The term memory in psychiatry includes the accumulation of information, storage and timely reproduction of accumulated experience. Memory is considered one of the most important adaptation mechanisms, since it allows you to retain thoughts, past sensations, conclusions, and acquired skills in your head for a long time. Memory is the basis of the work of intelligence.

The mechanisms of memory are not fully understood to date. However, it is already reliably known that there is memory based on quickly formed temporary connections - short-term, and memory with stronger connections - long-term.

The basis of both types is the chemical rearrangement of protein structures, RNA and activation of intercellular synapses. The transition of information from short-term to long-term memory is facilitated by the work of the temporal lobes of the brain and the limbic system. This assumption was based on the fact that when these brain formations are damaged, the process of information fixation is disrupted.

General etiology of memory disorders

Most often, memory impairments are caused by organic pathology and are persistent and irreversible. However, the pathology can also be symptomatic of disorders in other areas of the psyche. So, for example, increased distractibility in combination with accelerated thinking in patients with manic syndrome leads to a temporary disruption in the capture of information. Temporary memory impairment also occurs with impaired consciousness.

The process of memory formation occurs in three phases: imprinting (registration), storage (retention) and reproduction (reproduction). The influence of an etiological factor can occur at any phase of memory formation, but in practice it is extremely rare to find out.

Classification of memory disorders

Memory disorders are divided into quantitative - dysmnesia, and qualitative - paramnesia. The first includes hypermnesia, hypomnesia and various types of amnesia. The group of paramnesias includes pseudoreminiscences, confabulations, cryptomnesias and echonesias.

Dysmnesia

Hypermnesia- a term that defines the involuntary, disorderly actualization of past experience. The influx of past memories, often with the smallest details, distracts the patient, interferes with the assimilation of new information, and impairs the productivity of thinking. Hypermnesia can accompany the course of manic syndrome and occur when taking psychotropic substances (opium, LSD, phenamine). An involuntary influx of memories can occur during epileptiform paroxysm.

Hypomnesia- weakening of memory. As a rule, with hypomnesia, all components of memory are affected. It is difficult for the patient to remember new names and dates. Patients with hypomnesia forget details of past events, cannot reproduce information stored deep in memory, and they increasingly try to write down information that they could previously remember without difficulty. When reading a book, people with hypomnesia often lose the general plot line, to restore which they constantly have to go back several pages. With hypomnesia, a common symptom such as anekphoria- a situation in which the patient, without outside help, cannot extract words, titles, names from memory. The cause of hypomnesia is often vascular pathology of the brain, in particular atherosclerosis. However, it is necessary to mention the existence of functional hypomnesia, for example, due to overwork.

Amnesia- a collective term that refers to a group of various memory disorders in which loss of any of its parts occurs.

Retrograde amnesia- amnesia that developed before the onset of the disease. This phenomenon can be observed in acute cerebral vascular accidents. Most patients note a loss of time immediately preceding the development of the disease. The explanation for this lies in the fact that in the short period of time before loss of consciousness, new information has not yet had time to move into long-term memory and therefore is subsequently lost forever.

It should be noted that organic brain damage most often does not affect information closely related to the patient’s personality: he remembers his name, date of birth, remembers information about his childhood, and school skills are preserved.

Congrade amnesia- memory loss during the period of illness. It is not so much a consequence of a disorder of memory function as such, but rather the inability to perceive any information. Congrade amnesia occurs in people in a coma or state of stupor.

Anterograde amnesia- amnesia that developed for events that occurred after the completion of the most acute manifestations of the disease. At the same time, the patient is quite communicative and can answer the questions posed, but after some time he is no longer able to reproduce the events that took place the day before. If anterograde amnesia was the cause of twilight impairment of consciousness, then the fixation ability of memory can be restored. Anterograde amnesia in Korsakoff's syndrome is irreversible, as it develops as a result of a persistent loss of the ability to record information.

Fixation amnesia- a term used to denote a sharp decrease or complete loss of the ability to retain newly acquired information in memory for a long time. Patients with fixation amnesia have difficulty remembering events and words that just happened or very recently, but they retain memory of what happened before the disease, and often their professional skills. The ability for intellectual activity is often preserved. However, memory disorder leads to such deep disorientation of the patient that there is no need to talk about independent work. Fixation amnesia is part of Korsakoff's syndrome and also occurs in atherosclerotic dementia.

Progressive amnesia- most often is a consequence of progressive organic damage to the brain and consists of a sequential loss of increasingly deeper layers of memory. In 1882, psychiatrist T. Ribot formulated the sequence with which memory is destroyed. Ribot's law states that hypomnesia first appears, then amnesia for recent events develops, after which events that happened long ago begin to be forgotten. Next, the loss of organized knowledge develops. The last things to be erased from memory are emotional impressions and the simplest automatic skills. The destruction of the surface layers of memory sharpens the memories of childhood and adolescence.

Progressive amnesia can occur in non-stroke cerebral atherosclerosis and accompany Alzheimer's disease, Pick's disease, and senile dementia.

Paramnesia

TO paramnesia include such memory disorders in which distortions or perversions of the content of memories are observed.

Pseudoreminescence- the process of replacing lost memories with other events that occurred in reality, but in a different time period. Pseudoreminences are a reflection of another point of the law on the destruction of memory: the content of the experience - the memory of the content - persists longer than the temporary relationships of events - the memory of time.

