Memory Disorders

Memory Disorders, like “learning disabilities”, is not a term you will find in the “Diagnostic & Statistical Manual of Mental Disorders.”  Neither term is found in either edition.  This is the guide used by many American insurance companies for procedure codes and diagnostic criteria.  “Memory Disorder” is an oft used term by professionals and laypeople alike.  It is likely most people are trying to describe difficulty recalling verbal or visual information, in the absence of another cognitive impairment.  The DSM system refers to memory disorders as an “Amnestic Disorder.”

It is good to rule out a medical factor affecting a person’s ability to think; that is their cognition.  The official diagnostic nomenclature is an “Amnestic Syndrome (due to a general medical condition)”.  The first thing to realize is that a memory impairment caused by a medical condition is generally of rapid onset and dramatic.  Trauma to the central nervous system is the most common cause.  Viral and bacterial infections of the brain may cause mild to profound memory impairments as well.  The damaging factor does not have to originate in the central nervous system.  Low oxygen saturation in the blood and bodily dehydration are common causes of a memory impairment secondary to a medical condition.  Specific vitamin deficiencies may cause memory impairment, as well as unwanted reactions to many medications.  Most of these medical conditions also reduce attention, vigilance, and orientation to one’s environment.  Perhaps the most difficult to detect are sub-clinical vitamin deficiencies and dehydration that test within the average range, but produce a measurable decline in cognitive performance.

What should we expect from our memories in the first place?  By the age of 50, we all begin to have a reduced ability to find names for things, and difficulty recalling verbal information without some prompt or context.  Many people call this the CRS Syndrome; alternately entitled “can’t remember sh–.”  The differential diagnosis is the recognition memory of the person.  Utilizing memory tests with a recognition component reduces the gulf between chronological ages.  It is also necessary to utilize tests that have been normalized on different age groups.  These tests attempt to make a level playing field between different ages.  The differential diagnosis between normal aging and a dementia should be performed by a trained professional.

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If you believe you have a memory impairment, consider consulting a neuropsychologist.  They will administer tests normed for your specific age, and often education as well.  Do not consider yourself diagnosed based upon a test in a magazine or on the internet.  Memory is built upon other cognitive skills, such that verbal or visual memory should not be assessed in isolation.

Many people confuse poor immediate attention as a memory impairment.  It is likely at the root of many medical causes of an “Amnestic Disorder.”  The ability to sustain one’s attention over time is called “vigilance”.  If a person has poor immediate attention, they will have difficulty encoding new verbal and visual information.  If, after a delay, the person can recall the same small amount of information, then attention is likely a greater factor then memory.  It is also difficult for the attention impaired to chunk (organize) information for greater recall.

The initial step in the diagnosis of a “memory disorder” is to administer tests to determine if the disorder exists.  If the disorder exists, then consider ruling out medical factors causing the poor visual and/or verbal memory functioning.  If no medical factors can be determined, then the next step is remediation.  Immediate attention is the most proven remediable skill.  The remaining treatments are largely compensatory strategies to build on the patient’s cognitive strengths.  Please leave comments regarding this post on “memory disorders” in the space provided below.

Grief

Grief is not considered a mental disorder.  It is not even listed by its own name, but goes under the title of “bereavement” in the DSM-IV.  Most English speakers will typically use the term of “grief” to describe their emotional reaction after the death or separation from a significant other.  The mental and physical symptoms are not readily distinguishable from a Major Depression or an Adjustment Disorder.  About 30% of grief reactions meet the criteria of a Major Depression, and about 10% have psychotic symptoms.

Professionals do not regard grief as abnormal if the worst of the suffering is over by 6 months; a year at the longest.  Death from suicide or a medical illness is increased significantly during the grief reaction.  The immune system is depressed, cortisol levels increase, and there is an increased risk of heart disease and cancerous malignancy during the course of a grief reaction.

Most mental health clinicians will not diagnose grief or bereavement before six months from the time of the loss, though the DSM IV gives 2 months as the guideline.  It is normal to have thoughts about actions one might have taken to save their life or keep the person as an intimate attachment.  Grieving individuals often feel as if they should have died, instead of their significant other.  They typically feel worthless, and experience a profound slowing of thoughts and actions.  There is often impairment in social and occupational functioning for several months.  It is even common to hear the voice of, or see a fleeting image of, the lost significant other.

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It is not the intensity of suffering, but the duration and quality of the suffering that differentiates depression from grief.  Visual and auditory hallucinations are common in grieving, but considered abnormal if they persist longer than 6 months.  Additionally, the hallucinations of a grieving person are always associated with the missing object; never with someone physically present or personally unknown to the bereaved.  For example, if a person experiences hallucinations of their dead father, after the death of their mother, and a voice tells them to kill their brother, this is less grief than a psychotic disorder.  Expressions of worthlessness and regret are directly connected to the missing object; otherwise the grief is likely part of a chronic mental illness.  Thoughts of death are focused on the missing object.  Desiring to die in the place of the deceased, or feeling that life is not worth living without their significant other, is expected and considered normal.  Harboring a plan to commit suicide unrelated to the missing object is severe Major Depression.

I hope this article clears up some of the confusion between normal grief or bereavement at the loss of a significant other, and the more unrelenting chronic forms of mental illness.  Many people are surprised to learn the level of suffering mental health professionals consider normal in the bereaved individual.  They are also surprised that auditory and visual hallucinations of the lost object are common and considered to be within normal limits.  As professionals do not recommend treatment for normal bereavement, family and friends of the grief stricken play an invaluable role.  Mental health professionals may be consulted if the condition fails to lessen, or even becomes increasingly severe.  Most importantly, do not criticize their emotional reactions to the loss.  It is best to be a kind and patient listener, rather than an ersatz psychologist.  Encourage the mourner to talk at their own pace and rate.  Encourage the bereaved to participate in life without being pushy or critical.  Also pay special attention to important dates in the relationship between the bereaved and the lost object.  Mourners may have worked through most of their grief, but find themselves falling to pieces during times when they would have been together; e.g., the Christmas holidays, birthdays, etc.  Please leave comments about this article on grief in the space provided below.