Awareness of disease state without explicit knowledge of memory failure in transient global amnesia.

INTRODUCTION

Transient global amnesia (TGA) is a syndrome characterised by the rapid onset of antero- and retrograde amnesia, accompanied by temporal disorientation and iterative questioning. It is now established that the acute phase is associated with a raised level of anxiety and a depressed mood. We conducted a thorough investigation of patients' perceptions of their disease state, focusing on the links between their lack of explicit knowledge of amnesia during the acute phase and their emotional experience.

METHOD: Explicit knowledge of memory deficits was assessed during TGA by means of an original scale inspired by Bisiach et al. (1986) and self-reported scales measuring patients' perceptions of their current memory and their cognitive and behavioural functioning. At the same time, we probed the patients' emotional experience (sources of worry, and levels of worry, anxiety and depression) via questionnaires. Data were collected from 20 patients in the acute phase, 16 in the peri-acute phase, 16 who were assessed the day after the episode and 14 healthy controls. Each patient underwent a follow-up examination 2 months later.

RESULTS

Patients in the acute phase displayed a lack of explicit knowledge of their amnesia and overestimated their memory performances. They also expressed higher levels of worry and anxiety than controls, and a more depressed mood.

CONCLUSIONS

Although they were aware of their disease state, the TGA patients were unable to identify the nature of their memory deficits and overestimated their memory performances. These memory misperceptions and the inability to acknowledge memory failure occurred concomitantly with changes in the patients' emotional state. This particular pattern of awareness could be regarded as a reaction to the suddenness and massiveness of the amnesia.