Confabulation is the process of replacing memory loss with fictitious events. Confabulations often indicate a loss of criticism and comprehension of the situation, since patients not only do not remember that these events never happened, but also do not understand that they could not have happened. Such substitute confabulations should be differentiated from confabulatory delusions, which are not accompanied by the loss of previous memories, but are manifested by the fact that the patient believes that the fantastic events that happened to him took place. In addition, replacement confabulations are a component of Korsakoff's syndrome, fantastic confabulations are part of paraphrenic syndrome.

Cryptomnesia- memory disorders, when the patient fills in its missing links with events that he heard about somewhere, read, or saw in a dream. Cryptomnesia is not so much a loss of information itself, but a loss of the ability to determine its source. Cryptomnesia often leads to patients taking credit for the creation of any works of art, poetry, or scientific discoveries.

Echomnesia (Pick's reduplicating paramnesia)- the feeling that something happening at the present moment has already happened in the past. Unlike the déjà vu phenomenon, with echonesia there is no paroxysmal fear and the phenomenon of “insight”. Echoomnesia can accompany various organic brain diseases, especially lesions of the parietotemporal region.

Korsakov's amnestic syndrome

The syndrome was described by the scientist S.S. Korsakov in 1887 as a manifestation of alcoholic psychosis. However, it was later noticed that a similar combination of symptoms can be observed in other disorders.

One of the important signs of Korsakoff's syndrome is fixation amnesia. Such patients cannot remember the name of the attending physician or the names of their roommates.

The second component of Korsakoff's syndrome is anterograde or retroanterograde amnesia. The patient tries to fill the gaps in memory with paramnesia.

Significant memory impairment leads to amnestic disorientation of the patient. However, in a patient with Korsakoff's syndrome, orientation in a familiar environment (for example, at home) can be preserved.

