Government of India

CENTRAL INSTITUTE OF PSYCHIATRY

SEMINAR
DISORDERS OF MEMORY
Chairperson: Dr. A. K. Bakhla
Presenter : Dr. Archana Singh
Discussant : Dr. Sathishkumar S V

Presenter

Introduction
Classification Of Memory
Processes Of Memory Formation
Models Of Memory Processing
Types of memory Disorders
A. Amnesia
B. Paramnesia
C. Hyperamnesia
Clinical Assessment Of Memory
Conclusion

INTRODUCTION
The ability to store and recall information is one of the most amazing capacities of higher organisms. As
human adults, we can remember events that happened in our earliest childhood. We can recall skills learned
far in the past. Our memories encapsulate our sense of personal identity, our cultural identities, and the
meaning of our lives. We can even be influenced by memories that we cannot explicitly remember.
However, we all remember—of that there can be no doubt. Whether we remember accurately or
inaccurately, in detail or in abstract, are questions that researchers have investigated for many years.

Disturbance of memory is always of significance for the sufferers; sometimes, however, forgetting is equally
important and is an active process. The memory disturbance was a specific feature following head injury and
other conditions was recognised in various writings in mid 19 th century. . The earliest detailed study of
disordered memory was from a psychological perspective and subsequently described as an eponymous
condition, pointing out that gross disorder of memory may occur in patients in whom other intellectual
functions and judgement are preserved (Oyebode, 2008).

CLASSIFICATIONS OF MEMORY
 BASED ON DURATION BASED ON DURATION
 SENSORY MEMORY
 SHORT TERM MEMORY
 LONG TERM MEMORY SENSORY MEMORY
 WORKING MEMORY
 CLINICAL DIVISION
SHORT TERM MEMORY

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

LONG TERM MEMORY
  IMMEDIATE MEMORY
 RECENT MEMORY
 REMOTE MEMORY

SENSORY MEMORY
Sensory memory is the ability to retain impressions of sensory information after the original stimulus has
ceased. It refers to items detected by the sensory receptors which are retained temporarily in the sensory
registers and which have a large capacity for unprocessed information but are only able to hold accurate
images of sensory information momentarily. Sensory memory corresponds approximately to the initial
200–500 milliseconds after an item is perceived (Morgan et al., 1993). The two types of sensory memory
that have been most explored are iconic memory and echoic memory. Visual sensory memory is more
commonly referred to as iconic memory and auditory sensory memory is known as echoic memory. This
type of memory cannot be prolonged via rehearsal.

SHORT TERM MEMORY

Short-term memory (or "primary" or "active memory") is the capacity for holding a small amount of
information in mind in an active, readily available state for a short period of time. The duration of short-term
memory is believed to be in the order of seconds. Estimates of short-term memory capacity are 7 plus or
minus 2 units. Short term memory is memory that holds information received from sensory register for up to
about 30 seconds. Short-term memory is believed to rely mostly on an acoustic code for storing information,
and to a lesser extent a visual code (Morgan et al., 1993).

WORKING MEMORY
The concept of working memory (WM) was initially proposed by Baddeley and Hitch (1974) and developed
by Baddeley (1986), and is characterized by the assumption that short-term storage of information must be
considered as part of a more complex system involved in the execution of a specific task. Baddeley, (1986)
defined working memory as "A system for the temporary holding and manipulation of information during
the performance of cognitive task such as comprehension, learning and reasoning (Sims, 2003). The
information is stored in the WM as long as necessary and the structure need not be defined only in terms of
the dichotomy between short- and long term information storage. On the contrary, this system has the
ability to store and process information simultaneously (Cornoldi & Vecchi 2003).

LONG TERM MEMORY (LTM)

When memories
have been

M EM ORY
rehearsed in short
term memory, they
are encoded into
long term memory.
Long Term Memory
(LTM), provides
lasting retention of SENSORY MEMORY LONG TERM M EMSIMP
ORY
information and SHORT TERM MEMORY LE
DECLARAT IVE NON-DECLARATIVE
ICONIC ECHOIC PROC CLAS
skills from minutes MEM ORY M EM ORY SEMANTI EPISODI
EDUR SICAL PRIM ING
C C
to a lifetime and AL COND
ITIONI
has a limitless NG
capacity. Encoding is the process of placing information into what is believed to be a limitless memory
reservoir or LTM, can occur for specific stimuli as well as for the general memory (Casey and Kelly, 2007). ).

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

The storage of material in long-term memory allows for recall of events from the past and for the utilization
of information learned throughout life.

Divisions of Long Term Memory

Long-term memory is commonly divided into two major types -'declarative' and 'non-declarative (Oyebode,
2008).
Declarative memory also termed as explicit memory, encompasses all the information that we can
consciously describe or report. . It has been further subcategorized into:
(a) Semantic memory which concerns memory for meaning, the storage of abstracts and general facts.
(b) Episodic memory or autobiographical memory is memories based upon a personal experience relating to
self and is linked to a particular time and place in life.

Non Declarative memory refers to skills, habits or other manifestation of learning that can be expressed
without an awareness of what has been learned. It is heterogeneous collection of unconscious or implicit
memory abilities.
Subtypes - 1. Procedural
2. Simple classical Conditioning
3. Priming
Procedural memory, also known as implicit memory, is memory system that retains information we cannot
readily express verbally-for example, information necessary to perform skilled motor activities like riding a
bicycle (Baron, 2005). Although we retain these skills and abilities we are often completely unable to
introspect upon or describe how we do them. Procedural memory is very resistant to forgetting and is also
resistant to brain damage that eradicates other forms of memory like seen in anterograde amnesic patients
who forget simple events or verbal instructions after a few moments.

Simple Classical Conditioning is another type of non-declarative memory that generally occurs in the
presence of conscious awareness of conditioned stimulus (CS) and unconditioned stimulus (UCS)
contingency, but can occur without awareness also (Budson, 2001).

Priming When an object has just been perceived or processed, there is a tendency for that object to be
perceived more easily the next time. Such priming operates across a wide range of sensory and motor
systems, occurring at a range of different processing levels (Baron, 2005). For example, presenting a picture
of an airplane will make it easier for a subject to identify a highly fragmented version of the picture as an
airplane when it is presented shortly afterwards. In general, priming tends to be very specific, as though
some aspect of the perceptual system has been facilitated by being used recently. As mentioned earlier,
priming is usually preserved in amnesic patients good explicit learning do not influence implicit learning, and
vice versa. Another feature of implicit learning is the way in which it appears to bypass conscious awareness.

SEMANTIC MEMORY
Semantic memory refers to a person’s conceptual knowledge about the world. It includes knowledge of the
meaning of words, objects and other stimuli perceived through the senses, as well as a rich abundance of
facts and associated information. Semantic memory is immensely important because it constitutes the
knowledge base that allows us to communicate, use objects, recognize foods, react to environmental stimuli
and function appropriately in the world. Semantic memory does not break down in an all-or-none fashion.
Patients may know some words but not others, may recognize one exemplar of an object but not another,
and may retain partial information about a concept while other information is lost (Snowden, 2002).

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

The diagram indicates various neural structures thought to be important for different types of declarative
and non declarative memory.

