Functional Retrograde Amnesia Research Articles

A case of persistent retrograde amnesia following a dissociative fugue: Neuropsychological and neurofunctional underpinnings of loss of autobiographical memory and self-awareness

Autobiographical memory relies on complex interactions between episodic memory contents, associated emotions and a sense of self-continuity over the course of one's life. This paper reports a study based upon the case of the patient NN who suffered from a complete loss of autobiographical memory and awareness of identity subsequent to a dissociative fugue. Neuropsychological, behavioral, and functional neuroimaging tests converged on the conclusion that NN suffered from a selective retrograde amnesia following an episode of dissociative fugue, during which he had lost explicit knowledge and vivid memory of his personal past. NN's loss of self-related memories was mirrored in neurobiological changes after the fugue whereas his semantic memory remained intact. Although NN still claimed to suffer from a stable loss of autobiographical, self-relevant memories 1 year after the fugue state, a proportionate improvement in underlying fronto-temporal neuronal networks was evident at this point in time. In spite of this improvement in neuronal activation, his anterograde visual memory had been decreased. It is posited that our data provide evidence for the important role of visual processing in autobiographical memory as well as for the efficiency of protective control mechanisms that constitute functional retrograde amnesia.

Functional retrograde amnesia: A multiple case study

Functional retrograde amnesia (RA) is a rare pathology and has been rarely studied in detail across different patients. We extensively examined five functional RA patients and compared their neuropsychological profile including anterograde and retrograde memory performance, executive functions, emotional processing, and formally assessed psychiatric symptoms. Across patients, neuropsychological deficits beyond RA were most consistently seen in executive functions and attention suggesting that these dysfunctions contribute to the remote memory deficit. In a majority of the patients, problems in social cognition and emotional behaviour were reflected in Theory of Mind deficits and accompanying psychiatric symptoms. Aberrances in a measure of social desirability were detected, pointing to repressive tendencies in three out of the five patients. Future studies of functional RA patients may investigate more specifically which frontal-lobe associated (dys-) functions contribute to the memory retrieval deficit. Moreover, studying more closely the interaction between social cognition, repressive personality style and memory inhibition in this disease seems worthwhile pursuing.

Persistent Autobiographical Amnesia: A Case Report

We describe a 47-year-old man who referred to the Emergency Department for sudden global amnesia and left mild motor impairment in the setting of increased arterial blood pressure. The acute episode resolved within 24 hours. Despite general recovery and the apparent transitory nature of the event, a persistent selective impairment in recollecting events from some specific topics of his personal life became apparent. Complete neuropsychological tests one week after the acute onset and 2 months later demonstrated a clear retrograde memory deficit contrasting with the preservation of anterograde memory and learning abilities. One year later, the autobiographic memory deficit was unmodified, except for what had been re-learnt. Brain MRI was normal while H20 brain PET scans demonstrated hypometabolism in the right globus pallidus and putamen after 2 weeks from onset, which was no longer present one year later. The absence of a clear pathomechanism underlying focal amnesia lead us to consider this case as an example of functional retrograde amnesia.

Transient global amnesia and functional retrograde amnesia: contrasting examples of episodic memory loss.

We studied 11 patients with transient global amnesia (TGA) and ten patients with functional retrograde amnesia (FRA). Patients with TGA had a uniform clinical picture: a severe, relatively isolated amnesic syndrome that started suddenly, persisted for 4-12 h, and then gradually improved to essentially normal over the next 12-24 h. During the episode, the patients had severe anterograde amnesia for verbal and non-verbal material and retrograde amnesia that typically covered at least two decades. Thirty hours to 42 days after the episode, the patients had recovered completely and performed normally on tests of anterograde and retrograde amnesia. By contrast, patients with FRA had a sudden onset of memory problems that were characterized by severe retrograde amnesia without associated anterograde amnesia and with a clinical presentation that otherwise varied considerably. The episodes persisted from several weeks to more than two years, and some of the patients had not recovered at the time of our last contact with them. The uniform clinical picture of TGA and the variable clinical picture of FRA presumably reflect their respective neurologic ('organic') and psychogenic ('non-organic') aetiologies.

