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"Amnesia"
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097 A rare case of recurrent transient global amnesia
IntroductionTransient global amnesia (TGA) is a clinical syndrome characterised by the sudden onset of anterograde amnesia accompanied by repetitive questioning, sometimes with a retrograde component, lasting up to 24 hours, without compromise of other neurologic functions.CaseA 71 year old male presented to the neurology clinic with history of recurrent episodes of reversible anterograde amnesia with repetitive questioning. His first two episodes were in May 2016 and clinically very typical of TGA. After that he had recurrent episodes and he noted that they were happening on a monthly basis. He had an episode on 24 March 2017 at Yangon airport as he was returning from a trip to Myanmar. He had had three episodes in February 2017 and two in March and April 2017 and one episode on 20 May 2017. Initial MRI brain showed frontotemporal atrophy suggestive of Alzheimer’s disease and there was hypo-perfusion on the nuclear medicine study. EEG did not show any epileptic activity. His partner described a typical episode where the patient lost his memory for the preceding 24 hours and he had repetitive questioning such as ”what day is it” repeatedly. During the entire episode, he was conscious and able to converse appropriately. He had another episode of amnesia on 19 August and was admitted and underwent an MRI of brain, which showed characteristic punctate abnormalities in the bilateral hippocampi on B2000 DWI.ConclusionThe estimated annual rate of recurrence of TGA is 5.8%. Diagnosis is made from typical clinical features and typical MRI DWI findings of punctate lesions in the hippocampal with a DWI resolution of B=2000, and a thin slice thickness of 2 to 3 mm. Our patient had 11 documented episodes of transient amnesia and was a diagnostic dilemma until the characteristic hippocampal abnormalities were demonstrated on MRI.
Journal Article
A Randomized Controlled Trial of Multicomponent Exercise in Older Adults with Mild Cognitive Impairment
To examine the effect of multicomponent exercise program on memory function in older adults with mild cognitive impairment (MCI), and identify biomarkers associated with improvement of cognitive functions.
Subjects were 100 older adults (mean age, 75 years) with MCI. The subjects were classified to an amnestic MCI group (n = 50) with neuroimaging measures, and other MCI group (n = 50) before the randomization. Subjects in each group were randomized to either a multicomponent exercise or an education control group using a ratio of 1∶1. The exercise group exercised for 90 min/d, 2 d/wk, 40 times for 6 months. The exercise program was conducted under multitask conditions to stimulate attention and memory. The control group attended two education classes. A repeated-measures ANOVA revealed that no group × time interactions on the cognitive tests and brain atrophy in MCI patients. A sub-analysis of amnestic MCI patients for group × time interactions revealed that the exercise group exhibited significantly better Mini-Mental State Examination (p = .04) and logical memory scores (p = .04), and reducing whole brain cortical atrophy (p<.05) compared to the control group. Low total cholesterol levels before the intervention were associated with an improvement of logical memory scores (p<.05), and a higher level of brain-derived neurotrophic factor was significantly related to improved ADAS-cog scores (p<.05).
The results suggested that an exercise intervention is beneficial for improving logical memory and maintaining general cognitive function and reducing whole brain cortical atrophy in older adults with amnestic MCI. Low total cholesterol and higher brain-derived neurotrophic factor may predict improvement of cognitive functions in older adults with MCI. Further studies are required to determine the positive effects of exercise on cognitive function in older adults with MCI.
UMIN-CTR UMIN000003662 ctr.cgi?function = brows&action = brows&type = summary&recptno = R000004436&language = J.
Journal Article
The missing hours
\"Murderers are rarely who you imagine them to be ...\" One moment, Selena Cole is at the playground with her children ... the next, she has vanished without a trace. With engrossing characters, devilish twists, and evocative prose, The Missing Hours is that rare page-turner--as satisfying and complex as it is unpredictable.
Book
PO028 Time 2: a replication study of transient epileptic amnesia
BackgroundWe described the first large cohort of patients with Transient Epileptic Amnesia (TEA) in 2007 (n=50). Smaller series of patients have recently been reported from France and Italy. Continuing referrals to our website (http://projects.exeter.ac.uk/time/) from around the world suggest that the condition remains underrecognised. Here we describe findings in British patients referred to our study since 2007.Methods66 patients were recruited using previously established diagnostic criteria. We assessed clinical features and performed neuropsychological evaluation, using our previous test battery.ResultsTEA develops in later life (mean age of onset=60.5 years, mean age at presentation=64.8 years) and is more common in males (M:F=46:20). Attacks are typically infrequent (median 12/yr) and commonly occur on waking (61 of 66 cases). Duration of TEA episodes is variable, although the most commonly reported duration is 15–30 min. Interictal abnormalities are common and include Accelerated Long-term Forgetting (51/66), Topographical Amnesia (48/66) and Autobiographical Amnesia (58/66). Patients respond well to medications (attacks ceased in 61/66).ConclusionsThis second TEA cohort supports the existence of a distinctive amnestic presentation of late-onset temporal lobe epilepsy. We are currently investigating its aetiology and the effects of anticonvulsant treatment on interictal memory disturbance.
