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The
Memory Doc by Jill Joyce, PhD Volume
1: 32
*
Memory Thought: Serenity/Senility Prayer *
Mission Statement
*
Terminology and Memory Loss * Memory Loss Glossary Defined
*
The Most Severe Type of Memory Loss ********************************************
Serenity/Senility
Prayer God
grant me the senility to
forget the people I
never liked anyway, the
good fortune to
run into the ones I do, and
the eyesight to tell the difference. ********************************************* * Terminology: A Memory Loss Glossary Hello
again! The humorous Serenity/Senility prayer above should
be a clue as to where I'm going today. If
you've been here before, you know--it's hard for me to tolerate
the problems we can create by misusing labels related
to memory loss and cognitive disturbances. The
word "senility" is one of those misused terms. Thus,
I believe it's important that we understand what we are
dealing with--medically speaking--when there is a memory loss
concern. So
this week, just to get all of the formidable memory loss labels
out in the open, I'm providing a copy of the glossary from
my book "Don't Forget" (Appendix A). As
shown many times over, sometimes memory loss can be humorous,
but much of the time, it's just a very serious matter. Hopefully,
this information will help you if you must deal with
a memory loss situation and assist you when you speak to
your doctor. When
I talk to people about memory loss, it seems one thing most
people don't understand is how many different variations there
can be that constitute this problem. In
fact, my dear friend and colleague Dr, Andrew Boswell recently
read through “Don’t Forget” and commented that reading
the glossary was very enlightening and helpful for him. all
of you. These
specifics are not derogated only from problems common to
the elderly or to young people, to dementias or to head trauma
or even to post-traumatic stress syndromes, to ADHD, ADD,
or to learning disabilities. No,
these specifics are names, labels, and concepts used to
describe everyone of us whenever we manifest difficulties and
differences in our cerebral cortex. These
things can happen after surgery, stroke, head injury, wrong
medicines, toxins, diseases, drugs, alcohol abuse, hormone
imbalances, emotional abuse, psychological trauma and
even vitamin deficiencies. We can even be born with and
inherit some of these tendencies. When
focus and memory are thought to be the issues, the difficulties
described can run rampant among both the elderly
and school-aged children. In
many respects, these terms ought more rightly to be thought
of as aspects of our humanness that make us each unique
individuals instead of just deficiencies.
possess some of these. Some of them
our strengths. Some that
weaknesses. Though
the list may seem like just a lot of Greek, remember, much
of it is from the Greek language. But my definitions will
be in simple English. (This is a thorough but not exhaustive
list.) ********************************************** *
Terms (defined below) ~The Amnesias ~Aphasia ~Receptive Memory Loss ~Auditory ~Expressive Memory Loss ~Anomia/Dysnomia
~Apraxia/Dysarthrias
~Alexia/Dyslexia ~Gross/Fine Visual Discrimination
~Spatial Disorientation ~Acalculia ~Agraphia/Dysgraphia
~Agrammatism ~Astereognosis/Dysstereognosis ~Jargon ~Neologisms ~Paraphasias ~Perseveration ~Global Memory ~Age-Associated Memory Loss (AAMI), ~Age-Related Cognitive ~Minimal Cognitive Impairment (MCI) ********************************************** *Memory Loss Glossary
(from "Don't Forget: What Drug and Insurance Co.'s Don't Want You To Know About Memory Loss") ~
AMNESIA: Inability to remember experiences before a head trauma,
also called "retrograde amnesia," or to remember upcoming
experiences after a head trauma, "anterograde amnesia". The
anterograde amnesia category also affects learning of new
information. These persons can also experience symptoms
described throughout this glossary as "aphasic." ~
APHASIA: "Aphasia" is a language memory loss disturbance that
crosses over all necessary language modes. The
four main language modes (or modalities) include: Understanding
spoken language (reception), reading, talking
(expression), and writing (Schuell, 1974). This
glossary contains numerous characteristics of aphasia memory
loss unless otherwise specifed. ~ RECEPTIVE Memory Loss Aphasias: These are called decoding understanding and “.
. . patients who show some impairment of ability to
understand spoken language. This
memory loss impairment is characterized by reduced comprehension
of spoken words, by reduction of the auditory
retention span, and usually, in addition, by
some impairment of the ability to discriminate between
similar auditory patterns” (Schuell, 174, p. 93). ~
AUDITORY Discrimination: The inability to discriminate between
identical and dissimilar auditory signals has been called
“auditory discrimination.” Sometimes,
this discrimination can be so severely impaired
in a patient that “. . . much of the language they
hear is virtually unintelligible to them” (Schuell,
1974, p. 93). This
has been clearly demonstrated to be “not related to hearing
loss but instead to interferences with the processing
of the complex patterns of acoustic stimuli that
language presents to the ear” (Schuell, 1974, p. 92). ~
“COMPREHENSION is not an all-or none phenomenon. Many aphasic
patients comprehend frequently used words but fail
to understand words used less often” (Benson, 1985, p.