Comments

Olga August 17, 2011 I hope that Internet users who read this article will tell and warn their elderly loved ones against scammers, because the amount required for installing a “preferential filter” is equal to the amount of the pension, and the scammers come just in numbers when the pension should already be received and is kept in grandma's box; in addition, if there is not enough money, arrogant sellers offer to borrow the missing amount from neighbors or relatives. And grandmothers are responsible and respectable people, they themselves will go hungry, but they will pay off the debt for the unnecessary filter... Vasya April 18, 2012 decide on your location on the map Alexey August 17, 2011 It would be better if they sold books in offices as before :( Alexey August 24, 2011 if you have any problems using the program, please leave your comments here or email the author Milovanov Evgeniy Ivanovich August 26, 2011 Thank you, the program is good. If it is possible to make changes - the continuation of the certificate of incapacity for work by another user, we cannot remove the disease code, date of issue, gender. If it would be possible to simply make blank fields here, it would be great. Milovanov_ei vsw.ru EVK August 27, 2011 For doctors and health care facilities: on the website http://medical-soft.narod.ru the SickList program has been posted for filling out sick leave certificates by order of the Ministry of Health of the Russian Federation No. 347-n dated April 26, 2011.
Currently, the program is successfully used in the following health care facilities:
- GP No. 135, Moscow
- GB N13, Nizhny Novgorod
- City Clinical Hospital No. 4, Perm
- LLC “First Emergency Room”, Perm
- JSC MC "Talisman", Perm
- "Philosophy of beauty and health" (Moscow, Perm branch)
- MUZ "ChRB No. 2", Chekhov, Moscow region.
- GUZ KOKB, Kaliningrad
- Cher. Central district hospital, Cherepovets
- MUZ "Sysolskaya Central District Hospital", Komi Republic
- Rehabilitation Center LLC, Obninsk, Kaluga region,
- City Clinical Hospital No. 29, Kemerovo region, Novokuznetsk
- Polyclinic KOAO "Azot", Kemerovo
- MUZ Central Regional Hospital of the Saratov region
- Polyclinic No. 2 of the Kolomenskaya Central District Hospital
There is information about the implementation yet
in approximately 30 organizations, incl.
in Moscow and St. Petersburg. Lena September 1, 2011 Cool! I had just read the article when...the doorbell rang and my grandfather was offered a filter! Anya September 7, 2011 I, too, at one time encountered acne, no matter what I did, no matter where I turned... I thought that nothing would help me, it seemed to be getting better, but after a while my whole face was scary again, I no longer trusted anyone. Somehow I came across the magazine “Own Line” and there was an article about acne and how you can get rid of them. I don’t know what pushed me, but I again turned to the doctor who commented on the answers in that magazine. A couple of cleansings, several peelings and three laser treatments, everything is fine with my home cosmetics, and you should have seen me. Now I can’t believe that I had such a problem. It seems that everything is real, the main thing is to get into the right hands. Kirill September 8, 2011 Wonderful doctor! A professional in his field! There are few such people! Everything is done very efficiently and painlessly! This is the best doctor I have ever met! Andrey September 28, 2011 Very good specialist, I recommend him. A beauty too... Artyom October 1, 2011 Well, I don’t know...My aunt also installed a filter from them. She says she's happy. I tried the water. It tastes much better than from the tap. And in the store I saw five-stage filters for 9 thousand. So, they don't seem to be scammers. Everything works, the water flows decently and thank you for that.. Sergey Ivanovich October 8, 2011 There is no point in slandering them, the system is excellent, and everything is in order with their documents, my wife checked, she is a lawyer by training, and I want to say thank you to these guys, so that you go shopping and look for this filter, and here They brought it to you, installed it, and they also fix any problems, I have had this system for more than 7 months. the filters were changed, everything was fine, you should have seen the condition of the filters, they were all brown in mucus, terrible in one word, and those who don’t install them simply don’t go to think about themselves and their children, but now I can safely pour water for my child from the tap, without fear! Svetlana October 19, 2011 The most disgusting hospital I have ever known!!! Such a boorish and consumerist attitude towards women - you’re simply amazed how this can still happen in our time! I arrived in an ambulance with bleeding and went to bed to continue my pregnancy. They convinced me that it was impossible to continue the pregnancy, that there was already a miscarriage, now we will clean you up and everything will be fine! Imagine! She asked for an ultrasound, and the ultrasound showed that the child was alive, the heart was beating, and the child could be saved. I couldn’t get it cleaned, they had to put me in storage. She was treated with Vikasol and papaverine. ALL!!! No vitamins, no IVs, NOTHING! Well, okay, thank God, I escaped from there after 3 days and was treated at home. The treatment was prescribed by my gynecologist, IVs were also given at home... It is still unknown how it would have ended if I had stayed there for another week... But now everything is fine, in August I gave birth to a girl, healthy, strong... Now he is calling me my sister. She's at the cons. Yesterday they said that she is pregnant, 3 weeks due. Today I started bleeding with clots, etc. I did an ultrasound and was told to run to the hospital for cleaning. The duty officer AS ALWAYS Avtozavodskaya... But they didn’t accept her!!! Bleeding! The hospital is on duty!!! Just bitches! And they also talk so rudely... I will find justice for you, I will immediately call where necessary. And I leave this comment for others - so that they bypass this lair... Elenna October 25, 2011 spent my childhood there. I liked it.
Although I really didn’t like injections, nor did I like massages. Elena October 25, 2011 Yes, a lot of people have a grudge against this hospital! Good luck Svetlana in your affairs. I have the same opinion about this hospital. Elena October 25, 2011 who works and how. or rather promotes the product. I had aquaphor (a jug), so the water from it is also much better than tap water!
The point is to impose your product, as I understand it. Now they run from Zepter like fire. just because of excessive intrusiveness. Mila October 25, 2011 I really like it there, qualified specialists, and they try not to smuggle anything in, but to pick it up! I will note one of the minuses. queues. Quite a popular center. And thank you very much for lenses and solutions without a crazy markup! Misha October 25, 2011 In my work I came across distributors of various electronic cigarette manufacturers. And there are fig ones - like pons, and there are good ones - like rich. Unfortunately, in Izhevsk they sell the cheapest, that is, the most crappy ones. But! There is no smell from electronic cigarettes! And their advantage is that there are no resins, which are carcinogens! Quit smoking. It's hard with their help. and not disturb others and significantly reduce the harm from cigarettes - it will work out! Danya October 25, 2011 here you go, crooks! plundered!!! Elena January 28, 2012 In December we were there, they held a meeting, I was offended by the quality of our water, I’m from Kazan, but then they didn’t supply it, my son said it wasn’t necessary! But recently I went to a store with a geyser, they also have 5 stages, the same price here 9700, now you don’t even know, you should have installed it because that’s how they cost, they sell it right at home and without store markups! You need to make sure that all the documents are in order before you buy. no name January 28, 2012 here you decide for yourself whether you want it or not! It’s not like they’re forcing it to be installed. There’s still an agreement, first they’ll install it and then they’re dissatisfied with something, you have to think first when you’re giving the money. nonsense Catherine January 29, 2012 Now also in Cheboksary, Chuvash Republic....People, be careful! Nika January 26, 2012 I work in a rural area. Ours are paid compensation of approximately 100 - 300 rubles. What is this for? But you won’t expect anything from our head of the district health department. And in general - how long can you tolerate such boors and ignoramuses (bosses) because of which the personnel in literally "flow"?! Aksinya November 28, 2011 I was there once: after finding out whether it was possible to do an ECG, they told me to come the next day at 16:00, in the end I came, but they told me no, there is no one to do it, or wait another hour until the doctor comes. In the end, I waited an hour, they did it, asked without a description, as it turned out the price with and without a description was the same, although the day before they said that without a description it was cheaper.
Conclusion: I didn’t like the girls at the reception, they had sour facial expressions. It feels like they are doing me a favor. Vadyai November 28, 2011 I recently had an appointment with you, the impressions were very good, the staff was friendly, the doctor explained everything correctly at the appointment, they immediately did an ultrasound and passed tests
I had an appointment at Pushkinskaya, tests and ultrasound at Sovetskaya... thank you all so much!!!
Special greetings to Alexey Mikhalych!!!

Memory - the mental process of reflecting and accumulating immediate and past individual and social experience. This is achieved by recording, storing and reproducing various impressions, which ensures the accumulation of information and allows a person to use previous experience. Accordingly, memory disorders manifest themselves in violations of fixation (memorization), storage and reproduction of various information. There are quantitative disorders (dysmnesia), manifested in weakening, strengthening of memory, its loss, and qualitative (paramnesia).

Quantitative memory impairment (dysmnesia).