Journal Article
Pandorum
\"Two crewmen awaken from hyper-sleep aboard a spacecraft. None of their equipment is working, and their memories are incomplete. What was their mission? How much time has passed? Where are they? Who are they? As they try to piece things together, they discover they are not alone, and the ship's new inhabitants - tribal warriors carrying crudely made weapons - are moving among them, intent on killing all aboard. As the space travelers unravel the frightening and deadly secrets the ship harbors, they realize the survival of mankind hinges on their actions. They must regain control of the ship before PANDORUM takes over\"--Copyright descriptive material.
DVD
IVIG treatment of mild cognitive impairment due to Alzheimer's disease: a randomised double-blinded exploratory study of the effect on brain atrophy, cognition and conversion to dementia
ObjectiveTo determine the effect of intravenous immunoglobulin (IVIG) on brain atrophy and cognitive function in mild cognitive impairment (MCI) due to Alzheimer's disease (AD).Methods50 participant 50–84 years of age with amnestic MCI were administered 0.4 g/kg 10% IVIG or 0.9% saline every 2 weeks for a total of 5 infusions (2 g/kg total dose) in a randomised double-blinded design. MRI brain was completed at baseline, 12 and 24 months. Cognitive testing was completed at baseline and every 4 months. Participants were stratified into early and late (LMCI) MCI stages. Average annualised per cent change in ventricular volume was computed as a measure of brain atrophy.ResultsThere was significantly less brain atrophy (p=0.037, adjusted for MCI status) in the IVIG group (5.87%) when compared with placebo (8.14%) at 12 months; at 24 months, the reduction in brain atrophy no longer reached statistical significance. The LMCI participants who received IVIG performed better on Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog; p=0.011) and Mini-Mental State Examination (MMSE; p=0.004) at 1 year; these differences were not present after 2 years. There was no difference in conversion to AD dementia between the treatment and control groups after 2 years; however, at 1 year, there were fewer conversions from LMCI to AD dementia in the IVIG group (33.3%) when compared with control group (58.3%).ConclusionsThis exploratory study provides limited evidence that a short course of IVIG administered in the MCI stage of AD reduces brain atrophy, prevents cognitive decline in LMCI and delays conversion to AD dementia for at least 1 year; however, this effect of IVIG appears to wane by 2 years.Trial registration numberClinicalTrials.gov, NCT01300728.
Journal Article
The maze runner
Sixteen-year-old Thomas wakes up with no memory in the middle of a maze and realizes he must work with the community in which he finds himself if he is to escape.
Book
Encoding of contextual fear memory in hippocampal–amygdala circuit
In contextual fear conditioning, experimental subjects learn to associate a neutral context with an aversive stimulus and display fear responses to a context that predicts danger. Although the hippocampal–amygdala pathway has been implicated in the retrieval of contextual fear memory, the mechanism by which fear memory is encoded in this circuit has not been investigated. Here, we show that activity in the ventral CA1 (vCA1) hippocampal projections to the basal amygdala (BA), paired with aversive stimuli, contributes to encoding conditioned fear memory. Contextual fear conditioning induced selective strengthening of a subset of vCA1–BA synapses, which was prevented under anisomycin-induced retrograde amnesia. Moreover, a subpopulation of BA neurons receives stronger monosynaptic inputs from context-responding vCA1 neurons, whose activity was required for contextual fear learning and synaptic potentiation in the vCA1–BA pathway. Our study suggests that synaptic strengthening of vCA1 inputs conveying contextual information to a subset of BA neurons contributes to encoding adaptive fear memory for the threat-predictive context.
Previous studies implicate the hippocampal–amygdala pathway in contextual fear conditioning, in which animals learn to associate a neutral context with an aversive stimulus and display fear responses to dangerous situations. Here the authors show that selective strengthening of hippocampal–amygdala pathway contributes to encoding adaptive fear memory for threat-predictive context.
Journal Article