CLINICAL CLASSIFICATION
For clinical descriptive purposes, memory is often subdivided into three basic types— immediate, recent,
and remote—distinguished by the time interval between presentation of the stimuli and retrieval.
Immediate memory may refer to the registration of information as a memory trace for several seconds or
more, corresponding to both sensory and sometimes short-term memory described earlier. Recent memory
assumes some period of memory storage, and might include a person’s recall of day-to-day events, and may
refer to information learned hours, days, or even weeks ago. Remote memories typically include memories
of events or knowledge learned years ago, usually pre morbidly or before a brain injury (Strub and Black
2000 ).

PROCESSES OF MEMORY FORMATION

Description of the requirement for memory is chiefly referable to long term memory and can be subdivided
phenomenologically into the following five functions (Oyebode, 2008).
1) Registration or encoding is the capacity to add new information to the memory store.
2) Retention or storage is the ability to maintain knowledge that can subsequently be returned to
consciousness.
3) Retrieval is the capacity to access stored information from memory by recognition, recall or by
demonstrating that a relevant task is performed more efficiently as a result of prior experience.
4) Recall is the effortful retrieval of stored information into consciousness at a chosen moment. It requires
an active complex search process. It is influenced by primacy and recency effects.
5) Recognition is the retrieval of stored information that depends on the identification of items previously
learned and is based on either remembering (effortful recollection) or knowing (familiarity based
recollection).

Seven stages in memory: Following Welford, memory can be isolated in seven stages (Hamilton, 1984).

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

These are
1) Adequate perception, comprehension and response to the material to be learned.
2) Short-term storage mechanism.
3) Formation of a durable trace.
4) Consolidation in which traces are often modified or simplified by subsequent learning.
5) Recognition that certain material needs to be recalled.
6) Isolation of the relevant memory.
7) Using the recalled material in new situation.

MODELS OF MEMORY PROCESSING

Atkinson-Shiffrin model
Atkinson and Shiffrin considered memory to have three major constituents. In the Atkinson-Shiffrin theory,
memory starts with a sensory input from the environment which is held for a very brief period in the sensory
register associated with the sensory channels like
vision, hearing and touch etc. information that is
attended to and recognized in the sensory register is
passed on to short term memory where it is held for
about 20-30 seconds. Some of the information reaching
short term memory is processed by being rehearsed
and may then be passed along to long term memory; information that is not processed is lost. When items of
information are placed in long term memory they are organized into categories. It was assumed that the
longer an item is held in the short term memory, the more likely it is to go into long-term memory (Morgan
et al., 1993).

Working memory model- Baddeley and Hitch

In 1974 Baddeley and Hitch proposed a working memory model which replaced the concept of general short
term memory with specific, active components. In this model, working memory consists of three basic
stores: the central executive, the phonological loop and the visuo-spatial sketchpad. In 2000 this model was
expanded with the multimodal episodic buffer. The central executive essentially acts as attention. It channels
information to the three component processes: the phonological
loop, the visuo-spatial sketchpad, and the episodic buffer. The
phonological loop stores auditory information by silently
rehearsing sounds or words in a continuous loop: the articulatory
process.

The visuospatial sketchpad stores visual and spatial information.

The episodic buffer is dedicated to linking information across
domains to form integrated units of visual, spatial, and verbal
information and chronological ordering. The episodic buffer is
also assumed to have links to long-term memory and semantical
meaning. The working memory model explains many practical observations, such as why it is easier to do
two different tasks (one verbal and one visual) than two similar tasks (e.g., two visual).

Levels of processing model- Craik and Lockharts

Craik and Lockhart (1972) argued that the previous view of a short-term memory store relying on speech
coding and feeding a long-term memory store was inappropriate. They suggested that the more deeply
information is processed; the more likely it is to be retained (Baron, 2005). They argued that all of these
processes would lead to some long-term learning, but that the amount of learning depended on the type of
processing, with "deep" processing in terms of meaning leading to much better retention than "shallow"

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

processing. Maintenance rehearsal might keep material available, but would not enhance long-term
learning.

MEMORY DISORDERS
Memory disorders may affect the ability to recall both past events (retrospective memory) and future events
and intentions (prospective memory).
The two major brain regions that have generally been implicated in human memory dysfunction include the
diencephalon and the hippocampi (Emilien et al., 2004). The dysmnesic syndromes that involve these
structures include impairment of long-term data storage, disruption of the encoding of short-term into long-
term storage, or a loss of decoding or access to the long-term data storage. Dysmnesia is the preferred term
describing a partial memory loss, in contrast to the term amnesia, which implies a total memory loss.
Amnesia may be viewed as an extreme on a broad continuum of dysmnesic syndromes where mild
dysmnesic illnesses occur more commonly than total amnesia. There can be varied presentation of memory
impairments. A patient can have memory impairment in single memory domain, e.g. working memory, or
can have deficit in different domains simultaneously.

Memory disorders can be broadly classified into -

AMNESIAS (loss of memory)
PARAAMNESIAS (distortions of memory)
HYPERAMNESIAS
THE AMNESIAS
Amnesia is a general term meaning temporary or permanent impairment of some part of the memory
system. The term amnesia is typically applied to a deficit of long-term episodic memory, involving an
impaired capacity for new learning (anterograde amnesia), and/or a deficit in access to old memories
(retrograde amnesia). The classic amnesic syndrome involves impaired episodic memory, but with preserved
intellect, normal working memory and access to semantic memory, although new semantic learning is likely
to be impaired. Implicit memory is likely to be preserved, with patients able to acquire motor and perceptual
skills, to show perceptual priming, to be capable of classical conditioning, and of non-associative learning
(Emilien et al., 2004).

Its origin may be organic or psychogenic.

PSYCHOGENIC AMNESIAS
Psychogenic amnesias may appear without any organic disease present but the presentation of organic
brain disease is always modified by psychogenic factors,
(Oyebode, 2008).

Childhood amnesia
Freud used the concept of repression to account for
childhood amnesia. He said that we are unable to
retrieve childhood memories because they are
associated with the forbidden, guilt arousing sexual and
aggressive urges. These urges and their associations are
repressed and cannot be retrieved; they are forgotten
because being aware of them would result in strong
feeling of guilt or anxiety. Another interpretation of
childhood amnesia stresses over difference in the ways
young children and older people encode and store
information (Morgan et al., 1993).

Dream amnesia
Freud’s interpretation of dreams was based on
repression. He considered dreams to be expression of
forbidden sexual and aggressive urges. Other

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

interpretation stress the differences in the symbol system used in dreaming and waking, the memory-
symbol network in waking life are different from those of dreaming so it is difficult to retrieve dreams in
waking state (Morgan et al., 1993).

Defensive amnesia
This form of amnesia is usually considered to be a way of protecting oneself from the guilt or anxiety that
can result from intense, intolerable life situations or conflicts. People with this form of amnesia may forget
their names, place of living, occupation and many other important details of their past life. Amnesic episode
can last for weeks, months, or years (Morgan et al., 1993).

Anxiety amnesias
Anxiety amnesia occurs when there is anxious preoccupation or poor concentration in disorders such as
depressive illness or generalized anxiety. More severe forms of amnesia in depressive disorders resemble
dementia and are known as depressive pseudo dementia. Amnesias in anxiety and depressive disorders
are generally caused by impaired concentration and resolve once the underlying disorder is treated
(Casey and Kelly, 2007).