Hypermnesia – pathological exacerbation of memory, manifested by an excessive increase in the ability to recall events of the past that are insignificant in the present. At the same time, memories are of a vivid, sensory-figurative nature, emerge easily, and cover both events as a whole and the smallest details. Strengthening recall is combined with weakening memorization of current information. Reproduction of the logical sequence of events is disrupted. Mechanical memory is strengthened, logical-semantic memory is deteriorated. Hypermnesia can be partial, selective, when it manifests itself, for example, in an increased ability to remember and reproduce numbers, in particular in mental retardation.

It is detected during manic syndrome, hypnotic sleep, and some types of drug intoxication.

Hypomnesia – partial loss of events, phenomena, facts from memory. It is described as “perforated memory,” when the patient remembers not everything, but only the most important, frequently repeated events in his life. In a mild degree, hypomnesia is manifested by weakness in reproducing dates, names, terms, numbers, etc.

Occurs in neurotic disorders, in the structure of a large drug addiction syndrome in the form of “holey”, “perforated” memory ( palimpsests), with psychoorganic, paralytic syndrome, etc.

Amnesia – complete loss of memory of phenomena and events for a certain period of time.

The following amnesia warrants are distinguished in relation to the period undergoing amnesia.

Variants of amnesia in relation to the period undergoing amnesia.

Retrograde amnesia – loss of memory for events preceding the acute period of the disease (trauma, state of altered consciousness, etc.). The duration of the period of time undergoing amnesia can vary - from several minutes to years.

Occurs with cerebral hypoxia and traumatic brain injury.

Anterograde amnesia – loss of memories of events immediately following the end of the acute period of the disease. In this type of amnesia, the behavior of patients is orderly, criticism of their condition is preserved, which indicates the preservation of short-term memory.

Occurs in Korsakoff syndrome and amentia.

Congrade amnesia – loss of memory for events during the acute period of the disease (period of impaired consciousness).

Occurs in cases of stupor, stupor, coma, delirium, oneiroid, special states of consciousness, etc.

Anterograde (complete, total) amnesia – loss from memory of events that occurred both before, during and after the acute period of the disease.

Occurs in comas, amentia, traumatic, toxic brain lesions, strokes.

Based on the predominantly impaired memory function, amnesia is divided into fixation and anekphoric.

Fixation amnesia – loss of the ability to remember and reproduce new information. It manifests itself in a sharp weakening or absence of memory for current, recent events while retaining it for knowledge acquired in the past. Accompanied by a violation of orientation in the environment, time, surrounding persons - amnestic disorientation.

Occurs in Korsakoff syndrome, dementia, paralytic syndrome.

Anekphoria – inability to voluntarily recall events, facts, words, which becomes possible after prompting.

Occurs in asthenia, psychoorganic syndrome, lacunar dementia.

According to the course of amnesia, they are divided as follows.

Progressive – gradually increasing memory decay. It proceeds in accordance with Ribot's law, which proceeds as follows. If memory is imagined as a layer cake, in which each overlying layer represents later acquired knowledge and skills, then progressive amnesia is precisely the layer-by-layer removal of these skills and knowledge in the reverse order - from events less distant from the present time to more recent events. up to the “memory of the simplest skills” - praxis, which disappears last, which is accompanied by the formation of apraxia.

Identified in dementia, atrophic diseases of the brain (senile dementia, Pick's disease, Alzheimer's).

Stationary amnesia – persistent memory loss, not accompanied by improvement or deterioration.

Regressive amnesia – gradual restoration of memories of the amnesic period, with the events that are most important for the patient being restored first.

Retarded amnesia - delayed amnesia. A period is not forgotten immediately, but after some time.

According to the object subject to amnesia, the following types are distinguished:

Affectogenic (catathymic) – amnesia occurs under the influence of a psychotraumatic situation (psychogenically), through the mechanism of repressing individually unpleasant events, as well as all events that coincided in time with a strong shock.

Occurs in psychogenic disorders.

Hysterical amnesia - forgetting only individual psychologically unacceptable events. Unlike affectogenic amnesia, memory for indifferent events that coincide in time with the amnesiac is preserved. Included in the structure of hysterical psychopathic syndrome.

Observed in hysterical syndrome.

Scotomization – has a clinical picture similar to hysterical amnesia, with the difference that this term refers to cases that occur in individuals who do not have hysterical character traits.

Separately worth mentioning alcohol amnesia, the most striking type of which are palimpsests, described as a specific sign of alcoholism by K. Bonhoeffer (1904). This type of amnesia is manifested by loss of memory for individual events that occurred during alcohol intoxication.

Qualitative memory disorders (paramnesia).

Pseudo-reminiscences (false memories, “illusions of memory”) – represent memories of events that actually took place that occur in a different period of time. Most often, events are transferred from the past to the present. A type of pseudo-reminiscences are ecmnesia– blurring the line between the present and the past, as a result of which memories of the distant past are experienced as happening at the moment (“life in the past”).

Occurs in Korsakoff syndrome, progressive amnesia, dementia, etc.

Confabulations (“memory fictions”, “memory hallucinations”, “delusions of imagination”) – false memories of events that did not actually take place during the period of time in question, with the conviction of their truth. Confabulations are divided into mnestic (observed with amnesia) and fantastic (observed with paraphrenia and confusion). Mnestic confabulations are divided (Snezhnevsky A.V., 1949) into ecmnestic(false memories are localized in the past) and mnemonically e (fictional events refer to the current time). In addition, they highlight replacement confabulations – false memories that arise against the background of amnestic memory loss and fill these gaps. Fantastic confabulations - fictions about incredible, fantastic events that allegedly happened to the patient.

