objective indices of cognitive impairment. This represents the first report of concordance between subjective and objective measures of the effects of ECT on memory.
A 44-year-old woman presented with focal retrograde amnesia and complaints of rapid forgetting in the absence of episodes of transient cognitive disturbance. Her MRI and 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) were normal. On standard neuropsychological tests she performed within the normal range although a test of autobiographical memory confirmed impoverished recall especially involving recent life events. The electroencephalograph (EEG) recordings were suggestive of temporal lobe epilepsy but no clear diagnosis was established. After 4 years the patient's recurrent brief episodes of disorientation, suggestive of transient epileptic amnesia (TEA), were corroborated by her sister. This diagnosis was confirmed by an ambulatory EEG that revealed ictal activity. Several important points emerge from this study. Focal retrograde amnesia can be a prodromal symptom of TEA which can precede the full-blown syndrome by several years. Moreover, transient attacks might not be reported if patients live alone. The ictal EEG findings further substantiate the epileptic nature of the syndrome.
Classical amnesia involves a difficulty in transferring information to long-term memory and can be detected with standard clinical tests. However, there are some patients who pass these tests but nonetheless show longer-term memory impairments. A case study is presented of a patient, RY, with temporal lobe epilepsy, who exhibited such a profile of "accelerated long-term forgetting". To investigate the effect of recalling information on later retention, recall and recognition for pairs of novel stories were tested at five intervals ranging from 30 min to 4 weeks; we also manipulated whether or not recall and recognition were repeatedly tested for stories. Two studies are reported, one before RY commenced treatment with anticonvulsant medication, and one following 6 months of treatment. Very similar memory profiles were observed in both settings. Against a background of above average cognitive function, results showed that RY's free recall, although initially average or above, was significantly impaired at extended delays (within 24h) for non-repeatedly recalled episodic information. However, this contrasted with normal performance for information that had been repeatedly recalled. An unresolved issue in the field is the impact of anticonvulsant medication on alleviating long-term forgetting, and the current study shows that anticonvulsant medication can have negligible beneficial effects in improving the rate of long-term forgetting in this type of patient. In addition, our study highlights the possible protective effect of active review of recent episodic memories.
Twenty-seven medication-free, depressed patients (Research Diagnostic Criteria, endogenous subtype) were administered a comprehensive battery testing memory and other cognitive functions before and after a series of bilateral, brief-pulse electroconvulsive therapy (ECT) administered according to a dosage-titration procedure (8.9 +/- 1.981 treatments). A subset of patients (N = 14) were reexamined at 1 month and 6 months after the conclusion of the treatment. Anterograde (verbal and visuospatial tasks), as well as retrograde (famous and personal events), memory function was significantly impaired at the end of the ECT series. By 1 month follow-up, performance had improved to pre-ECT (depression) levels on both anterograde and retrograde tasks and exceeded these by 6 months. The memory deficits induced by ECT were not a consequence of generalized cognitive impairment. Furthermore, depression and ECT were shown to independently affect memory, and recovery from depression was not a consequence of the amnestic action of the treatment. The results generally confirm previous reports regarding the nature of ECT-induced memory impairment, in a different language and culture. They suggest that long-term effects of the treatment on memory are even less prominent than previously observed.