Chapter 7 Anterograde amnesia

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A patient with anterograde amnesia is the one who is grossly deficient in the formation of new memories. The diversity of findings in the field of anterograde amnesias is related to the current content-based dividing of memory, the diversity of brain regions implicated in memory processing and the various time-dependent stages of memory processing. The interaction between memory and other functions—such as attention, concentration, executive processes, language, and emotion—widens on the one hand the networks engaged in anterograde memory functioning and on the other implies that various forms and loci of brain damage affect memory. The multitude of memory-related subdivisions, processes and the embeddedness of memory functions in other cognitive and affective processes require a refined analysis of patient data with a thorough differentiation on the neuropsychological (diagnostic) side. The diagnostic tools, provided by static and dynamic neuroimaging techniques will be of considerable help in assessing the present patient status and in inferring his or her future prognosis and treatment possibilities.

Introduction

An ‘a-mnesic’ is the opposite of Mnemosyne, the Greek muse of memory who was supposed to possess an exceptionally good memory, both with respect to remembering old (retrograde memory) and encoding fresh facts and events (anterograde memory). Charcot (1892) probably coined the expressions ‘anterograde amnesia’ and ‘retrograde amnesia,’ though already in 1763 amnesias were classified (Sauvages de la Croix, 1763; cited in Nicolas and Penel, 2001). Until the last two decades of the last century, clinicians tended to refer to the ‘global amnesic syndrome’ (e.g., Corkin, 1984) when they had a patient who was grossly deficient in both areas, the formation of new memories and the retrieval of old ones (Fig. 7.1). Furthermore, at that time, memory was principally considered to be a unity, though a few researchers of the old times had already pointed out that brain-damaged patients may be impaired in some domains of memory, but not in others (e.g., Schneider 1912, Schneider 1928; see Markowitsch, 1992a for a review). Research on learning and memory was already common in the nineteenth century as the famous book of Ebbinghaus (1885) exemplifies.

The oldest descriptions of patients with memory disorders came from Korsakoff 1889, Korsakoff 1890, Korsakow 1890, Korsakow 1891, Korsakow 1892; a short portrait of Korsakoff was given by Krüger and Bräunig, 2004), from other Russian scientists (Bechterew, 1900), and from a number of reports on dementia patients and patients with memory disturbances related to psychiatric disorders (e.g., Alzheimer 1911, Donath 1908, Pick 1893, Tiling 1892; see Markowitsch, 1992a for an overview). Expressions such as anterograde and retrograde amnesia were already in use in the nineteenth century (e.g., Boediker, 1896) as were relations between specific brain damage—for example in the hippocampal region (Bechterew 1900, Bratz 1898), specific toxins (Bonhoeffer, 1901), or hypoxia (Boediker 1896, Lührmann 1896, Schulz 1908, Wagner 1891)—and amnesia. It was also differentiated into brain loci whose damage results more probably in anterograde (Campbell, 1909) or in retrograde amnesia (Cowles 1900, Paul 1899). Freud 1898, Freud 1899 work pointed to psychic origins of forgetfulness—that is to motivated amnesias; however, even his work had prominent predecessors (Kraepelin, 1886). Psychosurgery was attempted in a Swiss clinic before the turn of the twentieth century (Burckhardt, 1891) and infantile amnesia—the inability to retrieve memories from the earliest childhood as an adult—was a subject of debate (Potwin, 1901).

In 1870 Ewald Hering formulated in an unsurpassed manner in a lecture given in the high session of the Imperial Academy of Sciences in Vienna what constitutes memory (Hering, 1870; English translation: Hering, 1895). He stated that memory unites the countless single phenomena to a whole and that without its binding power our consciousness would disintegrate into as many fragments as there are moments. This view on the power of memory for our personality seems to have foreseen what recent workers see as the uniqueness of human memory (Tulving 1983, Tulving 2005, Tulving 1998) and what is described in case reports on patients who—after brain damage—lost the ability to glue together bits of newly incoming information.

Section snippets

Patient H.M

Patient H.M is considered to be the example par excellence of a subject who from one day to the next lost his ability to learn new information long term. William Scoville and Brenda Milner's description (Scoville and Milner, 1957) of this patient became a milestone for neuropsychological research which aimed to understand the functioning of the brain in long-term information storage. Shortly after the Second World War, the Canadian neurosurgeon Scoville performed a series of operations on

Memory systems

As mentioned in the introduction, memory is not a unique system, but has to be divided into several systems. Both researchers studying animals (Mishkin and Petri, 1984) and human subjects (Tulving 1972, Tulving 1983) divided memory on the basis of content and material. Nowadays five long-term memory systems are central for a proper description of human behavior (Fig. 7.5). These memory systems are considered to be hierarchically ordered, starting with procedural memory as the lowest and ending

Brain regions implicated in memory formation

At present, there is accumulating evidence for distinct neural networks involved in the acquisition and consolidation of information, in its representation, and in its retrieval (Markowitsch 2000, Markowitsch 2005). In line with this chapter's title I will focus on the encoding part of information processing and on the semantic and episodic memory systems.

The acquisition of new facts and events initially requires their short-term representation in buffer systems (Baddeley 2000, Baddeley 2001)

Syndromes associated with anterograde amnesia

There are a number of etiologies which lead to severe memory deteriorations (Table 7.1). Most of these have been known for more than a century, for example the Korsakoff syndrome (Korsakoff, 1889) or the observation that patients with schizophrenia may appear as demented, which led Bleuler (1911) to create the expression ‘dementia praecox’ for schizophrenia. It was also known since the nineteenth century that there exists a relationship between hippocampal damage, epilepsy, and amnesia (Sommer

Functional imaging studies on memory related regions

At present a huge amount of functional imaging studies have been performed to study memory (see also Chapter 4). Most of them were done with normal, non-brain-damaged subjects, but in a few instances, also brain-damaged patients were studied. One of these studies was done by Szelies et al. (1991) who used a number of different analyses based on PET methodology, and were able to show how divergent even limited thalamic infarcts influence other areas of the brain. Primarily affected were

Conclusions

The diversity of findings in the field of anterograde amnesias is related to the current content-based dividing of memory, the diversity of brain regions implicated in memory processing and the various time-dependent stages of memory processing. Furthermore the interaction between memory and other functions—such as attention, concentration, executive processes, language, and emotion—widens on the one hand the networks engaged in anterograde memory functioning and on the other implies that

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