A Study of Recovery of Memory Function in a Case of Witnessed Functional Retrograde Amnesia

We describe a case of transient functional retrograde amnesia that had features of a fugue state, and that was accompanied by loss of personal identity and significant autobiographical amnesia. Uniquely, we were able to gather information from witnesses who observed the episode from its onset, and we were also able to monitor the acute stages of recovery of memory function over the subsequent four-week period. The profile of memory loss was characterised by impaired performance on both autobiographical and public events memory tasks, in the context of normal anterograde memory test scores. Shrinkage of retrograde amnesia took place over a four-week period, with autobiographical and public events components of retrograde memory recovering at the same rate. We discuss the possible role of unconscious processes underlying the episode, as compared to conscious simulation. We argue that most cases of functional retrograde amnesia may represent a combination of conscious simulation and unconscious processes.

Making explicit 3-year-olds' implicit competence with their own false beliefs

Three-year-olds usually fail to recall a previous false belief once they have discovered the true state of affairs. The failure is so dramatic that researchers have treated it as a case of functional retrograde amnesia. We found in a series of studies that the memory trace is indeed available but is inaccessible under traditional testing procedures. We also provided a new prediction that reminding children that they had briefly held a picture of an object would be a more powerful retrieval cue than a reminder that they had held the small object itself. It was further shown that an effective picture was one that reminded children of the content of the target belief and not one that would enable them to reconstruct the contextual cause of why they had held the belief - a case of “recall without insight”. However, there was evidence that successful recall was associated with either (a) an insight that the recall was of a thought rather than of a pretence (delayed post-test technique) or (b) a readiness to attach a mentalistic label to the recall (immediate post-test technique). The results serve to narrow an assessment of the competence gap between 3- and 4-year-olds in recall of their own false belief. Rather than a sudden ability to preserve the memory in association with insight into its informational origins, it is only the latter that comes on stream in 4-year-olds. Alternative explanations of the picture facilitation effect suggest different research strategies, each of which aims at a gap in current formulations of false belief recall.

The great escape: A neuropsychological study of psychogenic amnesia

This paper describes the neuropsychological test performance of a patient who experienced a “fugue” episode (functional retrograde amnesia) lasting 7 days, but who continued to complain of a virtually complete loss of autobiographical memory for well over a year. Subsequent evidence revealed that she had been at least partially simulating her amnesia during this prolonged period. Neuropsychological testing took place soon after admission to hospital, at intervals thereafter, and after an Amytal abreaction, which produced a substantial recovery of her memories. On various anterograde tests, designed to detect simulation, the patient's performance was unimpaired, including recognition memory tasks, word-stem completion priming for “neutral” word-lists and for post-onset autobiographical material, and some aspects of semantic memory. However, her pattern of performance on an autobiographical and a remote News Event test differentiated her from patients with organic amnesia, because she showed a grossly disproportionate autobiographical memory loss and an extreme recency effect. In addition, a rating scale, on which she showed impaired feelings-of-knowing for items from her autobiographical memory, suggested simulation. On a word-completion task for pre-onset autobiographical material, she showed absent “priming” relative to “baseline” material. However, following the Amytal abreaction, there was a substantial improvement on this task, relative to recognition and cued recall performance. This finding has been interpreted within an hierarchical model of awareness in memory, derived from studies of normal memory and organic amnesia; and it is suggested that patients with “psychogenic amnesia” may manifest different levels of awareness for differing memories.

Functional retrograde amnesia: A quantitative case study

The memory impairment of a patient suffering from functional retrograde amnesia was assessed both during amnesic episode and after its termination. The patient's performance on a task tapping semantic memory was nearly identical on the two test occasions, but his performance on a task tapping episodic memory substantially changed across test sessions. Cueing procedures revealed that in spite of the patient's restricted access to episodic memory during the amnesic period, a relatively intact “island” of episodic memories could be uncovered. The distinction between episodic and semantic memory, as well as the relation between organic and functional retrograde amnesia, are discussed in light of the case study.