Katathymic amnesia
Also known as motivated forgetting. It is the inability to recall specific painful memories and is believed to
occur due to defense mechanism of repression. Though the term is often used interchangeably with
dissociative amnesia, katathymic amnesia is more persistent and circumscribed than dissociation in that
there is no loss of personal identity (Casey and Kelly, 2007).

Dissociative or hysterical amnesia

This is a sudden amnesia that occurs during periods of extreme trauma and may be concerned about the
stressful or traumatic life events that may last for hours or even days. The amnesia will be for personal
identity such as name, address and history as well as for personal events, while at the same time the
ability to perform complex behaviors is maintained (Casey and Kelly, 2007). Dissociation may be
associated with a fugue or wandering state in which the subject travels to another town or country, and
is often found wandering and lost. Four types of amnesia are been described.

 Localized amnesia being the commonest type, have inability to recall the events over
circumscribed period of time corresponding to stressor.
 Selective amnesia related to only selective events of a particular period related to stressful life
event without impairment of memory in other events of same time period.
 Continuous amnesia, inability to recall all the personal events from the time of stressful situation
till present time.
 Generalized amnesia, rarest inability to recall whole life in face of stressful life event (Ahuja,
1999).

ORGANIC AMNESIAS
Organic impairment of memory is referred to as true amnesia and can affect different functions of memory.
There can be impairment of registration, retention, retrieval or recall, or recognition.

Acute brain disease In these conditions memory is poor owing to disorders of perception and attention.
Hence there is a failure to encode material in long-term memory. In acute head injury there is amnesia,
known as retrograde amnesia that embraces the events just before the injury. Anterograde amnesia is
amnesia for events occurring after the injury; these occurred most commonly following accidents and are
indicative of failure to encode events into long-term memory. Blackouts are circumscribed periods of
anterograde amnesia experienced particularly by those who are alcohol dependent during and following
bouts of drinking. They indicate reversible brain damage and vary in length but can span many hours. They
also occur in acute confusional states (delirium) due to infections or epilepsy (Casey and Kelly, 2007).

Subacute coarse brain disease The characteristic feature of this disorder, is an amnestic state in which
the patient is unable to register new memories leading to inability to learn new information (anterograde

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

amnesia),and the inability to recall previously learned material (retrograde amnesia). However, memories
from the remote past remain intact, as does recall of over learned material from the past and immediate
recall. As improvement occurs, the amnestic period may shrink and recovery may sometimes be total (Casey
and Kelly, 2007).

Chronic coarse brain disease Patients with a progressive chronic brain disease have an amnesia
extending over many years, though the memory for recent events is lost before that for remote events. This
was pointed out by Ribot and is known as Ribot's law of memory regression (Casey and Kelly, 2007).

THE AMNESIC SYNDROMES

Korsakoff’s syndrome
Korsakoff ’s syndrome results from prolonged and excessive alcohol intake. The thiamine (B1) deficiency has
a direct effect on the brain, specifically on the medial thalamus and possibly on the mammillary bodies of the
hypothalamus (Victor et al., 1989).The most common symptoms associated with this syndrome include
anterograde as well as retrograde amnesia, confabulations, and a general sense of apathy. Korsakoff ’s
syndrome has long been recognized the prototype of diencephalic amnesia, although it is now recognised
that Korsakoff ’s syndrome commonly involves cortical atrophy, especially the frontal lobes and damage to
other brain regions (Parkin, 1991 ). In addition to their Anterograde memory deficit, Korsakoff ’s syndrome
patients have severely impaired retrograde memory. In Korsakoff ’s syndrome memory for events in the
more distant past preserved relative to memory for more recent events (Butters & Granholm, 1987; Parkin,
1991). Patients with Korsakoff’s syndrome have a striking anterograde and retrograde amnesia, often with
marked confabulation but preserved attention, personality, social functioning, STM, and nondeclarative
memory. Korsakoff patients, like other amnesics, exhibit severe impairments in the ability to learn new
information.

Transient global amnesia

In most cases of amnesia, the severity of the memory deficit remains stable over a period of years, but there
are conditions such as transient global amnesia where recovery occurs. Global amnesia is characterized by a
relatively circumscribed deficit in LTM for new information. It appears that transient global amnesia may be
caused by temporary bilateral dysfunction of medial temporal lobe structures, including the hippocampus,
entorrhinal cortex, and parahippocampal gyrus (Fisher, 1982). This dysfunction is most likely due to
ischaemia, perhaps caused by vertebrobasilar hypoperfusion or migrainous vasospasm of vertebrobasilar
vessels (Caplan et al., 1981; Crowell et al., 1984). This type of amnesia is characterised by a patient’s inability
to learn new material, by their repeated asking of questions that have been answered and being able to
recall events that antedate the onset of the episode. Transient global amnesia occurs in middle aged and
elderly men more commonly than women (Fisher and Adams, 1964). The condition, which is still not clearly
understood, can emerge in times of severe stress, pain, or emotion, and has been attributed to migraine,
epilepsy, drug use, hypoglycaemia, stroke, and neoplasms but is still not clearly understood. Fortunately,
these patients normally improve spontaneously, within a few hours, and are neurologically normal the
following day. In the clinic, transient global amnesia is typically assessed by means of recall and recognition
tests that require retrieval of recently learned information. Patients with global amnesia also manifest
retrograde amnesia. Frequently, remote memories are better preserved than memories for events that
occurred shortly before brain injury.

Visual memory-deficit amnesia

Vision and visual imagery play a central role in a variety of memory tasks (Rubin, 1995). Biographical memory
appears to rely on visual imagery to a much greater extent than other sensory modalities. A form of amnesia
called visual memory deficit amnesia, caused by damage to areas of the visual system that store visual
information, has been described (Rubin & Greenberg, 1998). Because it is caused by a deficit in access to
stored visual material and not by an impaired ability to encode or retrieve new material, it has the otherwise

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

infrequent properties of a more severe retrograde than anterograde amnesia with no temporal gradient in
the retrograde amnesia.

PARAMNESIA (DISTORTIONS OF MEMORY)

This term was coined by Emil Kraepelin in analogy of terms such as paranoia, paraphasia, and paraphrenia,
as a general term to explain illusions and hallucinations of memory (Burnham, 1889). This is the falsification
of memory by distortion. This can occur in normal subjects due to the process of normal forgetting or due to
proactive and retroactive interference from newly acquired material and is also seen in persons suffering
from emotional problems or other organic states.

It can be divided into Distortions of recall

Distortions of recognition

DISTORTIONS OF RECALL

Retrospective falsification
Retrospective falsification refers to the unintentional
distortion of memory that occurs when it is filtered through
a person's current emotional, experiential and cognitive
state (Casey and Kelly, 2007).Though it can occur in any
psychiatric illnesses, it is often found in those suffering from
depressive illness and hysterical personality and is
invariably related to the insight of the patient as well as to
suggestibility.

Retrospective delusions
Retrospective delusions are found in some patients with
psychoses who backdate their delusions in spite of the clear
evidence that the illness is of recent origin (Casey and Kelly,
2007). Thus, the person will say that they have always been
persecuted or that they have always been evil.

Delusional memories
Primary delusional experiences may take the form of
memories and these are known as delusional memories,
consisting of sudden delusional ideas and delusional
perceptions. Delusional memories are variously defined,
some authorities believing them to be delusional interpretations of real memories (Pawar & Spence, 2003),
while others such as the Present State Examination (PSE) suggest that they are experiences of past events
that did not occur but which the subject clearly remembers. There are two components to a delusional
memory, i.e. the perception (either real or imagined) and the memory.

