Case Report on Anterograde Amnesia

Question: Write about the Case Report on Anterograde Amnesia. Answer: Patients Background Jeremy Cust, a 27 years old male patient is an averagely intelligent person. He was an athlete and was a Law student at Cambridge University. He lives alone. He was found to have anterograde amnesia many years ago when he has collapsed in his professors office during the teaching session. He was in unconscious state with sudden seizure episodes and spillage of blood everywhere. MRI scan has showed that there was a severe damage in the pathway of the hippocampus. He has developed anterograde amnesia because of an accident and is unable to develop newer memories after that incident. This condition has made him to micro-tape or writes down in a journal to recall moments. Because of his amnesia, he is unable to continue his Law profession and is greatly supported by his mother. Description of Impairment Neurologic-Examination Jeremy has anterograde amnesia after a head injury that has damaged the pathway of hippocampus (Mastin, 2010). His GCS at the time of post-accident was 7/15 and currently it is 15. His physical examination was completely normal and had no other abnormalities. The cranial nerves, motor with sensory neurological-examination was normal. Jeremy was friendly, highly cooperative and affable with upset speech. Jeremy has good insight about his memory loss. He has severe anterograde amnesia with memory impairment and is unable to remember what he eats daily and doesnt recognize the contacts in phone, faces, names as well as places (Michael, 2005). He forgets what the therapist teaches him and has to record everything to recall. If not, he will repeat same questions several times (Mastin, 2010). His episodic memory is affected whereas semantic memory is almost intact. Cognitive-Assessment Jeremy is unable to form newer memories from the point that is presented and is unable to recall recently formed memories because of the inability to move information into longer-term memory (Squire, 2011, Sherer, 2014). His declarative memory (recollecting) has impaired but procedural memory (learning skills) remains intact (Mastin, 2010). Jeremy is able to remember how to do tasks as preparing meals but doesnt remember what he has eaten last day. He is unable to add recent memories into his past and so his life has changed dramatically. His impairment has made him to change his career from lawyer to furniture craftsmen. Jeremy is oriented to time, place and person. He remembers his friends but forgets what he speaks to them unless recorded. He speaks clearly, freely and fluently. He is able to recognize the persons touch. He is attentive to his therapists but forgets all the recent information if not recorded (Squire, 2011). Digital span tests showed that he can make forward span b ut delayed reverse span. Personality-Assessment His amnesia has not changed his personality from him as well as his sense of self. He is depressed and frustrated because of traumatic incident that has made him to change his profession. Assessment MRI-scan shows that there was a severe damage in the pathway of the hippocampus. Neuropsychological examination shows that his Galveston-orientation with amnesia testwas 80/100 indicating normalcy. He doesnt remember the time, mode of admission and transport and events after injury. He remembers his town but not his building. Symbol-digit modalities test is used to assess attention, which reveals that he has no cognitive difficulties (writing, speech/visual), except difficulties in recollecting information (Kiely, 2014). The d2-test for attention shows that he is attentive to his therapists (selective attention) but forgets all the recent information (no sustained attention) if not recorded (Mastin, 2010). His finger-tapping and grip-strength test shows that he has mild tremors while writing but was able to write. Token-test, controlled-oral word-association and Boston-naming test shows that his receptive as well as expressive language is normal and clock-drawing and Rey-figure test shows that he has good visual-spatial organization. Halstead-Reiten Neuro-psychological Battery shows that his visual, auditory with tactile aspects are normal. WAIS scale shows that he is moderately intelligent man and is able to perform activities. Wechsler-memory scale and Rey-auditory verbal-learning test indicates that his declarative memory was severely affected but his procedural memory remains intact. Test for higher-order cognitional processes suggests that he has mild difficulty in solving problem but has self-monitoring with self-regulatory skills. He has good adaptive skills. Beck depression-inventory and depression-anxiety stress scale indicates that he has mild depression. He was given with drug citalopram for seven days to reduce his depressive features. Now he is on psychotherapy to overcome his depression. Impact of Anterograde Amnesia on Jeremys Life Jeremys anterograde amnesia has affected his day-to-day activities severely. He has inability to develop shorter-term memories and hence unable to recollect memories. The most terrible thing is that he is unable to add newer information that makes him to live from moment to moment existence. But he lives alone courageously by micro-tape recording or noting the information in a journal including breakfast, phone numbers, etc. He has changed his profession from Lawyer to furniture crafting as it suits his impairment. He manages with his old memories and his procedural memories though his declarative memory has affected (Kipps, 2005). Jeremy carries out all his daily activities by noting down all the moments and executing it. He notes down the therapy sessions to proceed with it. Rehabilitation Jeremy was rehabilitated by multi-disciplinary neuro-psychologist by counselling and helping him to cope with deficits. Physical-therapists have trained him to promote motor control, strength and balance with coordination. Occupational-therapists have trained him to improve sensori-motor functioning, daily-activities and work-based skills. Psychotherapy was given to cope with impairment and adjust with it. He was assisted to use compensatory strategies as computers, typed-notes and beepers to aid in performing activities. He was demonstrated about environmental-adaptation methods as compensatory-technique education to train, organizational-techniques, visual-imagery with verbal-labelling. Other techniques as implicit-tasks, speech with mnemotechnics were used (Gordon,2006). He was advised to use external reminders to facilitate skill acquisition (De-Guise,2005). He was helped with cognitive re-mediation to substitute and restore his impaired function and was given with familiar tasks to improve his performance (Wixted, 2010). Reference De-Guise. (2005) Effect of an integrated reality orientation programme in acute care on post-traumatic amnesia in patients with traumatic brain injury, Brain Injury. 19, pp. 353-362. Gordon, W.Aet al.(2006) Traumatic Brain injury Rehabilitation. State of the Science, American Journal of Physical Medicine and Rehabilitation. 85, pp. 343-382. Kiely. (2014)The Symbol Digit Modalities Test: Normative Data from a Large Nationally Representative Sample of Australians, Arch Clin Neuropsychol. 29 (8), pp. 767-775 Kipps, C.M. (2005) Cognitive Assessment For Clinicians, J Neurol Neurosurg Psychiatry. 76(1), pp. i22i30. 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