memory impairment
Introduction
Introduction to memory impairment MemoryDisorders means that a person is in a state in which information or skills cannot be remembered or recalled, and may be permanent or temporary memory disorders due to pathophysiological or contextual causes. Memory includes memorization, retention, and reproduction, and is closely related to neuropsychological function. According to neurophysiological and biochemical studies, memory is divided into transient memory (in minutes, seconds) short-term memory (days) and long-term memory (months, years). Memory and forgetting are accompanied, and forgetting has time and selectivity. The newly memorable materials are the fastest to forget, and gradually develop into distant things, and things that have caused high attention are hard to forget. There is currently no effective way to treat memory disorders. Mainly to find the primary disease, treatment for the primary disease. Preventive measures for memory disorders also vary depending on the disease caused. In general, a healthy diet such as a reasonable diet, moderate exercise, good at learning, and positive emotions can help prevent the occurrence of memory impairment. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: depression
Cause
Cause of memory impairment
Dementia (30%):
Dementia refers to a more serious and persistent cognitive disorder. Clinically, the slow decline in mental decline is the main feature, accompanied by varying degrees of personality changes, but unconscious disorders. Because of the slow onset and long course of disease, it is also known as chronic brain syndrome.
Cerebral infarction (25%):
Cerebral infarction (cerebral infarction, ischemic stroke) refers to ischemic necrosis or brain softening of localized brain tissue caused by blood supply disorders, ischemia, and hypoxia. The common clinical type of cerebral infarction is cerebral thrombosis. Formation, lacunar infarction and cerebral embolism, etc., cerebral infarction accounted for 80% of all strokes.
Wernicke encephalopathy (20%):
Wernicke's encephalopathy (WE) is a metabolic disease of the central nervous system caused by vitamin B1 (ie, thiamine) deficiency, which is common in chronic alcoholism.
There are many diseases that cause memory disorders, various degenerative diseases of the brain (such as Alzheimer's disease), brain trauma and boxer dementia; subcortical arteriosclerotic encephalopathy, lacunar infarction, cerebral infarction and cerebral hemorrhage After the disease; after encephalitis; carbon monoxide poisoning and other cerebral hypoxia; nutritional deficiency encephalopathy (such as Wernicke encephalopathy); alcoholism and biochemical metabolic disorders can cause, memory impairment is a complex pathological process, any of the above The causes of the frontal lobe, temporal lobe, hippocampus, thalamus, cingulate gyrus, diencephalon and midbrain reticular formation can all have memory disorders, and mental patients also have memory disorders.
Memory enhancement
The retention of memory in normal people greatly exceeds the level indicated by the forgotten curve, or greatly exceeds the breadth of memory (7 ± 2); patients with mania show increased memory on the basis of high emotions; some patients with mental illness Special vigilance and attention to the surrounding things, showing increased memory; temporal lobe epilepsy and some infectious and toxic sputum, memory enhancement can also occur.
Memory loss
Memory loss may be related to decreased activity of neurotransmitters and proteins. Patients who are common in neurasthenia, cerebral arteriosclerosis and other brain organic damage can also be found in normal elderly.
Forgotten
Common causes of forgetting are disturbances of consciousness and organic diseases. The disturbance of consciousness may be the process of memorization that interferes with memory, or it may be due to the influence of disturbance of consciousness that cannot form a lasting memory trace to be preserved, or the three processes of memory are damaged, and the temporal lobe in organic disease The frontal lobe damage is most likely to cause forgetting.
Malformation and fiction
Due to brain atrophy, brain degeneration and cerebral hypoxia, brain damage is caused, and long-term alcohol abuse causes malnutrition, which may cause thiamin deficiency. Common in senile and arteriosclerotic psychosis, alcoholic psychosis, toxic psychosis and paralytic dementia.