24). ~
EXPESSIVE Memory Loss Aphasias: These are encoding disorders
and encompass the difficulties in verbalizing and
speaking (De Vito, 1970). First,
memory loss/aphasic patients have difficulty in “word
finding” as a result of their weak vocabulary. Their
speech is fragmented and disjointed due to a condition
known as “anomia” (to be explained below) and,
of course, due to reduced attention span and lack
of focus. Patients
with severe “word finding” problems talk in single
words first, followed later by phrases and short
sentences (Schuell, 1974). ~
AGNOSIAS: “Agnosia” bears resemblance to the difficulties
of poor discrimination and poor reception just
discussed, but implies a more total “absence of knowledge”
(Reitan & Wolfson, 1992, p. 295). In
aphasia, agnosia is an “ . . . impairment of ability to
recognize the symbolic meaning of stimulus material” as
in reading, writing, listening, or speaking (Bauer & Rubens,
1985; Reitan & Wolfson, 1992, p. 295). ~
AUDITORY agnosia applies “ . . . to the total inability to
differentiate all varieties of sound,” from fine speech sounds
to grosser environmental noises (Spreen et al., 1995,
p. 430). This
also occurs in auditory discrimination, but at a less
severe level. Other “agnosias” also bear mentioning. ~
VISUAL agnosia, an inability to diffferentiate visual information
and symbols affects reading ability. ~
TACTILE agnosia affects the reception of information touched
and felt by the skin in and about the environment. ~ DYSGNOSIA: “In contrast to "agnosia," "dysgnosia"
represents significance
of information reaching the brain” (Reitan &
Wolfson, 1992, p. 301). ~
ANOMIA: This is a form of "aphasia" in which the ability to
retrieve common vocabulary words is affected and is also referred
to as a “word finding difficulty” (Benson, 1985, p.
24). This
aspect of aphasia most makes an aphasic individual like
a visitor in his or her own culture. He or she is familiar
with the language and often understands much more
than others realize, but cannot find the words. Again,
he or she is like “someone trying to use a language that
he or she once knew but now recalls only imperfectly” (Schuell,
1974, p. 87). "Anomia"
is undoubtedly the most common and well-known linguistic
memory loss difficulty and is caused by the overall
reduction of available vocabulary. Also,
because of the reduced verbal attention span, “The
aphasic patient can only hold a limited number of
words in his [or her] mind at a time” (Schuell, 1974,
p. 90). Words
that are most frequently used in the language will be
the “words aphasic patients can use first,” recover most
easily, and use most often thereafter (Schuell, 1974,
p. 90). “Anomia”
occurs across all language modalities: understanding,
reading, talking, and writing (Schuell, 1974). ~
DYSNOMIA: [Partial] “Impairment of the ability to name
objects, resulting from a brain lesion” (Reitan &
Wolfson, 1992, p. 301). Again,
as in the use of the terms aphasia/dysphasia, this
term, “dysnomia”, could probably be used more accurately
than “anomia” in describing that condition. However,
“anomia” has been the commonly accepted term used
to describe partial loss of the ability to name objects. ~
APRAXIA and DYSARTHRIA: These are motor disorders and
may coexist with aphasia, but are not due to aphasia. The
muscle weakness of “dysarthria” or the lack of voluntary motor
control of “apraxia,” which has been described as an "inability
to carry out motor activities on verbal command," may
be occurring simultaneously with the aphasia (Benson, 1985,
p. 24). This
is not to be confused with any forms of paralysis to the
speaking mechanism. Although
“dysarthria” and “apraxia” are a result of stroke or
head trauma, these disorders can exist alone or in combination
with the memory loss of aphasia. Typically,
“right hemispheric lesions” are responsible for these
motor deficits and “do not cause aphasia [memory loss]
in most people” (Kertesz, 1985, p. 48). In
addition, the level of impairment of the articulation affected
by “dysarthria” and “apraxia” is "not correlated with
the severity of language deficit" (Schuell, 1974, p.
