Amnesia – pathological loss of memories of the current or last circumstances of life. Enters symptomatology of neurologic diseases, mental disorders, sharp poisonings, chronic intoxications. In the course of diagnostics results of neurologic and mental inspection, EEG, MRT, KT, biochemistry of blood, the analysis of cerebrospinal fluid are considered clinical yielded. Treatment is made according to causal pathology, by the main methods are psycho - and pharmacotherapy. In the presence of a tumor, a hematoma their surgical removal is carried out.
Amnesia in translation from Latin means unconsciousness. Lack of memoirs not always is a pathological state. There is childhood amnesia – most of people does not remember an event of the first 2-3 years of life. In medical aspect amnesia is considered as loss of the memoirs which were available earlier on significant events of life, inability to remember recent circumstances. The Amnestichesky syndrome in combination with other symptomatology acts as a component of clinic of various neurologic and psychiatric diseases. By some estimates, about 25% of the population of the planet suffer from violations of memory. Along with amnesia such violations include the high-quality mnestichesky frustration which are characterized by easing of ability to remember, difficulty of a recall.
Etiofaktora of an amnestichesky syndrome are numerous and various. At advanced age the leading role in an etiology belongs to vascular disorders and degenerate processes. At young patients traumatic and psychological factors prevail. All reasons of loss of memory can be divided into two big groups: organic and psychological.
The organic reasons lead to metabolic, morphological or bioelectric changes of cerebral structures:
- Craniocereberal trauma (heavy concussion, brain bruise). Amnesia of the events preceding a trauma which can have temporality is typical.
- Brain tumors. Loss of memoirs is caused by a sdavleniye and death of neurons.
- The cerebral hypoxia provokes violation of mezhneyronalny communications, death of nervous cages. It is observed at disorders of brain blood circulation (a stroke, TIA), asphyxia, poisoning with carbon monoxide, big blood loss, respiratory insufficiency.
- Neuroinfections (neurosyphilis, neuroaIDS, tick-borne encephalitis, purulent meningitis) can proceed with amnesia owing to damage of cerebral fabrics by infectious agents and mediators of an inflammation.
- Intoxication. Amnesia results from toxic damage of a brain. It is observed at alcoholism, drug addiction, overdose of medicines, poisoning with household solvents, pesticides.
- Degenerate diseases of TsNS (Alzheimer's disease, vascular dementia, Peak disease). Loss of mnestichesky functions is caused by a demiyelinization, gliozy, an atrophy of brain fabrics.
- Epilepsy. Loss of memory extends to the attack period, is connected with consciousness loss.
- Migraine. The Amnestichesky symptomatology is provoked by the disorder of cerebral haemo dynamics arising in the period of a migrenozny paroxysm.
The psychological reasons influence only mentality of the person, do not exert pathological impact on a brain:
- Psychological trauma (accident, death of the loved one, rape, stealing, terrorist attack, military operations). Amnesia concerns the psychoinjuring events, is formed as protective reaction.
- Mental disorders. Loss of memory has incidental character. It can be noted at schizophrenia, dissotsiativny frustration, hysteria. Partial amnesia is observed after a deliriya.
The exact mechanism of development of amnesia is unknown. It is considered that function of storage and reproduction of information is born by cerebral neurons. Destruction of mezhneyronalny messages, dysfunction of neurons is the cornerstone of mnestichesky violations of organic genesis. The full loss of information which is available in a brain caused by death of the structural elements storing it is possible. Psychogenic amnesia has other mechanism of formation. In literature on neurology and psychiatry authors explain it as loss of ability to recollect certain information. Selective loss from memory of separate group of the interconnected events making subjective inner meaning for the patient is typical.
Amnesia is classified taking into account an etiology, volume, the temporary characteristic of the lost memoirs, development of the arisen violations. On completeness of loss of memory happens:
- Full – absolute loss of memoirs for a certain period of the past.
- Partial – there are vague images, scraps of memoirs.
- Local – selective amnesia of separate skill. It is characteristic of psychogenic disorders of memory.
Depending on time of the forgotten events in relation to the moment of emergence of problems with memory there are following types of amnesia:
- Retrograde – lack of memory on the events taking place to a frustration debut.
- Anterograd – memories of the circumstances which occurred after the beginning of a disease are broken.
- Anteroretrogradny – represents a combination of the first two forms.
- Fiksatsionny – loss of memory on the events at present. Several minutes can proceed.
As a current allocate the following options:
- Regressing – gradually occurs restoration of memoirs.
- Stationary – memory state remains without dynamics.
- Progressing – amnesia is aggravated, from memory events of the present and more and more remote past are erased.
Basic symptom – impossibility to remember the occurred circumstances. Loss of memoirs concerns a certain temporary interval in the patient's life. The sequence is described by Ribot's law: in the beginning what occurred recently, then the facts of the next past, then – older events is forgotten. Restoration of memory happens upside-down. Konfabulyation – fictional memoirs with which the patient tries to fill the formed gaps in memory are sometimes noted. The Amnestichesky simptomokompleks is observed in combination with other manifestations peculiar to the main disease.