Latent memory, old things like new diseases, familiar feelings and repetitive memory errors
Its mechanism is related to genetic factors, damage to basic brain structures, and cerebral hypoxia. Common in epileptic mental disorders, functional psychosis, brain organic mental disorders and infectious toxic psychosis.
Prevention
Memory impairment prevention
Be good at learning, regular, use the brain without interruption, ensure enough sleep, let the brain get enough rest, use the brain, should arrange short breaks and outdoor activities.
Try to avoid excessive tension, anxiety and agitation, prevent bad emotions from causing strong stimulation to brain cells, and at the same time strengthen mental cultivation, improve psychological quality, properly handle various relationships, and treat people and things around you in a harmonious, relaxed and happy mood. It is beneficial to prevent the decline of intelligence and memory, develop good habits, put the items in a relatively fixed position, put them back in place after use, and take a pen record for some important things.
Increase brain nutrition, eat more foods rich in vitamin B, C, fresh vegetables, and mineral-rich, choline foods such as apricots, bananas, grapes, oranges, seaweed, fish, egg yolks and cabbage, etc., corn , brown rice, whole wheat, soybeans, garlic, mushrooms, yeast, milk, animal liver, sardines, lean meat, etc. are also beneficial to the brain.
Complication
Memory impairment Complications depression
This disease can affect work and study due to memory impairment. If the patient continues to have memory impairment, it can greatly affect learning and work interest, resulting in various troubles. Therefore, for patients with a tendency to depression, depression can be induced, resulting in boring work, odorless life, and even suicidal tendencies. Therefore, it should be brought to the attention of clinicians to prevent patients from suffering from depression.
Symptom
Symptoms of memory disorder Common symptoms Retrograde amnesia Brain organic mental disorder Sedative amnesia Memory impairment Intermittent amnesia Deprivation Psychiatric disorder Depression Transcendental comprehensive forgetting
Clinical memory impairment can be divided into two aspects: the aspect of memory (memory enhancement, memory loss, forgetting), and the aspect of memory (skeletal disorder, fictitious disorder, latent memory, etc.)
Memory enhancement
As a pathological memory enhancement, it means that when people are under pathological conditions or other special circumstances, things that have been forgotten in the past, long-term experience or things that can't be remembered at all can be remembered, and remember very clearly. If a person's memory ability is significantly superior to that of an ordinary person, and the intelligence is supernormal, this memory enhancement cannot be considered abnormal.
Pathological memory enhancement, manifested as something that can not be and is not important before the disease can be recalled. For example, the patient recalls some of his childhood life events, what games he has done, and who has performed dances. Even very detailed scenes can be clearly recalled, or some memories that he has completely lost in normal times, can be restored at this time.
Memory loss
It refers to the general decline in memorization, preservation, recognition and recall, and is more common in clinical practice.
The decline of memory is mainly the general decline of memorization, preservation, recognition and recall. In the early clinical stage, the memory is often weakened, especially the recall of date, age, proper nouns, terminology and concepts, which can be expressed as near, Far memory declines, and some can be expressed as memory loss from near and far.
Forgotten
It refers to the forgetting of an experience limited to a certain thing or a certain period of time. It is not a reduction in the universality of memory, but a loss of memory.
1. Advance forgetting: that is, recalling the events experienced during the period after the disease occurs, and the time of forgetting and the disease begin at the same time. If you can't remember how to get hurt, how to stay in hospital.
2. Retrograde forgetting: It means that you can't recall the events at a certain stage before the disease. The patient can't recall where he was before the injury, what he was doing, and the forgetting may be complete or partial, but most of them only involve a shorter period of time.
3. Cardiac Forgetting: Caused by a heavy traumatic emotional experience, the cause of the disease is often related to the patient making a serious mistake or crime. Forgotten content is limited to things related to certain painful experiences.
4. Progressive forgetting: that is, in addition to forgetting, patients are accompanied by increasing dementia and apathy. As the brain damages, the memory damage is progressively worsened. The most affected are recognition and recall.