Filling of consciousness with abundant confabulations of everyday content, combined with false recognition of the surrounding environment and persons, incoherence of thinking, fussiness and confusion is defined as confabulatory confusion.

Confabulosis(Bayer W., 1943) – the presence of abundant systematic confabulations without gross memory disorders or gaps, with sufficient orientation in place, time and one’s own personality. At the same time, confabulations do not fill memory gaps and are not combined with amnesia.

Confabulatory disorders occur in Korsakoff's syndrome, progressive amnesia.

Cryptomnesia – memory impairment, manifested by alienation or appropriation of memories. One of the variants of cryptomnesia is associated(painfully appropriated) memories - in this case, what was seen, heard, read is remembered by the patient as having taken place in his life. This type of cryptomnesia includes true cryptomnesia(pathological plagiarism) is a memory disorder, as a result of which the patient assigns to himself the authorship of various works of art, scientific discoveries, etc. Another variant of cryptomnesia is false associated (alienated) memories- real facts from the patient’s life are remembered by him as having happened to someone else, or as something he had heard, read, or seen somewhere.

Occurs in psychoorganic syndrome, paranoid syndrome, etc.

Echomnesia (reduplicating Pick paramnesia) – memory deceptions in which some event or experience appears doubled or tripled in memories. The main difference between echonesias and pseudoreminiscences is that they are not of a replacing nature in amnesia. Occurring events are projected simultaneously into the present and into the past. That is, the patient has the feeling that this event has already taken place once in his life. However, at the same time, echonesias differ from the phenomenon of “already seen”, since with them, not an absolutely identical situation is experienced, but a similar one, whereas with the phenomenon of “already seen”, the current situation appears identical to what has already happened.

Observed in psychoorganic syndrome.

Phenomena of what has already been seen, heard, experienced, told, etc. – what is seen, heard, experienced, told for the first time is perceived as familiar, encountered before. Moreover, this feeling is never associated with a specific time, but refers “to the past in general.” The opposite of these phenomena are phenomena of things never seen, never experienced, never heard, etc., in which the known, familiar is perceived as something new, never seen before. This type of memory disorder is sometimes described within the framework of depersonalization and derealization disorders.

Memory is the mental process of imprinting, preserving and reproducing past experiences.

The strength of memory depends on the degree of concentration of attention on incoming information, the emotional attitude (interest) to it, as well as on the general condition of the person, the degree of training, and the nature of mental processes. A person’s conviction that information is useful, combined with his increased activity in memorizing it, is an important condition for the assimilation of new knowledge.

Types of memory based on material storage time:
1) instantaneous (iconic) - thanks to this memory, a complete and accurate picture of what the senses just perceived is retained for 0.1-0.5 s, without any processing of the received information;
2) short-term (KS) - capable of storing information for a short period of time and in a limited volume.
As a rule, for most people the volume of the CP is 7 ± 2 units.
The CP records only the most significant information, a generalized image;
3) operational (OP) - operates for a predetermined time (from several seconds to several days) depending on the task that needs to be solved, after which the information can be erased;
4) long-term (LP) - information is stored for an indefinitely long period.
the DP contains the material that a practically healthy person should remember at any time: his first name, patronymic, last name, place of birth, capital of the Motherland, etc.
In humans, DP and CP are inextricably linked.

Memory disorders

Hypomnesia- violation of short-term memory (decreased memory, forgetfulness).
Fixation hypomnesia is a violation of the memory of current events.
Hypomnesia occurs normally with severe fatigue, psychopathy, alcoholism, drug addiction.

Amnesia- impairment of long-term memory (memory loss, memory loss).
Retrograde amnesia is the disappearance from memory of events preceding the trauma.
Anterograde amnesia is the disappearance from memory of events following trauma.
Congrade amnesia is loss of memory only for the period of immediate impairment of consciousness.
Perforation amnesia (palimpsest) is loss of memory for some events.
Amnesia occurs with organic brain lesions, neurotic disorders (dissociative amnesia), alcoholism, drug addiction.

Paramnesia- distorted and false memories (memory errors).
Pseudo-reminiscences(memory illusions, paramnesia) - erroneous memories of events.
Confabulation(memory hallucinations) - memories of something that did not happen.
Cryptomnesia- inability to remember the source of information (the event was in reality, in a dream or in a film).
Paramnesia occurs in schizophrenia, dementia, organic lesions, Korsakoff's syndrome, and progressive paralysis.

In addition, there is hypermnesia- pathological increased ability to remember.
Hypermnesia occurs during manic syndrome, taking psychotropic drugs (marijuana, LSD, etc.), at the onset of an epileptic attack.

Ribot's law

Ribot's law- memory loss of the “memory reversal” type. With memory disorders, memories of recent events first become inaccessible, then the subject’s mental activity begins to be disrupted; feelings and habits are lost; finally, instinctive memory disintegrates. In cases of memory recovery, the same steps occur in reverse order.