Confabulation
Confabulation is the falsification of memory occurring in clear consciousness in association with organic
pathology. It manifests itself as the filling-in of gaps in memory by imagined or untrue experiences that have
no basis in fact. There are two broad patterns, the embarrassed type in which the patient tries to fill in gaps
in memory as a result of an awareness of a deficit and fantastic type in which the lacunae are filled in by
details exceeding the need of the memory impairment. The confabulation diminishes as the impairment
worsens.
Some related disorders include
 Pseudologia fantastica

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

Pseudologia fantastica or fluent plausible lying (pathological lying) is the term used to describe the
confabulation that occurs in those without organic brain pathology such as personality disorder of antisocial
or hysterical type. Typically the subject describes various major events and traumas or makes grandiose
claims and these often present at a time of personal crisis, such as facing legal proceedings. Although it
seems that the person with pseudologia believes their own stories and there is a blurring of the boundary
between fantasy and reality, when confronted with incontrovertible evidence these individuals will admit
their lying (Casey and Kelly, 2007). Minor varieties of this occur in those who falsify or exaggerate the past in
order to impress others.
 Vorbeireden or approximate answers
Vorbeireden or approximate answers is seen in patients with hysterical pseudodementia, named after
Ganser who, in 1898 described four criminals showing several common features (Casey and Kelly, 2007).
Prominent features present in such patients include: clouding of consciousness with disorientation, auditory
and visual hallucinations (or pseudo-hallucinations), amnesia for the period during which the symptoms
were manifest, conversion symptoms and recent head injury, infection or severe emotional stress.
Approximate answers suggest that the patient understands the questions but appears to be deliberately
avoiding the correct answer, for instance, to avoid a court appearance .It is distinguished from
pseudodementia in which consciousness is clear. Many now believe that the Ganser syndrome is indicative
of either an organic or a psychotic state rather than hysteria as originally believed .Ganser syndrome and
malingering/factitious disorder are often confused in spite of the conscious basis for the latter. Vorbeireden
is also found in acute schizophrenia, usually the hebephrenic type.
 Munchausen's syndrome
It is a variant of pathological lying in which the individual presents to hospitals with bogus illnesses, complex
medical histories and often multiple surgical scars. A proxy form of this condition has been described in
which the individual, usually a parent, produces a factitious illness in somebody else, generally their child.
The diagnosis of Munchausen’s by proxy is itself a controversial diagnosis (Casey and Kelly, 2007).

False memory
False memory is the recollection of an event (or events) that did not occur but which the individual
subsequently strongly believes did take place (Brandon et al, 1998). The syndrome refers not to distortion of
true memories, as in normal forgetting, but to the actual construction of memories around events that never
took place (Casey and Kelly, 2007). Memory distrust syndrome is a type of false memory which originates
from the person's own fundamental distrust of their memory known as 'source amnesia'. This source
amnesia arises because of difficulty remembering the source from which the information was acquired,
whether from one's own recall or from some external source as recounted by others.

Screen memory
This is a recollection that is partially true and partially false; the affected individual only recalls part of the
true memory because the entirety of the true memory is too painful to recall (Casey and Kelly, 2007). It is
difficult to find out precisely which elements of such memories are true and which is false.

Multiple personality disorder (W .H .0, 1992 ; Oyebode,2008)

This disorder is rare, remains controversial due to lack of reliable information, unclear prevalence, selection
bias and psychopathological imprecisions (Oyebode, 2008). The essential feature is the apparent existence of
two or more distinct personalities within an individual, with only one of them being evident at a time. Each
personality is complete, with its own memories, behaviour, and preferences: these may be in marked
contrast to the single premorbid personality. In the common form with two personalities, one personality is
usually dominant but neither has access to the memories of the other and the two are almost always
unaware of each other's existence. Change from one personality to another in the first instance is usually
sudden and closely associated with traumatic events.

Cryptamnesia

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

Cryptamnesia is described as 'the experience of not remembering that one is remembering,
(Oyebode,2008).For example a person writes a witty passage and does not realize that they are quoting from
some passage they have seen elsewhere rather than writing something original. There is no indication as to
whether this is a common phenomenon or whether it is associated with any specific psychiatric disorder
(Casey and Kelly, 2007).

State-dependent memory
State dependent memory is the recall of events or learned material only when the person is in the same
drug or medication-induced state under which the event was experienced or the material learned. Patients
with psychosis or severe mood disorder experience this phenomenon and, when well, will not recall
dramatic experiences that occurred when ill. When ill again, the memories are again accessible and recalled
(Murphy-Eberenz et al. 2006).

DISTORTIONS OF RECOGNITION
Déjà vu is not strictly a disturbance of memory, but a problem with the familiarity of places and events. It
comprises the feeling of having experienced a current event in the past, although it has no basis in fact.

Jamais vous is the knowledge that an event has been experienced before but is not presently associated
with the appropriate feelings of familiarity.
Déjà entendu is the feeling of auditory recognition.
Déjà pense, a new thought recognized as having previously occurred, is related to déjà vu, being different
only in the modality of experience . These experiences occur occasionally in normal persons but they may
become excessive in temporal lobe lesions.

Misidentification
This may occur in confusion psychosis and in acute and chronic schizophrenia.
Misidentification may be 1. Positive misidentification and 2. Negative misidentification
Positive misidentification
The patient recognizes strangers as his friends and relatives. Some patients assert that all of the people
whom they meet are doubles of real people. In acute schizophrenia, it can be based on a delusional
perception.

Negative misidentification
The patient denies that his friends and relatives are people whom they say they are and insists that they are
strangers in disguise. Leonhard has suggested that negative identification could result from an excessive
concretization of memory images, so that the patient retains all the minute details of the characteristics of
the people whom he encounters. When he sees the same person again he compares the new perception
with the exact memory image.

The Basic Misidentification Syndromes (Joseph, 1986)

Capgras Syndrome
The essential feature of this syndrome is hypoidentification. Patients insists that a particular person (or
persons), usually somebody with whom the patients is emotionally linked, is not the person he claims to be
but is really a double; is often accompanied by depersonalization and occurs in a paranoid setting. The
commonest cause of capgras syndrome is schizophrenia and less common causes include involutional
depression and hysteria.

Amphitryon illusion
In this patients believe that their spouses
are doubles.

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

Sosias illusion
In this patients believe that other people as well as the spouse are doubles (Hamilton 1984) .

Fregoli syndrome
In fregoli syndrome hyperidentification takes place. The patient identifies a familiar person (usually his
persecutor) in various strangers, who are therefore fundamentally the same individual.

Syndrome of Subjective Doubles

It is characterized by delusions of doubles exclusively of the patient’s own self. The misidentification can be
either hallucinatory or delusional. There may be hypoidentification or hyperidentification.

Syndrome of Intermetamorphosis
In this syndrome the patient falsely recognizes the key figure in various others, who are perceived as taking
on the physical appearance of the person who they are believed to be.

Reduplicative paramnesia
In reduplicative paramnesia, patients believe that a physical location has been duplicated. It can occur with
other misidentification syndromes. The major difference between reduplicative paramnesia and Capgras
syndrome is that a patient with reduplicative paramnesia misidentifies a place, whereas a patient with
Capgras syndrome misidentifies a person.