5. Staged forgetting: Due to mental factors, there may be a complete forgetfulness of life experience for a period of time, and the memory before and after is good.
6. Localized forgetting: Due to the different parts of the cerebral cortex, visual, auditory, motor and name memory impairments may occur.
7. Comprehensive forgetting: diffuse damage to the brain can cause generalized dementia and comprehensive memory impairment called comprehensive forgetting.
8. Posterior amnesia: At the beginning of the recovery of the disturbance of consciousness after brain damage, the memory was still good. After a period of time, obvious symptoms of amnesia appeared.
9. Systematic forgotten: In the amnesia of brain damage, it is simply forgotten to obtain a late foreign language knowledge, but maintain the knowledge of the native language.
10. Temporary comprehensive forgetting: It is a syndrome that suddenly starts to disease and is mainly caused by paroxysmal severe memory disorder. There is no aura before the attack, and the patient's memory structure suddenly and completely stops functioning, so that the patient can't remember the experience at the time of the onset. With the continuation of the attack, the patient can't remember that the performance of the situation is more obvious, and the patient's long-term memory remains intact. It usually lasts for one to several hours. As the seizure subsides, the memory function gradually recovers. First, it can remember the long-term events. Later, it can recall the events closer to the episode. At the same time, the patient gradually shows signs of beginning to remember the local experience at that time. After more than an hour, the patient's memory returned to normal, and after the patient's memory was completely restored, there was still a permanent forgetfulness experienced during the episode, as well as a permanent retrograde amnesia ranging from a few minutes to several hours.
Malformation and fiction
Misconstruction: It is a wrong memory. It means that the details of the error are added to the recall of a real event. Fiction: Also known as the illusion of memory: it is to say that things or experiences that have never happened in the past are indeed true, and that there is no factual basis to fill the gaps in memory.
1. A disordered disease: a patient who has occurred in an organic disease. It is said that the patient has experienced an event that has been experienced in the past but did not occur during the time he refers to. And firmly believe in the facts and respond accordingly.
2. Fictionality: The patient fills in the memory of the imaginary, unsubstantiated content, accompanied by severe memory impairments. When the patient talks about these "experiences", it seems to be true, because the fictional plot cannot be maintained. The second fictional content is not remembered once, so its content often changes, more common in organic encephalopathy.
Latent memory, old things like new diseases, familiar feelings and repetitive memory errors
After brain function and brain organic damage caused by various reasons, memory impairments such as latent memory, old things such as new symptoms, familiarity, and repetitive memory errors may occur.
1. Latent memory: Patients are confused about memories from different sources, reversing each other, and recalling memories of things they have seen or heard in their past or experienced in their dreams. It can be divided into two situations: one is to recall what others have experienced as what he actually happened; the other is to recall what the patient actually experienced has been heard or seen or As mentioned, this is a special manifestation of the old as a new disease.
2. The feeling of deja vu: When a patient experiences something completely strange, there is a feeling that he has experienced in the past, also known as familiarity. Normal people can also have it, but they will soon realize that this is a mistake in their own feelings or memories, but mental patients insist that they have indeed experienced it.
3. Old things such as new diseases: the feeling that the patient has completely stranged to the things he has experienced in the past, also known as strangeness. It can be part of a disintegration of personality and a real symptom.
4. Repetitive memory errors: The patient's life experience for a period of time seems similar, just like the replay.
Examine
Memory impairment examination
Revised the Wechsler Memory Scale, which was revised by Gong Yaoxian and others. In addition to the original 7 subtests, three additional subtests were added. The revised Wechsler Memory Scale check included:
(1) Long-term memory test: Regarding personal experience, there are 5 questions about the subject's own experience, asking the subject to answer, such as how old you are this year; who is the current Premier of the State Council, etc., time and space orientation: Including 5 simple questions, such as which year is this year; where are you waiting now, the numerical order relationship: a, 1-100-sum; b, 100-1 consecutive reciprocal; c, accumulating: starting from 1 each time 3, such as 1, 4, 7, 10 until 49, and all need to be timed.
