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Psychopathological Factors, Memory Disorders and Transient Global

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Psychopathological Factors, Memory Disorders and Transient Global The British Journal of Psychiatry (2008) 193, 145–151. doi: 10.1192/bjp.bp.107.045716 Psychopathological factors, memory disorders and transient global amnesia Audrey Noe¨ l, Peggy Quinette, Be´ renge` re Guillery-Girard, Jacques Dayan, Pascale Piolino, Sophie Marquis, Vincent de la Sayette, Fausto Viader, Be´ atrice Desgranges and Francis Eustache Background Results Some studies have shown the presence of During the acute phase, participants with transient psychopathological disorders in transient global amnesia. global amnesia displayed a higher level of anxiety and a more depressed mood than controls. An alteration Aims of emotional state, as measured by the Adjective Mood To determine whether transient global amnesia is associated Scale, was correlated with deficits in anterograde with psychopathological disorders and to assess the memory. influence of these psychopathological disorders on memory impairments. Conclusions Method Transient global amnesia comprises sudden changes Levels of anxiety and depression before and during in people’s emotional state, which has a major transient global amnesia were rated. Memory performances impact on and interacts with episodic memory were assessed by means of original episodic memory impairment. tasks and working memory tasks. These data were collected in 17 individuals observed during the very acute phase, 18 individuals examined in the peri-acute phase and 26 Declaration of interest controls. None. Funding detailed in Acknowledgements. Transient global amnesia is a time-limited memory disorder that people start to recover. We estimated the end of the acute phase is characterised by the sudden onset of massive anterograde using several types of clinical data. When individuals still amnesia, usually accompanied by variable retrograde amnesia. displayed memory disorders but no longer presented temporal Several studies1,2 have stressed the frequent reporting by individ- disorientation or repetitive questioning, they were included in uals of emotional precipitants, i.e. intense and personal emotional the peri-acute phase group. People in both groups (acute and incidents occurring just before the episode. Others highlighted the peri-acute phases) were matched according to age and level of presence of psychopathological disorders such as agoraphobic education (Table 1). All of them fulfilled the criteria for transient personality traits, and symptoms of depression or panic global amnesia,5 and for six of them, the witness was present for attack.2–4 The first aim of the present study was to establish much of the attack but not at the very beginning. In order to list whether anxiety and mood disorders intervene before (i.e. play a precipitants, i.e. unusual events preceding the attack, we used role as predisposing factors) and/or during the episode (i.e. can questionnaires previously described in Quinette et al.2 We system- be considered as one of its symptoms). To gain a better under- atically looked for the presence of risk factors that have previously standing of the role of these psychopathological factors, we been reported in the literature and which could supply infor- studied the putative influence of anxiety and mood disorders on mation on the aetiology of such episodes (Table 1). A control memory impairment observed during transient global amnesia. group consisted of 26 strictly selected healthy people, matched with the two case groups according to age (control group mean age: 60.2 years (s.d.=7.3) and level of education (control group Method mean: 11.8 years (s.d.=3.7)). All participants gave informed consent to the study, which was Participants performed in compliance with the Declaration of Helsinki. This Ours is the largest ever neuropsychological study of participants study was approved by the local ethical committee. experiencing a transient global amnesia episode. Between 2005 and 2007, 35 people with transient global amnesia were admitted to the emergency department of Caen University Hospital. The Psychopathological assessments selection of participants was systematically carried out by senior In order to determine whether anxiety and mood disorders could neurologists, in line with a codified procedure. The clinical and be considered to be predisposing factors, participants completed, neurological examinations of the individuals were all normal, the day after the episode, two questionnaires assessing anxious except for memory disturbance. Brain computed tomography personality trait (State–Trait Anxiety Inventory (STAI))6 and the (CT) scans and electroencephalograms performed during or after presence of a depressive state at least 2 weeks before the episode the episode were also normal. Seventeen people were examined (abridged version of the Beck Depression Inventory (BDI) during the very acute phase. Eighteen others were recruited during composed of 13 items).7 Two other psychopathological scales the peri-acute phase, i.e. within 24 h of onset. The exact end of the completed during the attack allowed us to measure the level of acute phase is difficult to gauge.2 Although the onset of the attack anxiety (first part of STAI) and depression (Adjective Mood Scale is usually easy to pinpoint because it is so sudden, recovery is (or Befindlichkeits-Skala)),8 and to determine whether these gradual and there is no criterion to determine the point at which disorders could be regarded as symptoms specific to this episode. 