HYPERAMNESIA
The opposite of amnesia and paramnesia can also occur and is termed hyperamnesia, or exaggerated
registration, retention and recall. Flashbulb memories are those memories that are associated with intense
emotion. They are unusually vivid, detailed and long-lasting. Flashbacks are sudden intrusive memories that
are associated with the cognitive and emotional experiences of a traumatic event such as an accident. It may
lead to acting and/or feeling that the event is recurring. It is regarded as one of the characteristic symptoms
of post-traumatic stress disorder but is also associated with substance misuse disorders and emotional
events (McGee, 1984). It is also likely to be a term that is used inaccurately and should not be confused with
intrusive recollections, which lack the emotional familiarity of flashbacks. Flashbacks involving hallucinogenic
experiences can occur in association with hallucinogenic drugs and possibly cannabis use after the short-
term effects have worn off. These incorporate visual distortions, false perceptions of movement in
peripheral fields, flashes of color, trails of images from moving objects, after-images and halos, as well as
classical hallucinations. Eidetic images represent visual memories of almost hallucinatory vividness that are
found in disorders due to substance misuse, especially hallucinogenic agents(Casey and Kelly, 2007).

CLINICAL ASSESSMENT OF MEMORY

Tests for memory (Strub & Black, 2000)

Valid memory testing presumes that the patient is reasonably attentive, can relate to and cooperate with the
examiner, and has no defect that impairs language comprehension or expression.

IMMEDIATE RECALL (short term memory)

Immediate memory usually tested by digit repetition.

RECENT MEMORY
Tested for constantly changing facts. Indian adaptation (Pershad & Wig, 1988):
1. कल आपने रात के खाने में क्या खाया?

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

 2. आज सुबह आपने नाश्ते में क्या खाया?
3. इस महिने का क्या नाम है?
4. आज कौन-सा दिन है?
5. कल आपसे कौन-कौन मिलने आया या कल आप किस किस से मिलने गये?

REMOTE MEMORY
These evaluate the patient’s ability to recall personal and historic events. Personal events must be verified
from a reliable source other than the patient, and performance on the recall of historic information must be
interpreted in light of the patient’s premorbid intelligence, education, and social experience.

Indian adaptation (Pershad & Wig, 1988). The following items to be enquired-
1. आपकी उम्र कितनी है?
2. आपका जन्म कहाँ हुआ?
3. आपकी शादी कब हुई?/आपने नौकरी या व्यसाय करना कब से चालु किया?/आपने पढ़ना कब छोडा या हाई-
स्कू ल कब पास किया?
4. आपके सबसे छोटे बच्चे या भाई बहिन की उम्र कितनी हौ?
5. आप इस विभाग में पहली बार अपने इस इलाज के लिये कब आये?
6. पिछलि बार आप इस विभाग कब आये थे?
Each correct answer to be scored one thus a maximum score of 6. (Pershad & Wig, 1988)

FOUR UNRELATED WORDS

Instructions: Tell the patient, “I am going to tell you four words that I would like you to remember. In a few
minutes, I will ask you to recall these words”. To ensure that the patient has heard, understood, and initially
retained the four words, have him or her to repeat the words immediately and to correct any errors. Older
patients may require several trials to learn the words.
Then he is asked to recall the words at 5, 10 and 30 minutes. To eliminate possible mental rehearsal,
interference should be used between presentation and recall of words.
Scoring: Normal persons accurately recall 3-4 words after a 10-minute delay. In some, after being reminded
of the correct words i.e., by verbal cues, whether he/she recognizes the appropriate word from the series of
words and improve their performance after 10 and 30 minutes may be seen, but patients with dementia
cannot improve even on subsequent trials.

Indian adaptation (Pershad & Wig, 1988)

Set 1 छाता, फू ल, घडी, तस्वीर, पैंसिल Set 2 मछली, लैंप, रुपया, ताज, खिलैना

VERBAL STORY FOR IMMEDIATE RECALL

Instructions: tell the patient, “I am going to read you a short paragraph. Listen carefully, because when I
finish reading, I want you to tell me everything that I told you.” A short paragraph is read out to the patient
which he is required to reproduce immediately. As the patient retells the story the number of items recalled
is indicated. The normal individual is expected to produce at least 10 of these items, though this number
decreases with age. If recall is good then he may be asked for another recall after 30 minutes.

Indian adaptation
There are three sentences of increasing length. First sentence is read slowly, distinctly and at a uniform rate
and note down the recalled sentence verbatim or each of the correctly recalled clauses. One mark for each
clause correctly reproduced. (Pershad & Wig, 1988)
1. राम कु र्सी से उठा, दरवाजा खोला और घर चला गया।

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

 2. रोगी को मेज पर लिटाया, उसको देखा, दवा लिखी और कल आने के लिए कहा।
3. मोहन के घर पानी नहीं था, उसने बाल्टी उठाई, बाजार के नल पर गया, पानी भरा और वापिस लौट आया।

VISUAL MEMORY (hidden objects) (Strub & Black, 2000)

Five small, commonly used, easily recognizable objects are hidden in the patient’s vicinity while he is
watching. Each item is named while being hidden. Then interfering stimuli is provided for 5 minutes. After
this period he is asked to name and indicate the location of each hidden object. Finding out fewer than three
objects indicates impaired visual memory.

PAIRED ASSOCIATE LEARNING

Instructions: Tell the patient, “I am going to read you a list of words, two at a time. Listen carefully because I
will expect you to remember the words that go together. When the patient understands the directions,
continue as follows: “Now listen carefully to the words as I read them.” The patient is read out a list of
paired words at the rate of one pair every 2 seconds. Then he is given the first words from the pairs, one
after another and given 5 seconds for each response. After completion of the first recall list the second
presentation list is provided after a 10 second interval and proceeds in the same way.
A normal person under 70 years is expected to recall the two easy paired associates and at least one of the
hard associates of the first recall trial and to recall all paired associates on second trial. Some patients can
learn the paired words with strong natural associations but cannot learn the pairs without such associations
which indicate an inability to learn new material that cannot be associated with memories already in
storage.

Indian adaptation (Pershad & Wig, 1988)

Retention for similar pairs For dissimilar pairs

पेड़ फू ल मेज काला
मीठा नमकीन पेड़ ऊँ चा
आदमी औरत लैंप खुरदरा
दिन रात बच्चा कड़वा
काला सफे द सपना गहरा

CONCLUSION

Our memories reflect the accumulation of a lifetime of experience and, in this sense; our memories are who
we are. We learn to walk, to dance, to drive a car, to throw a ball, and to play a video game—a myriad of
acquired skills we come to take for granted. We learn to fear dangerous situations, to appreciate particular
types of music and styles of art—a broad range of aversions and enjoyments we have assumed as elements
of our preferences and personality. We learn world history, and we learn our own family tree and personal
autobiography—all of these, and much, much more, compose the vast contents and intricate, complex
organization of memories that make each of us a unique human being. Disorders of memory affect various
dimensions of life & may present as discrete dysfunction or as part of psychiatric syndrome. There are

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

various clinical and neuropsychological tools to assess these and hence early interventions to manage these
can be used.