(2) Short-term memory test
d, visual recognition: two sets of identification cards, each set has 8 contents, there are pictures, words, and symbols, let the test record for half a minute, and then ask them to find out on another card. 8 things.
e, picture recall: Let the test see a picture with 20 pictures, after one and a half minutes to recall the picture content.
f. Visual Regeneration: Give 3 pictures to the subject for 10 seconds at a time. After each reading, you should draw them on the paper.
Diagnosis
Diagnosis of memory impairment
Differential diagnosis
Memory enhancement
(1) Affective disorders
1. Mania: The first onset age is 16 to 30 years old, and the onset is acute. The main manifestations are high emotions, thinking and emotional excitement. The patient is accelerating because of the high emotions. The concepts are produced one after another, and the following words are written. A lot of poetry creations, rhyming words and adjectives are hand-in-hand, especially the patients who are scornful, on the basis of similar associations and close associations. Remembrance of details of some past life events.
2. Depression: Mainly manifested as depression, slow thinking and psychomotor inhibition. It produces self-blame and sinful thoughts on the background of depression. Its sinful thoughts can be traced back to childhood life experiences and its crimes are in childhood. Some of the mistakes caused by the mistakes, generally can not recall these after the recovery.
(2) Schizophrenia: The disease is slow onset, and the onset is mostly in middle age. It is dominated by ridiculous and illusory illusions, accompanied by emotional disharmony and speech disorder. Patients who have systemic delusions are indulged in the illusion of delusion experience, showing a sense of isolation and isolation, special vigilance and attention to the surrounding things, even the fine details that the normal people can not notice can be remembered without any omission.
(3) Temporal lobe epilepsy: In the paralyzed state of temporal lobe epilepsy, patients can recall some scenes of past life experiences that have long been forgotten, and even specific fragments of early childhood life that cannot be remembered at all. Children, generally have changes in EEG.
(4) Infectious and toxic sputum: It occurs in the paralyzed state after brain damage caused by infection and toxic diseases. The appearance of the previous life scene reappears in the mind of the patient, continuously appears, or appears as rich and colorful illusion and Illusion, or expression of whimsical and incoherent thinking.
Memory loss
(A) neurasthenia: onset between 11 to 40 years old, mainly manifested as headache, sleep disorders, memory disorders, autonomic dysfunction and fatigue and weakness. Memory impairment is mostly memory loss, especially near memory loss, and far memory is normal. This memory loss is often due to the inability to concentrate, not true memory impairment. Chaos, the impression is not deep, can not grasp the center content, see the familiar people for a time difficult to call the name, but once reminded, can still remember, and the nature of memory impairment of brain organic diseases is completely different.
(2) Cerebral arteriosclerotic psychosis: more common in elderly people over 50 years old, is a chronic degenerative disease caused by multiple factors, initially showing symptoms of neurasthenia, prominent symptoms are obstacles in sleep, memory and emotion. Memory loss is a common symptom. It begins with a near-memory reduction, the most memorable name, and the immediate reproduction of things and people. However, it is still fresh in the past, and the understanding is good. Powerless or easy to forget, but everyday things can still cope, patients often send notebooks to make up for their memory loss, often lack of initiative and creativity in the work.
(C) craniocerebral injury: acute brain trauma, memory disorders are often retrograde and antegrade forgotten, after chronic brain injury (usually one month or several months after traumatic brain injury), headache, dizziness, attention to revitalization, memory loss And sleep disorders, etc., are closely related to the nature, part, age, quality and psychological environment of the patient's injury.
(4) Mental disorders associated with brain tumors: The mental symptoms of brain tumors can be manifested in various aspects of mental function, such as consciousness level, cognitive function or emotion. Cognitive function is often characterized by slow thinking, lack of association, and difficulty in memory. Etc., the midbrain brain tumor is most prone to memory impairment, performance attention can not focus on the current things, can not learn new things, forget things, and distant memory and other cognitive functions remain intact, and can have fiction .