97). ~
ALEXIA: Loss of the ability to read and understand the symbolic
significance of words. This is more commonly and
appropriately coined “dyslexia.” ~
DYSLEXIA: “Impairment (due to a brain lesion) of reading ability
and the understanding of the symbolic significance of
words. A symptom of [aphasia] dysphasia” (Reitan & Wolfson,
1992, p. 301). All
aphasia memory loss patients will show some reduction Of
reading vocabulary and in verbal attention span. This Will
affect retention and integration of what they read. ~
VISUAL Discrimination, (Fine and Gross Levels): Inability to discriminate
between visual symbols. Some
patients will have a more marked impairment of that
could cause confusion in reading between letters and words
that look alike called “FINE visual discrimination.” As
severity increases, “GROSS visual discrimination” could be
affected and cause patients not to recognize that letters are
actually different from another or to see words or lines on
a page. ~
SPATIAL Disorientation, a loss of sense of direction or position,
may cause a person not to keep his or her place and
follow well while reading (Schuell, 1974, p. 94). ~
VISUAL Field Neglect also coined VISUAL Field Defect. The
person may be unable to see well either to the left or
to the right (Schuell, 1974, p. 94) in attempting to read
written material. ~
ACALCULIA: A disturbance of the ability to do mathematics as
related to the loss of memory and communication skills. ~
AGRAPHIA/DYSGRAPHIA: “A loss of ability to form letters when
writing, resulting when a brain fails to understand words
used less often” (Benson, 1985, p. 24). ~
AGRAMMATISM: A disturbance of the ability to properly use well-known
grammatical forms. One common example is the confusion
between pronouns informing others of gender, like
using ‘him’ for ‘her’ or ‘she’ for ‘he,’ etc. ~
ASTEREOGNOSIS: “Inability to identify objects through the sense
of touch” (Reitan & Wolfson, 1992, p. 296). ~ DYSSTEREOGNOSIS: “Impairment of ability [a partial inability] Wolfson, 1992, ~
DEMENTIA: “Significant deterioration of intellectual and cognitive
functions (Reitan & Wolfson, 1992, p. 300). ~
ASSOCIATED Deficits that often overlap aphasia memory losses
include: ~
DYSPHAGIA: difficulty in swallowing ~
RIGHT-left confusion in reading and writing ~
CONSTRUCTIONAL deficits in connecting language ideas. ~
FRONTAL lobe deficits of distractibility, poor attention,
personality changes, and loss of motivation. ~
JARGON: Connected speech utterances having little or no meaning. ~
NEOLOGISMS: Made up words. ~
PARAPHASIAS: Word substitutions that have a similar sound to
the target word. (E.G. Did you take the dog outside? Yes, the
dog beeped and booped.) ~ PERSEVERATION: Abnormal and severe disability in repetition stuttering. ************************************************** *
The
Most Severe Type of Memory Loss stroke, etc.) GLOBAL
Memory Loss of Aphasia: A total loss of language, in
which both expressive and receptive language of all varieties
are seriously impaired (Benson, 1985; Damasio, 1981;
Peach, 1987). These
patients understand little or nothing, speak only in stereotypical
utterances, if that, and as a rule, have limited recoveries
(Kertesz & McCabe, 1977). Global aphasia represents the most severe form of memory loss However,
global patients have been known to make dramatic recoveries
with treatment, especially during the initial six
months to a year after the disorder ensues. The
probability of improvement often seems limited due to their
apparent lack of response, but ongoing attempts at language
stimulation can be rewarded suddenly and significantly. However,
there are never any guarantees and because of that
concern, many researchers believe that the majority of
global patients do not improve immensely. As
researcher and therapist of this population for 20 years, I
concur, global memory loss aphasia is the most difficult type
of rehabilitative memory loss to conquer. But
I hasten to add, ongoing treatment, in the face of periods
with little response, is often the missing variable in
the equation that could correct this form of aphasia memory
loss. The
reason for this lack of therapy is apparent. There are no guarantees
of success. However, there are no guarantees of failure
either. It
is fair and has not been unusual practice in the past to
give at least six months of retraining about 3-5 days per
week before deciding to stop therapy in such cases. ********************************************** These
are only some of the labels used by medical practitioners
to describe disorders that include memory
loss. If
there's one thing I could wish for all of us now, it would
be that we take really good care of ourselves to avoid
these problems. The
medical world can only play a small part in the future to
help us with these. It used to help and has the technology through
therapy to help. But managed care insurance systems have
removed the correct therapies for memory loss, learning, and
cognitive concerns. continues
to grow! Stay
well, Dr.
Jill E-Mail:
drjjoyce@att.net |
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