DISCUSSION

Discussion will be covered under following headings

AMNESIA IN THE CURRENT NOSOLOGY

MODELS OF MEMORY: A BRIEF CRITICAL APPRAISAL

NEUROBIOLOGY OF MEMORY

REMEMBERING, FORGETTING AND KNOWING

AGING, MILD COGNITIVE IMPAIRMENT AND DEMENTIA

MEMORY DYSFUNCTION IN PSYCHIATRIC DISORDERS

MEMORY DISORDERS IN EPILEPSY

DRUG INDUCED MEMORY ALTERATION

MEMORY DISTURBANCES AND ECT

EMOTIONAL AND SOCIAL CONSEQUENCES OF MEMORY DISORDERS

MEMORY REHABILITATION

CONCLUSION

AMNESIA IN THE CURRENT NOSOLOGY

Amnesia forms the core component or a part of symptomatology of a number of psychiatric disorders in the
current nosological system. The diagnostic categories in the current nosological systems with amnesia as the
core component of the diagnosis include:
ICD-10: The ICD-10(World Health Organization, 1992), provides two diagnostic categories for describing
amnesic disorder depending on the etiology of the disorders rather than the symptomatology. The lCD-10
differentiates amnesia due to organic conditions from amnesia due to use of substance — single or multiple.
The diagnostic categories are:
F 04: Organic Amnesic Syndrome not induced by alcohol and other psychoactive substances
F1x.6: Mental and Behavioral disorder due to use of psychoactive substances — Amnesic Syndrome.
DSM-IV-TR: The DSM-lV-TR (American Psychiatric Association,1994) categorization of amnesic disorders
bears resemblance to the lCD-10 except for the fact that the two diagnostic categories are clubbed under
one roof as Amnestic disorders with further categorization into that due to general medical condition,
substance induced amnestic disorder. The amnestic disorders are labeled under axis-I disorders with a
description of the underlying medical condition to be provided under the axis-Ill category wherever
applicable. The diagnostic categories are:
294.0: Amnestic disorder due to a general medical condition
Substance induced persisting amnestic disorder (Specific substances to be coded as 291.1 Alcohol induced
persisting amnestic disorder.292.83 Secobarbital induced persisting amnestic disorder and the likewise).
294.8 Amnestic disorder not otherwise specified.

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

MODELS OF MEMORY: A BRIEF CRITICAL APPRAISAL

Atkinson and Shiffrin’’s Model (1968): The model by Atkinson and Shiffrin (1968) was criticized as being too
rigid and simplistic as information must flow in both the directions since there is good deal of interaction
between various stores, for example we tend to pay attention to relevant information from the sensory
register but this relevance must be stored in a long term way. It also does not take into account the types of
information taken into memory as some items seemed to flow into Long Term Memory (LTM) far more
readily than others. It also ignores factors such as the effort and strategy subjects may show while
remembering and why information changes in coding from one memory store to another (Hill, 1998).
Craik and Lockharts Model: In the ensuing years researchers while analyzing Craik and Lockharts deep
processing model found out that the complex semantic processing produced better cued recall than simple
semantic processing and called this mechanism as elaboration. Eyesenck and Eyesenck (1980) found even
words processed phonetically were better recalled if they were distinctive or usually labeled and termed it as
distinctiveness. Tyler et al. (1979) found better recall for words presented as difficult anagrams like OCDTRO
than simple anagrams like DOCTRO and termed it Effort. Rogers et al. (1977) found better recall for those
questions which have personnel relevance (e.g. describes you) than general semantic ones (e.g. means) (Hill,
1998).
Baddeley and Hitch Model (1974): There remain problems in defining deep processing and further clarifying
as to why it is so effective as semantic processing does not always lead to better retrieval. It was the working
memory model of Baddeley and Hitch (1974) which then gave further insights into the memory processing
and its revised model of 1990 is currently the most accepted models in memory processing (Hill, 1998).

NEUROBIOLOGY OF MEMORY

According to current views, information from the senses is temporally stored in various areas of the
prefrontal cortex as working memory. It is also passed to the medial temporal lobe, and specifically to the
parahippocampal gyrus. From there, it enters the hippocampus and is processed in a way that is not yet fully
understood. From the hippocampus it leaves via the subiculum and the entorhinal cortex and somehow
binds together and strengthens circuits in many different neocortical areas, forming over time stable remote
memories that can now be accessed by many different cues (Ganong, 2005).

midline thalamic nuclei hippocampal region

dorsomedial thalamus
entorhinal cortex
anterior thalamus
perirhinal parahippocampal
mammillary nuclei cortex cortex

frontal sensory
association association
areas areas

Do amnesias of temporal lobe, diencephalic and frontal lobe differ?

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

Memory deficits differs across patients with either medial temporal, diencephalic, or frontal
pathology.Temporal lobe pathology gives rise to accelerated forgetting,but it is not observed with
diencephalic amnesia. Alternative hypothesis is that the diencephalon and medial temporal lobes differ in
their contribution to context memory. Parkin and others argued that diencephalic lesions produce larger
deficits in temporal order memory , whereas spatial context deficits are larger for the medial temporal lobe
pathology

Pathology to the frontal lobes has been thought to be damaging to executive functions such as planning, the
organization of material, monitoring of responses, the inhibition of inappropriate responses.

Neuroimaging investigations

Functional neuroimaging studies reviewed by Rugg (2002), found frontal activations in memory encoding
and retrieval, where the left frontal region was particularly involved in the encoding of episodic memories,
and the right frontal region was involved in episodic memory retrieval. Functional MRI (fMRI) study has
produced evidence that there is left right material-specific asymmetries during encoding in both the medial
temporal lobes and the pre-frontal cortex.

REMEMBERING, FORGETTING AND KNOWING

Remembering is an intensely personal experiences of the past, those in which we seem to recreate previous
events and experience with the awareness and experiences mentally. The process of remembering has four
parts-registration, retention, retrieval and recall.
Knowing is referred to experience of the past in which we are aware of knowledge that we process but in a
more impersonal way without awareness of reliving them mentally or familiarity of facts (Kopelman, 2002).
Forgetting refers to the apparent loss of information already learned and stored in long term memory. Much
is forgotten but enough enters so that we have a sketchy record of our lives. Much of what we think we have
forgotten does not really qualify as “forgotten” because it was never encoded and stored in the first place.
(Morgan et al. 2007).

Intereference theory

Forgetting is a result of some memories interfering with others.

Proactive interference: Old memories interfere with ability to remember new memories.

Retroactive interference: New memories interfere with ability to remember old memories.

Intereference is stronger when material is similar.

AGING AND MEMORY IMPAIRMENT

Both physical and cognitive functions change as we get older. In general, memory deteriorates, but is to
some extent compensated by the increased use of knowledge, memory aids, and strategies. In the case of
working memory, the phonological loop is reasonably robust, the visuo-spatial sketch pad somewhat less so,
while at least some executive processes tend to decline. In the case of long-term memory, episodic memory
shows a slow but steady decline from the twenties onwards, with memory for names being particularly
sensitive to the effects of ageing. Semantic memory continues to grow, but speed and reliability of access
declines. Implicit learning shows a mixed pattern, with some types of learning being relatively preserved, but
others deteriorating. As age advances, we find it harder to maintain performance against distraction,
particularly under levels of high arousal. Nutritional factors may also influence the elderly more, as they are

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

less able to maintain blood glucose level during the gaps between meals, resulting in poorer memory
performance (Baddeley, 1999).