145 Downloaded from https://www.cambridge.org/core. 27 Sep 2021 at 11:41:01, subject to the Cambridge Core terms of use. Noe¨ letal Table 1 Clinical characteristics of individuals with transient global amnesia according to the stage at which the test was carried out Acute phase (n=17) Peri-acute phase (n=18) Gender, women/men 8/9 9/9 Age, years: mean (s.d.) 62.8 (6.3) 60.3 (9) Level of education, years: mean (s.d.) 10.9 (3.4) 9.9 (3.7) Duration, h: mean (s.d.) 7.6 (1.7) 3.7 (3.1) Start of examination, h: mean (s.d.)a 4.8 (1.5) 10.7 (7.5) Recurrences, n 4 (second episode) + 1 (third episode) 2 (second episode) Precipitants, n Stressful event 4 5 Physical effortb 84 Intercourse 1 4 Water contact 1 1 No precipitant 3 4 Risk factors, n Transient ischaemic attack 1 0 High blood pressure 8 7 Hypercholesterolemia 12 4 Diabetes 3 0 Heart disease 1 0 Migraine 2 4 Psychiatric disordersc 37 a. Number of hours between onset of amnesic episode and start of neuropsychological examination. b. This category included activities such as gardening, cutting a hedge and sport. c. Psychiatric disorders were sought in medical files and comprised previous episodes of depression in eight people, panic attacks in one person and a suicide attempt in one person. Because transient global amnesia is a short-lived syndrome, we 6.36 (s.d=0.56) and 4.89 (s.d.=0.59) respectively. In this test, we chose scales that did not take long to complete. Because we also selected the 40 most representative words in each category, i.e. thought that moods before and during the episode might be 40 negative (mean score 2.42 (s.d.=0.51)), 40 positive (mean score radically different, we used the Adjective Mood Scale, which was 6.67 (s.d.=0.48)) and 40 neutral (mean score 4.71 (s.d.=0.24)). designed to measure brief variations in mood. This scale is a This produced four lists of 10 words for each valence (matched particularly sensitive measure of changes in depressive symptoma- for word frequency, word length and level of concreteness),12 tology and is correlated with other depression scales such as BDI.9 which were used either as a target or a lure to counteract any list The Adjective Mood Scale has already been used to determine effect. For the task itself, we only selected two of the four lists, one the links between current mood state and neuropsychological as a target and one as a lure. disorders, notably in psychogenic amnesia.10 In this scale, parti- During the study session, individuals had to memorise a list of cipants must choose between two contrasting adjectives, selecting 10 positive, 10 negative and 10 neutral words (intentional encod- the one which best characterises them at the time of the test. ing) and judge the emotional valence of these 30 words on an 8- Another kind of answer is possible if neither adjective is relevant. point scale (from 1=highly negative to 8=highly positive). The test According to the score, people are classified as relaxed (mean score session took place 5 min later (the interval was filled with a 12.02), worried (mean score 19.32) or utterly depressed (mean working memory task). Retrieval was assessed by means of a dual score 34.40). The maximal score is 56. forced-recognition task. To assess the state of consciousness associated with each response, we used the Remember/Know/ Neuropsychological assessment Guess (R/K/G) paradigm.13 A Remember judgement meant that participants re-lived the learning context (i.e. thoughts, feelings General cognitive function or perceptions) and a Know judgement corresponded to a feeling General cognitive assessment consisted of an assessment of of familiarity in the absence of recollection. A third response was orientation and general knowledge. To this end, we used sub-tests possible if participants were unsure (Guess judgement). taken from the Mattis Dementia Rating Scale, including spatio- One emotional judgement score (study session) and one temporal orientation, a semantic categorisation task and a recognition score (accuracy) were obtained for each valence list. 11 categorical fluency task. The measure of accuracy corresponded to A’, calculated according to the following formula:13 A’=1/2 + [[(Hit – Falm alarm Anterograde component of episodic memory (FA))(1+Hit –FA)]/4Hit (1 – FA)]. We also calculated recollection A recognition task was specially designed to assess the anterograde and familiarity scores using the number of Remember (R) and component of episodic memory.
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