Memory disorders
Pathopsychological mnestic disorders underlie many mental illnesses.
There are such memory disorders:
1. Amnesia - a memory disorder in the form of an impairment of the ability to remember, store and reproduce information.
Types of amnesia:
- Retrograde amnesia- memory impairment, in which it is impossible to reproduce information acquired before the episode of impaired consciousness that occurred with the person;
- Anterograde amnesia- difficulties in reproduction relate to the time after an episode of impaired consciousness;
- Anterograde amnesia- memory impairment in which it is impossible to reproduce information acquired before and after an episode of impaired consciousness.

2. Partial memory impairment (partial memory impairment):
- Hypomnesia- memory loss,
- Hypermnesia- memory enhancement,
arise on the basis of emotional disorders, forming a depressive and manic spectrum of symptoms, respectively.

3. Paramnesia:
- Confabulation- memory deceptions, in which the inability to remember events and reproduce them leads to the reproduction of fictitious events;
- Pseudo-reminiscences- violation of chronology in memory, in which individual events of the past are transferred to the present;
- Cryptomnesia- memory disorders in which a person appropriates other people's thoughts and actions to himself.

Ribot's law of the formation of mnestic disorders: violation (loss) of memory (as well as its recovery) occurs in chronological order - first, memory is lost for the most complex and recent impressions, then for older ones. Restoration occurs in reverse order.
According to Mr. Connery, memory impairments based on the reasons for their occurrence are divided into:

1. Not caused by obvious physiological reasons - dissociative:
- Dissociative amnesia(inability to remember important events or information related to personal life, usually of an unpleasant nature, that is, people suffer from retrograde amnesia, they rarely have anterograde amnesia);
- Dissociative fugue(a person not only forgets the past, but can also go to an unfamiliar place and imagine himself as a new person), usually follows severe stress, such as military action or a natural disaster, although it can also be caused by personal stress - financial or legal difficulties or a depressive episode . Fugues affect only memories of one's own past, not universal or abstract knowledge. Most people with dissociative fugue recover their memory completely or almost completely, and there is no relapse;
- Organic dissociative identity disorder (a person has two or more different personalities who cannot always remember each other’s thoughts, feelings and actions).

2. The physiological reasons for their occurrence are obvious - organic. Organic causes of memory impairment can be: traumatic brain injuries, organic diseases, and improper use of medications. Memory impairment caused by physiological reasons - amnestic disorder (mainly affects memory). People with amnestic disorders sometimes have retrograde amnesia, but they almost always have anterograde amnesia.
Anterograde amnesia often results from damage to the brain's temporal lobes or diencephalon, areas that are primarily responsible for converting short-term memory into long-term memory.

In severe forms of anterograde amnesia, new acquaintances are forgotten almost instantly, and problems solved today are dealt with the very next day.
Korsakov's amnestic syndrome- people constantly forget information they have just learned (anterograde amnesia), although their general knowledge and intellectual abilities remain unchanged. Characteristic symptoms: confusion, disorientation, tendency to confabulation. Caused by chronic alcoholism in combination with poor nutrition and, as a result, a lack of vitamin B and (thiamine).
Note. In TV shows and movies, hitting the head is portrayed as a quick way to lose memory. In reality, after mild traumatic brain injuries - a concussion, for example, does not lead to loss of consciousness - people rarely have large memory lapses, and those that do appear certainly disappear after a few days or months. Conversely, almost half of all severe traumatic brain injuries cause chronic problems with learning and memory, both anterograde and retrograde. When memories finally return, the older ones tend to return first.
- Dementia(affect both memory and other cognitive functions, such as abstract thinking or speech).
The most common form of dementia is Alzheimer's disease, which usually affects people over the age of 65. It may first appear in middle age, but it is more common after the age of 65, and its prevalence increases sharply among people aged 80. May last 20 years or more. It begins with minor memory impairment, weakening of attention, speech and communication problems. As symptoms worsen, the person begins to have difficulty completing complex tasks or forgetting important meetings.
Eventually, patients have difficulty performing simple tasks, they forget about events that are more distant in time, and personality changes often become very noticeable in them. For example, a person may become unusually aggressive.
People with Alzheimer's disease may initially deny that they are experiencing any difficulties, but soon become anxious and depressed about their mental state. As dementia progresses, they become less aware of their limitations. In the later stages of the disease, they may refuse to communicate with others, have poor orientation in time and space, often wander aimlessly and lose discretion. Gradually, patients become completely dependent on the people around them. They may lose almost all their previous knowledge and the ability to recognize the faces of even close relatives. Everyone sleeps worse at night and dozes during the day. The last phase of the disorder can last from two to five years, with patients requiring constant care.
Victims of Alzheimer's disease usually remain in fairly good health until the later stages of the disease. But as their mental functions weaken, they become less active and spend most of their time sitting or lying in bed. As a result, they become prone to various diseases, such as pneumonia, which can result in death.
Most organic memory disorders affect more declarative memory (memory for names, dates, facts) than procedural memory (learned techniques that a person performs without having to think about them: walking, scissoring, or writing).

Sometimes the patient’s relatives pay more attention to memory impairment than the patient himself (usually in older people, often with dementia). Doctors and patients are often concerned that memory loss is a sign of developing dementia. This concern is based on the general understanding that memory loss is usually the first symptom of dementia. However, in most cases, memory loss is not associated with the onset of dementia.