MILD COGNITIVE IMPAIRMENT (Emilien,2004)

A large group of elderly cognitively impaired subjects do not meet the criteria for dementia or other specific
neurological and psychiatric disorders.
Several descriptors including MCI, incipient dementia, and isolated memory impairment have been used.
The terminology “mild cognitive impairment” refers to subjective memory disturbances verified by objective
deficits of memory at testing.

DEMENTIA
Dementia was initially thought of as a unitary behavioural syndrome, characterised by a homogeneous
decline in intellectual functions, regardless of aetiology.
Dementia is defined as decline of memory and other cognitive functions in comparison with the patient’s
previous level of function, implying a change between two or more assessment points (McKhann et al.,
1984).

ALZHEIMER’S DISEASE
The dementia of AD typically includes anterograde and retrograde amnesia early in its course.
Deficits in recent memory are typically the first symptoms of AD and may be clinically reported as misplacing
objects, repeating questions and statements, and forgetting names.
Impairments in visuospatial memory are often experienced as getting lost. This anterograde amnesia reflects
impaired encoding and consolidation of the material
Several hypotheses have been proposed to account for this impairment of episodic memory in AD,
which might affect both encoding and retrieval of information, and would result from attentional
deficiencies, working memory dysfunction, semantic difficulties, or neglect of contextual information
It has also been suggested that recent memories are more vulnerable than remote memory especially in
dementia (Ribot law).
In general, remote memory remains relatively intact early in the course of AD. With disease progression,
a slight temporal gradient becomes evident. The remote memory impairment in AD is a temporal gradient,
with recall of recent events being more severely impaired than recall of more remote events. In moderate to
severe AD, the temporal gradient disappears and patients show marked retrograde amnesia for all decades
of life (Butters et al., 1995). This general pattern of impairment has been demonstrated for memory for
famous faces and public events, visuospatial information, and autobiographical information.

Semantic memory- Naming

A naming disturbance has been recognised as one of the core clinical features of AD. The anomia tends to be
a relatively early manifestation of the disease. It progressively worsens over the disease course and is
strongly correlated with overall dementia severity.

SEMANTIC DEMENTIA
Semantic dementia is a recently documented syndrome associated with non-Alzheimer degenerative
pathology of the polar and inferolateral temporal neocortex with relative sparing (at least in the early stages)
of the hippocampal complex (Hodges et al., 1992).
Core features of semantic dementia
1. Selective impairment of semantic memory causing severe anomia, impaired spoken and written single-
word comprehension, reduced generation of exemplars on category fluency tests, and an impoverished fund
of general knowledge about objects, persons, and the meaning of words.
2. Relative sparing of other components of language output and comprehension, notably syntax and
phonology.

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

3. Normal visuo-perceptual and spatial skills, working memory, and non-verbal problem-solving abilities.
4. Relatively preserved autobiographical and day-to-day (episodic) memory.
(Hodges et al., 1992).
MEMORY PROBLEM IN PSEUDODEMENTIA
It is important differentiate memory problems commonly seen in elderly patients with depression and those
seen in dementia. With the help of features given below we can differentiate between the above conditions.
In pseudodementia:-atients generally have prominent depressive symptoms, more insight into their
symptoms and it is usually acute in onset without prior cognitive disturbances. There is a personal or family
histrory of affective episodes, marked psychomotor retardation with reduced social interaction.Self
reproach, diurnal cognitive dysfunction(worse in the morning).Subjective memory dysfunction in excess of
objective findings.Circumscribed memory dysfunction that can be reversed with proper coaching and
treatment.

Meta-memory(Emilien,2004)

Meta-memory is the subjective judgment about one’s own memory capabilities. It is influenced by the
present state of emotion. Patients who are depressed subjectively experience their performance to be worse
than in fact, while those in manias or with the frontal lobe disinhibited syndrome experience their
performance to be better than in fact. Patients with temporal lobe epilepsy overestimate their memory
capacities and their self-monitoring is less accurate for verbal or non-verbal recall depending on the side of
the seizure focus.

MEMORY DYSFUNCTION IN PSYCHIATRIC DISORDERS

The most common psychiatric disorders in which memory impairment may be seen are schizophrenia,
depression, and anxiety. The objective cognitive impairment is often mild with alterations in such functions
as attention, STM, and speed of processing.

SCHIZOPHRENIA

Memory deficits observed in schizophrenia are not restricted to a single element of memory but strike
different systems, such as declarative memory, short term, and working memory (Goldberg et al.,
1993).There are deficits in long-term memory, including evidence of impaired retrieval in both recall and
recognition. There is also evidence of impaired short term memory. Furthermore, there is evidence of
impairment of working memory and semantic memory but procedural or implicit memory remains intact
(McKenna et al., 2002). Cognitive impairment is a central manifestation of the schizophrenic illness that
impacts on the quality of life of the patient.

ANXIETY

The presence of distracting, task-irrelevant thoughts is a common feature of anxiety. As worry occupies
some of the limited capacity available to the working memory system, this negatively impacts tasks that rely
heavily on the working memory system. The adverse effects of anxiety will be evident on tasks carried out in
conjunction with a task treated as more “primary”, as this reduces the capacity available for further tasks.

DEPRESSION

STM or the retention of small amounts of information over very short durations has been found to be
unaffected among depressive patients (Austin et al., 1992; LTM seems to be more prone to impairment.
Depression is associated with a number of deficits in episodic memory and learning. There is involvement of
both explicit verbal and visual memory in patients with both melancholic (endogenous) and non-melancholic
(nonendogenous) depression (Austin et al., 1999).Impaired delayed memory as opposed to preserved
immediate recall has also been found among depressive patients (Cohen et al., 1982).People with major

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

depressive disorder, including those who have recently attempted suicide, have difficulty retrieving specific
autobiographical memories in response to cue words (Williams, 1996).

Obsessive compulsive disorder

Obsessive compulsive disorder (OCD) is characterized by recurrent unwanted thoughts and repetitive,
ritualistic behaviors that lead to severe impairments in daily functioning. There are deficits in learning and
memory, especially for non verbal information in OCD patients. The difficulty in retrieving specific
autobiographical memories exhibited by OCD patients might reflect excessive cognitive capacity
consumption due to preoccupation with intrusive thoughts typical of major depression.
Panic disorder

Patients with panic disorder have a defect in fear-relevant episodic memory, and their panic attacks arise
from automaticity in recollecting fear-relevant emotional–automatic clusters. The cluster as a component of
fear appears to have been dissociated from cognitive structure, episodic or informative memory trace, or
from information structures.
Post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) is a specific anxiety disorder of significant prevalence and morbidity
that develops following exposure to extreme emotional trauma. Three symptoms clusters characterize the
disorder, all of which represent direct or indirect effects of memory processes:
(1) Persistent re-experience of the traumatic event,
(2) Persistent symptoms of increased arousal,
(3) Persistent avoidance of stimuli associated with the trauma that may include amnesia for an important
aspect of the traumatic event.
Adult PTSD patients often report a wide range of cognitive problems in memory, concentration, attention,
planning, and judgment.
PTSD may be conceived as a clinical condition that involves both memory intensification for the core
traumatic event and memory impairment for the context surrounding the trauma. The latter comprises
dissociation of the experience from ordinary autobiographical memory.
MEMORY DISORDERS IN EPILEPSY