Forgotten
(1) antegrade forgetting and retrograde forgetting
1. Concussion: Concussion is a mild craniocerebral injury, which is characterized by short-term disturbance of consciousness immediately after injury, often with memory impairment, anterograde and retrograde amnesia, often associated with the degree and duration of disturbance of consciousness. It usually recovers after a few days, weeks or months.
2. Transient memory loss: This disease often occurs after a large amount of alcohol consumption. There is no alcohol dependence. When the patient drinks alcohol, there is obvious memory loss, and there is anterograde amnesia. The far memory and immediate memory are good, and the short memory is damaged. For hours, even days, patients can talk to people for fine activities, but all of them can't be remembered the next day.
3. Carbon monoxide poisoning: In the case of acute poisoning, there may be disturbance of consciousness. After recovery of consciousness, there may still be signs of brain damage. A few cases may have Coxakov syndrome, apathy, mental retardation, etc., and retrograde amnesia occurs, which is the latest in regression. symptom.
4. Psychogenic response: sudden or persistent trauma is the direct cause of the disease. There are many acute onsets, and there may be disturbance of consciousness after trauma, loss of orientation, inattention, and inability to fully recall after recovery. Have a dreamlike experience.
(2) Progressive forgetting
1. Multiple infarction dementia: mainly dementia as the main symptom, early in the main memory impairment, late distant memory also decreased, amnesia, began to forget to be transient, late forgetting is persistent, with dementia aggravated Forgetting is also aggravated. It is impossible to recognize acquaintances, time, place, and intelligence. There may be fiction, sluggishness, etc., and life cannot take care of itself.
2. Alzheimer's disease usually starts from 50 to 60 years old, and the insidious onset is clinically characterized by persistent mental retardation and memory impairment. Memory impairment is the first symptom to remember the loss of new knowledge and the long-term memory. The difficulty is characterized by the early forgetting of the disease, which can reproduce the fiction. The forgetting is aggravated with the aggravation of dementia, the work ability is reduced, and the self-care is poor. It often dies 2 to 8 years after the illness.
(3) Heart-forgetting, staged forgetting and late-forgotten
1. The onset of snoring often has mental factors. After the trauma, a selective stage of forgetting occurs suddenly. The patient can forget all the experiences in his past life, and even his own name, age, occupation, etc. can not be remembered. Can be long or short. The patient has a hysterical character, which is slightly high, and generally mild stimulation can promote cost.
2. The psychogenic response is acute, with a history of major trauma, and there is a disturbance of consciousness in the trauma. After the recovery of consciousness, it is often impossible to recall. The content of forgetting is related to trauma.
3. Brain trauma in patients with acute brain injury, the patient's consciousness is blurred, there is disorientation, and after the consciousness is completely awake, there may be fragmentary memory or total forgetting of the disease. Individual cases are in a conscious interval. There may be renewed disturbance of consciousness, and late amnesia occurs. Most of the loss of consciousness after head trauma is within 6 hours.
Malformation and fiction
(A) brain trauma: mainly seen in traumatic amnesia. Most patients with more extensive and severe brain trauma, loss of consciousness for 6 to 72 hours or more, after the recovery of consciousness, there are still time and space orientation disorders, showing no serious memory impairment, can not be firmly recorded The impression that the residence perceives, especially the most recent things are most forgotten. The patient can't remember the name of the person who touched it. I can't remember the work and the process that I did on the day. I can't even find my own ward and bed. The patient often uses fictional people. And things to fill the forgotten situation, to cover up their memory ambiguity, although it is fictional, but like telling the real thing, when you ask questions, you can answer it casually, the patient expresses euphoria, talks freely, sometimes the emotion is not hidden If you are irritable, it can last for several months.