The most common and earliest complaint associated with memory impairment is difficulty remembering names and places where frequently used household items, such as car keys, are located. As memory loss worsens, patients may forget to pay bills or miss appointments. Severe memory impairment can be dangerous if patients forget to turn off the stove, lock the house, or lose sight of a child they are supposed to be keeping an eye on. Depending on the cause of the memory loss, other symptoms may appear, such as depression, confusion, personality changes, and difficulty performing daily activities.

There are two types of memory: declarative, explicitly oriented memory (semantic or episodic), which stores memories that can only be recalled consciously. This is necessary, for example, in order to recognize certain things (apples, animals, faces). Procedural memory does not require conscious effort to remember and recall. This is necessary, for example, for learning to play the piano.

Causes of memory impairment

The most common causes of memory impairment include the following:

• memory impairment associated with aging (most common cause);
• mild cognitive impairment;
• dementia;
• depression.

Most people experience some memory loss as they age. It becomes difficult for them to remember new information (for example, the name of a new neighbor, a new computer password). Age-related changes lead to occasional forgetfulness (such as losing your car keys) or confusion. However, mental abilities are not affected. If a patient with age-related memory changes is given enough time to think about and answer a question, then he, as a rule, copes with the task, which indicates the preservation of memory and cognitive functions.

Patients with mild cognitive impairment have true memory decline, in contrast to slower recall with relatively intact memory in age-matched patients without cognitive impairment. With mild cognitive impairment, there is a tendency to primarily impair short-term (or episodic) memory. Patients find it difficult to remember the content of a recent conversation, the place where frequently used items are stored, and they forget about appointments. However, memory for distant events usually remains intact, and attention also does not suffer (the so-called working memory - patients can reproduce a list of any objects and perform simple calculations).

Patients have difficulty finding words and/or naming objects (aphasia), performing familiar movements (apraxia), or planning and organizing daily activities such as cooking, shopping, and paying bills (executive functioning disorder). The patient's personality may change - for example, irritability, anxiety, agitation and/or intractability that was previously uncharacteristic for a person may appear.

Depression is common in patients with dementia. However, depression itself can lead to memory impairment that resembles dementia (pseudo-dementia), but such patients usually have other symptoms of depression.

Delirium is an acute state of altered consciousness that can be caused by severe infection, medication (adverse event), or drug withdrawal. Patients with delirium may have memory impairment, but the main problem is not this, but severe global changes in mental status and cognitive function.

To form declarative memory, information first reaches the corresponding association areas of the cerebral cortex (eg, secondary visual cortex) through a specific primary sensory cortical area (eg, primary visual cortex). From here, through the entorhinal cortex (field 28), this information goes to the hippocampus, which is of great importance for the long-term storage of declarative information. Through the mediation of structures in the midbrain, basal forebrain, and prefrontal cortex, this information is again stored in the association cortex. Thus, information is first stored through sensory memory by short-term memory, which can only hold it for a few seconds to minutes. This information can be transferred to long-term memory, for example, through repetition. However, such repetitions are not mandatory conditions for the formation of long-term memory. Glutamate is the most important neurotransmitter in the hippocampus (NMDA receptors). Memory consolidation is provided by adrenaline and acetylcholine (nicotinic receptors). Neurotrophins maintain the viability of the neurons involved. Ultimately, memory consolidation requires a change in the influence of the synapses involved.

It is the transfer of information to long-term memory that is disrupted when the above structures are damaged due to neurodegenerative diseases (for example, Alzheimer's disease), trauma, ischemia, the effects of alcohol, carbon monoxide and inflammation. Electric shock can temporarily stop memory formation.

Lesions of the hippocampus or its connections lead to antegrade amnesia. In such patients, new declarative memory can no longer be formed from the moment of the lesion. They will remember the events before the defeat, but not the subsequent ones.

Retrograde amnesia, i.e. loss of already stored information, occurs when there are disturbances in the corresponding associative fields. Depending on the degree and location of the disorders, memory loss can be reversible or irreversible. In the first case, the patient will lose part of his memory, but it can be restored. In irreversible loss, specific elements are lost forever.

Damage to the dorsomedial nucleus results in loss of episodic memory. Transient bilateral functional disorders of the hippocampus can cause antegrade and retrograde (days or years) amnesia (transient global amnesia). With Korsakoff's syndrome (often found in alcoholism), both antegrade and retrograde amnesia can be observed. Patients often try to cover up gaps in memory with the help of fiction.

With lesions of the hippocampus, procedural (implicit) memory does not suffer. This makes imprinting, skill acquisition, sensitization, adaptation, and conditioning possible. Depending on the task at hand, this may involve the cerebellum, basal ganglia, amygdala, and cortical fields. When mastering a skill, the cerebellum and basal ganglia play an important role. The corresponding impulses reach the cerebellum through the olive and pons nuclei. The memory capacity of the cerebellum can be lost, for example, due to toxic damage, degenerative diseases and injuries. Dopaminergic projections of the substantia nigra also play a certain role in the formation of procedural memory.

The amygdala is involved in the formation of conditioned anxiety reactions. They receive information from the cortex and thalamus and, through the reticular formation and thalamus, influence motor and autonomic functions (eg, muscle tone, heartbeat [tachycardia alert], goose bumps). Shutting down the amygdala (for example, due to trauma or under the influence of opiates) erases conditioned anxiety reactions. Bilateral shutdown of the amygdala, along with parts of the hippocampus and temporal lobe, leads to amnesia and uninhibited behavior (Klüver-Bucy syndrome).