Patients with epilepsy frequently complain of memory difficulties. In some cases this is secondary to
problems of concentration and attention and may therefore not be a memory defect per se. For patients
with temporal lobe abnormalities, memory may be selectively affected. Seizures may have an acute effect on
memory but this is usually transient and does not affect prospective memory .But poor memory of patients
with temporal lobe epilepsy does not correlate with seizure frequency. In patients who are undergoing
temporal lobectomy careful testing of memory function prior to surgery is mandatory, and deficits may
occur following removal of offending lobe.
DRUG INDUCED MEMORY ALTERATION

Some drugs that may impair or improve memory

Drugs

IMPAIRED MEMORY Type of memory impaired/improved

Lorazepam and diazepam Explicit and Implicit Memory

Methylenedioxymethamphetamine Verbal and visual Memory

(MDMA or “Ecstasy”)

Ethanol and temazepam LTM

IMPROVED MEMORY

Citicoline Facilitates recovery of function and cognition

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

 after traumatic brain injury

Over the past three or four decades, there has been increasing interest in neuropharmocological regulation
of memory. Some drugs have been identified as cognitive enhancing agents or ‘’SMART DRUGS’’. These
groups of drugs have displayed memory-enhancing effects in experimental settings through diverse
mechanism of actions. Important mechanisms includes cholinergic agonists at the muscarinic and nicotinic
receptors, cholinesterase inhibitors such as physostigmine, CCB’s like nimodipine, neurotransmitters such as
norepinaphrine, GABA-B receptor blockers, peptides like vasopressin corticotropin, glucose
etc(Emilien,2004).
Lithium usually causes mind slowing (bradyphrenia) and cognitive deficits are more when used along with
ECT.
Anticholinergics mainly affects short term memory especially encoding and storage of information.
Ethanol acute ingestion induces BLACKOUT AMNESIA which refers to profound STM deficits and it may be
associated with hypoglycemia, hypomagnesemia etc. Chronic ingestion causes korsakoff’s psychosis where
we can see the memory deficits as confabulation as the patient tries to fill the memory gaps with
unnecessary details.
Beta blockers may produce poor memory particularly for emotionally valent information.
Corticosteroids causes memory impairment mainly by its deleterious effects on hippocampus.
Barbiturates tend to impair acquisition and interfere with retention of learned behavior.
Antiepileptic drugs may exacerbate pre existing memory problem by affecting concentration, attention and
psychomotor abilities. Phenytoin and primodone are associated with cognitive decline.
Topiramate causes word finding difficulties.
Cognitive enhancers (cerebroactive drugs). There are various drugs claimed to be having cognitive
enhancing property. But as per the Cochrane review there is no definitive evidence.
Cholinergic activators: Donepezil, Rivastigmine, Galantamine, Tacrine.
Glutamate(NMDA) antagonist: Memantine
Miscellaneous cerebroactive drugs: Piracetam, Pyritinol, Dihydroergotoxine, Piribedil,
Ginkgo biloba.
MEMORY DISTURBANCES AND ECT

Memory disturbances are seen occurring immediately after ECT and includes short lived impaired learning
ability, defective retrievals along with permanent loss of memories of events (especially autobiographical
memories) preceding immediately to ECT treatment. These deficits are proportional to strength of current,
duration of electrical stimulus, number of sessions given to the individual, the area of the brain where the
current pulse is given (dominant or non-dominant area of the brain) and finally bilaterality of ECT. Therefore
ECT if applied unilaterally, in non-dominant side of the brain not only hastens recovery but also causes less
post ictal amnesia, confusion and memory disturbances. However amidst various ongoing controversies
regarding the ECT generated memory deficits the effects do not seem to last more than six months and
some researchers currently have pointed out that ECT does not cause more than a temporary disturbance in
memory (Oyebode, 2008).
EMOTIONAL AND SOCIAL CONSEQUENCES OF MEMORY DISORDERS

These are acquired neuropsychological disorders fall within the domain of psychosocial functioning.
Emotional responses occur within the context of an individual’s personality structure and their environment
underlying stable traits, and transient fluctuations in emotional affective and mood states, which occur in
response to day to day events. Those with fairly circumscribed memory disorders are well placed to harness
their intelligence and other neuropsychological strengths and implement compensatory strategies to
circumvent the memory disorders. This enables them to access a range of life otherwise it will be difficult to
achieve productive work, independent lifestyles and a regular social life in the presence of other
neuropsychological impairments in addition to memory disorder makes it difficult to attribute any emotional
or social disturbance to the memory disorder itself, as opposed to some concomitant neuropsychological
problem that the person may experience, such as aphasia, executive impairment, attention deficit and so
forth. The literature regarding emotional and social consequences for people with a range of

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

neuropsychological problems is relevant and important, given that the majority of adults who experience
acquired memory disorder also have additional neuropsychological impairments.
MEMORY REHABILITATION

How are the memory difficulties manifested in everyday life?

• What problems cause most concern to the family and the memory-impaired person?
• What do we know about the cultural background and level of support available?
• What coping strategies are used?
• Are the problems exacerbated by depression or anxiety?
• Is this person likely to be able to return to work (or school)?
• Can this person live independently?
• What kind of compensatory aids did this person use premorbidly?
• What kind of memory compensation strategies are being used now?
• What is the best way for this person to learn new information?
Ten Key Memory Tips
Take it easy
1. Try not to do too many things at once.
2. Anxiety and tiredness can affect memory, so try to avoid stressful situations. Be positive and have regular
breaks.
3. If you do forget something, don’t get too upset about it. Stay calm and think of connections that may jog
your memory. Be well organized
4. Keep to a fixed routine, with set things at set times of the day and on set days of the week.
5. Be systematic: Have a place for everything and put everything back in its place.
Put labels on drawers and files.
Concentrate better
6. If you have to do something, do it now rather than later: “Do it or lose it.”
7. Try not to let your mind wander: Keep on track.
8. If you have to remember something such as a message or a name, go over it in your mind at regular
intervals.
9. Try to find meaning in things you have to remember (e.g., by making associations or linking things
together). (Wilson, 2009).
10. Use memory aids

External memory aids are effective in improving everyday memory functioning, and this benefit is
particularly evident in the area of prospective memory.
1. An electronic diary to keep a record of appointments.
2. An alarm which provides auditory cues, with or without text information, at preset, regular or irregular
times.
3. A temporary store for items such as shopping lists, messages, etc.
4. A more permanent store for information such as addresses, telephone numbers, etc.
5. In more expensive models, a communication device that can receive and send information, such as
reminders and factual knowledge.

CONCLUSION

Memory is not a unitary phenomenon. Capacities to remember vary for the different senses and
perceptions. When individuals with extraordinary memories complain of memory loss, ordinary memory
tests may be inadequate to detect their deficits, as their relative memory loss may have reduced their
capacities to a point within the range of most normal people. Various psychiatric disorders and drugs used to
treat them are associated with memory disturbance caution is needed while chosing a drug. There is
considerable overlap in the effect of focal lesions of brain regions, and in the brain activations associated
with specifc memory tasks.We can assist an individual with memory impairment through the memory
rehabilitation so that he is able to carry out his activities of daily living with minimal distress.

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.

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APPENDIX- 1

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Budson, E.A., Price, B.H. (2001). Memory: Clinical Disorders. ENCYCLOPEDIA OF LIFE
SCIENCES, Macmillan Publishers Ltd. / www.els.net

Disorders of Memory Dr. A. K. Bakhla, Dr.Archana Singh, Dr.Sathishkumar S. V.