(2) Alzheimer's disease: In the aging process of life, the onset of memory often occurs first, first forgotten, followed by loss of distant memory, fiction and misconception, misunderstanding, orientation and speech Obstacles, with the increase in dementia, the above symptoms are also aggravated, the ability to work is reduced, and life cannot take care of themselves.
(3) toxic mental disorder in wine: also known as Wernicke encephalopathy. Often acute onset, sudden onset of disturbance of consciousness and paralysis, but also directional loss, memory impairment and fiction, often with seizures, followed by indifferent and progressive dementia.
(4) Toxic psychosis: Mild industrial toxic psychosis, often causing symptoms of neurosis, such as memory loss, fatigue, insomnia, and emotional instability. Severe post-poisoning mental disorders may have rapidly developing disorientation, memory impairment, and judgment of damage, often with obvious disturbances of consciousness. For memory defects after recovery of consciousness, they may be replaced by misconstruction and fiction, and may be accompanied by other A variety of mental symptoms, such as hallucinations, delusions, and so on.
(5) Paralytic dementia: recessive onset, slow development, early symptoms of neurasthenia, work ability gradually decline, the development period is mainly the change of intelligence and personality, memory is significantly reduced, from near memory to far memory, Often misplaced and fictional, there may be a variety of delusions, emotional instability, irritability, advanced dementia is becoming more serious, unrecognizable to family members, indifferent emotions, can not understand simple problems, and instinctive activities are relatively hyperactive, and even intent Inverted. In addition, patients often have physical symptoms and signs of the nervous system.
Latent memory, old things like new diseases, familiar feelings and repetitive memory errors
(1) Epileptic mental disorder: Most of these mental symptoms involve the function of temporal lobe, one of which is the episode of cognitive impairment, mainly characterized by memory and concept episodes, and the manifestations of memory impairment are self-consciousness disorder and recall errors. The patient has symptoms such as forgetfulness, similarity, past experience, past events such as new and never experienced, and can not recall the past experience during the attack, but can be remembered after the attack. There may also be disintegration symptoms such as feelings of closeness and non-reality. In the dream state of epilepsy, the patient can express the daily life of the people as the first time, the familiar living environment, such as the first place, completely unfamiliar, can have repetitive professional operation, and can have a dream full of illusion delusion experience world.
(2) Personality disintegration neurosis: Acute onset, the patient suddenly feels the size, shape and color of the surrounding objects, and feels that the world is novel, special, and strange, as if he were in a dream, and some can also be expressed as What he was familiar with in the past became strange. When the patient is in this situation, there will be varying degrees of anxiety or fear.
(C) brain organic psychosis: brain organic diseases caused by various reasons, serious memory disorders, can appear strange, familiar, etc., but generally have their own unique medical history and body and The signs of the nervous system can also have abnormalities in the EEG.
(4) Functional psychosis
1. Depression: mainly manifested as decreased mental activity, inhibition of thinking activities and depression, etc. On the basis of low mood, there may be emotional loss, alienation and strangeness, often seeing the outside world dim and gloomy. With serious anxiety and suicidal ideation.
2. Schizophrenia: In the early manifestations of schizophrenia, the patient may experience special discomfort and head pressure. On the basis of somatosensory and body-shaped sensory disturbances, speculative symptoms and perception may occur. Comprehensive barriers are more common. A small number of patients may appear to be similar and non-realistic. They think that the world is not true, there is a sense of strangeness, and there are generally identity disorders. In addition, there are other obstacles in thinking and emotion. .
3. Hysteria: There are obvious mental factors in the onset of the disease. The patient has a high degree of suggestiveness and self-suggestion. In the state of consciousness disorder, the time lasts for a long time, and can replay childhood life or replay the battlefield life, etc. The orientation is incomplete, the association is suppressed, the judgment is lacking, and sometimes the patient may have illusions and hallucinations, but it is closely related to the mental factors.