Examination for memory impairment

The most important thing is to identify delirium that needs urgent treatment. Assessment then prioritizes differentiation between the less common mild cognitive impairment and early dementia and the more common age-related memory changes and common forgetfulness. A complete assessment to detect dementia usually requires more time than the 20-30 minutes allotted for an outpatient appointment.

Anamnesis. Whenever possible, the history should be obtained separately from the patient and family members. Patients with cognitive impairment may not always be able to provide detailed and accurate information, and relatives may have difficulty presenting the history impartially in the presence of the patient.

The medical history should include a description of the specific types of memory impairment (eg, forgetting words or names, times when the patient got lost) and their time of onset, severity, and progression. The extent to which these symptoms interfere with daily activities at work and at home should be determined. It is important to check for changes in speech, eating, sleep, and mood.

Information about organ systems can help establish a history of symptoms suggestive of a particular type of dementia (eg, parkinsonian symptoms in dementia with Lewy bodies, focal deficits in vascular dementia, upgaze and fall palsy in progressive supranuclear palsy, choreiform hyperkinesis in Huntington's disease , gait disturbances with normal pressure hydrocephalus, imbalance and fine motor skills with vitamin B deficiency 12).

The medical history should include information about previous illnesses and complete information about the drugs (both prescription and over-the-counter) that the patient received.

Family and social history should include information about the patient's baseline intelligence, education, work history, and social functioning. A history or current history of alcohol or drug abuse should be inquired about. It is necessary to find out whether there is a family history of dementia or early cognitive impairment.

Physical examination. In addition to a general physical examination, a complete neurological examination with a detailed mental status assessment is performed.

A mental status assessment involves the patient following specific instructions to check the following:

• orientation (the patient is asked to state his name, date and place in which he is located);
• attention and concentration (for example, the patient is asked to repeat a few words, do simple calculations, say the word “earth” backwards);
• short-term memory (for example, the patient is asked to remember and reproduce after 5, 10 and 30 minutes a list of several words);
• speech (for example, naming common objects);
• praxis and executive actions (for example, performing an action consisting of several stages);
• constructive praxis (for example, copy a drawing or draw a clock).

Various scales can be used to assess these aspects.

Warning signs. Please pay special attention to the following changes:

• disturbances in daily activities;
• decreased attention or altered consciousness;
• symptoms of depression (eg, loss of appetite, lethargy, suicidal thoughts).

Interpretation of survey results. The presence of actual memory decline and impairment of daily activities and other cognitive functions allows us to separate age-related memory impairment from mild cognitive impairment and dementia. Differentiating depression from dementia can be challenging until memory impairment becomes more severe or other neurological disorders (eg, aphasia, agnosia, apraxia) develop.

Decreased attention can differentiate delirium from the early stages of dementia. In most patients with delirium, memory loss is not a leading symptom. However, delirium must be excluded to make a diagnosis of dementia.

If the patient himself sought medical help, because... he began to worry about forgetfulness; the most likely reason is age-related memory loss. If the medical examination was initiated by a family member of the patient, and the patient is less concerned about memory loss, then dementia is more likely to be present.

Additional research methods. The diagnosis is established primarily on the basis of the clinical picture. However, the results of any brief mental status examination are influenced by the patient's level of intelligence and education, and therefore such tests are not very accurate. Thus, patients with a high level of education may score an inflated number of points, while those with a low level of education may score underestimated. If the diagnosis is unclear, formal neuropsychological testing should be performed, the results of which have high diagnostic accuracy.

If the possible cause of the violation is the use of a drug, then it can be discontinued or the patient can be prescribed a different drug.

If the patient has neurological symptoms (for example, paresis, gait disturbance, involuntary movements), then an MRI or CT scan is necessary.

If a patient is diagnosed with delirium or dementia, then further examination is necessary to clarify their causes.

Treatment of memory impairment

Patients with age-related memory loss need support. Patients with depression require medication and/or psychotherapy. As depression is eliminated, there is a tendency for memory impairment to level out. Delirium should be treated according to its cause. In rare cases, dementia can be reversed with specific therapy. The remaining patients with memory impairment receive supportive treatment.

Patient safety. Rehabilitation and physical therapy specialists can evaluate a memory loss patient's home for safety to help prevent falls and other incidents. You may need to take safety precautions (for example, hide knives, turn off the stove, remove the car and its keys). Some countries require that patients with dementia be notified to traffic regulators. If the patient is at risk of getting lost, a tracking system can be used or the patient can be enrolled in a safe return program.

Finally, outside help (eg, a home health worker or home social worker) or changes to the environment (eg, moving to a step-free home or placing the patient in a general care or skilled nursing facility) can be used.

Measures to change the environment. People with dementia feel more comfortable in familiar surroundings, in settings that help them find their way, in bright and cheerful surroundings and with regular activity. The patient's room should contain sources of sensory stimulation (eg, radio, television, night light).

Health care staff in care facilities should wear a large name badge and be reintroduced to the patient when necessary.

Features in elderly patients

The prevalence of dementia increases from approximately 1% in people aged 60 to 64 years to 30-50% in people over 85 years of age. The prevalence of dementia in people living in residential care homes is about 60-80%.