Postinsultny amnesia is combined with a gipomneziya (the general decrease in memory on present events), a paramnesia (confusion of circumstances of the past and the present), speech disturbance, motive deficiency. The amnesia which is a component of a psychoorganic syndrome is shown against the background of cognitive frustration: declines in the ability to acquire information, reduction of attentiveness, slowness of thinking. Dissotsiativny loss of memory is accompanied by absent-mindedness, affective states, vagrancy are possible. Tranzitorny global amnesia is characterized by passing episodes up to the patient's disorientation. The combination of various types of amnesia is characteristic of Korsakov's syndrome.
Stationary frustration is taken by patients hard, provokes formation of false sense of guilt, development of a depression. The progressing amnesia lead to disability. Patients forget a way home, are incapable to be guided in the acquaintance before the area. From memory the acquired knowledge, skills disappear. In the subsequent it is observed disorientations in time, in own personality. The patient demands permanent care.
The diagnostic algorithm is individual, is formed according to a clinical picture of a disease. Is implemented by the neurologist with attraction in need of the psychiatrist, the narcologist, the infectiologist, the neurosurgeon. Are in the plan of diagnostics:
- Collecting anamnesis. Careful inquiry about the events preceding a disease, displays of a disease is made with involvement of relatives of the patient.
- Assessment of the neurologic status. Gives the chance to reveal symptoms of an organic disease of TsNS, to define extent of post-traumatic changes.
- Comprehensive psychological examination. It is necessary for patients with psychogenic amnesia, mental violations.
- Researches of cerebral haemo dynamics. Are carried out at suspicion on vascular genesis of disorders of memory. The easiest way – a rheoencephalography, more informative – UZDG of vessels of the head, duplex scanning, MRT of vessels.
- Visualization of brain structures. KT of a brain is appointed to patients with ChMT, an intra cranial hematoma. MRT of a brain is effective in diagnosis of tumors, degenerate processes, the postinsultny centers.
- Electroencephalography. It is carried out by the patient with epilepsy symptoms. Allows to diagnose paroksizmalny activity of a brain, to define its character.
- Biochemical blood test. Level of B1 vitamin, toxic substances is determined by indications, a drug test is made.
- Research of tserebrospinalny liquid. It is carried out at the assumption of an infectious etiology, intra cranial hemorrhage.
Treatment of amnesia
Therapy is selected in compliance an etiology and symptomatology of the main disease. At organic amnesia mainly drug treatment is applied, at psychogenic – psychotherapeutic. In pharmacotherapy of organic forms are used:
- Vascular means (vasodilating, antiagregant) – improve a cerebral blood-groove and food of fabrics.
- Neuroprotectors and antioxidants – optimize metabolism of neurons, increase their resistance to a hypoxia and adverse effects.
- Antikholinesterazny pharmaceuticals – slow down progressing of dementia at advanced age, increase day activity.
- Memantina – improve mnestichesky functions. Are effective in therapy of Alzheimer's disease.
- Nootropa – stimulate cognitive abilities, intensify metabolism of cerebral fabrics.
The psychotherapeutic techniques directed to adaptation of the patient to existence of gaps in memoirs are in addition used. In some cases for a remembering of the past resort to hypnotherapy. Existence of a cerebral tumor, hematoma, the site of a razmozzheniye is the indication to treatment by neurosurgical intervention.
Treatment of psychogenic forms aims not at restoration of the lost memoirs, but acceptance by the patient of the fact of their absence. Therapy is carried out by the psychotherapist (psychiatrist), includes:
- Psychotherapy. Development of the new relation to problems with memory is reached by cognitive and behavioural therapy. The dissociated amnesia caused by the family conflict demands family psychotherapy. In the presence of children's psychoinjuries the psychoanalysis allowing the patient to reconsider the relation to the incident is used.
- Creative treatment. Suits the patients not inclined to show the feelings and thoughts. It is carried out by means of a skazkoterapiya, art therapy, etc.
- Medicamentous therapy. It is necessary as addition to psychotherapy at patients with uneasiness, a depression, fidget, mental deviations. Individual selection of medicines of the following groups is made: antidepressants, sedative, neuroleptics.
Forecast and prevention
The current and outcome of pathology are closely connected with an etiofaktor, a basic disease, age of the patient. Post-traumatic amnesia usually has reversible character. Amnesia owing to degenerate changes of TsNS differs in steadily progressing current. Psychogenic frustration is inclined to partial regress as a result of the carried-out therapy. At young age memory is restored better, than at elderly. Prevention of an amnestichesky syndrome includes the prevention of injuries of the head, infections, intoxications, the psychoinjuring influences, correct and timely treatment of migraine, epilepsy, vascular frustration.