in any illness.
And to be honest, most people know nothing about memory disorders. Retrograde amnesia, especially, is very mysterious, elusive and hard to detect somehow. If it affects autobiographical memory then the result will likely be behaviour change and quiet confusion on the part of the patient, especially if hypoventilation [depressed breathing rate] is involved.
The devil is in the details. “The devil is in the details” is an idiom alluding to a catch or mysterious element hidden in the details: something might seem simple at a first look but will take more time and effort to complete than expected. It comes from the earlier phrase “God is in the details“, expressing the idea that whatever one does should be done thoroughly; that is, details are important. Wikipedia https://en.wikipedia.org/wiki/The_devil_is_in_the_details
Paula told her doctor that suddenly, and day, she could not remember how to do her job. She did not know why. The doctor didn’t either and simply assumed a sudden lack of confidence on her part. He could not imagine that she literally could not remember how to do her job from one day to the next. The doctor never thought of amnesia [forgetting how to do the content of her job- completely and thoroughly, and acutely upon waking up suddenly in distress].
If the doctor had thought about it, he might at least have thought that Paula might have had some kind of stroke or insult affecting her retrospective memory from that point on…..but he knew nothing of brain dysfunction or memory disorders. Instead, he was fixated only on mood.
Paula did not know that she had retrospective amnesia and could not report it to anyone in any meaningful way. She knew that it sounded absurd and impossible . She was only aware of it for a a few seconds during which she felt confused, before her insight [as limited as it was], disappeared.
Paula did not repeat things like an Alzheimer patient, she simply failed to remember how to respond to familiar things, such as what to say to her friends, when they talked to her. She mostly remained quiet, not knowing what to say. She failed to remember personal facts and general facts. And she kept this to herself because she was so embarrassed [she knew it was strange]. Her memory was so fragile, it took a lot of physical effort to keep in mind what she wanted to say. And it somehow took even more effort to speak. And, like her psychiatrist and her family doctor, no one understood that she had retrospective amnesia even when she said she could not remember.
Mostly , she kept her worries to herself and brooded about it all day [and most of the night] .
Simple memory tests would have identified a memory problem. She could not even subtract even one serial seven from 100….her arithmetic ability was that impaired. She could not remember the numbers 100- 7, long enough to figure out the answer. She had impaired forward digit span and no memory for backward digit span. She failed the TrailMaker B test. Her memory was too impaired to link the first item to the other. She could not follow or understand what she read. She couldn’t follow or remember movies she watched. Everything was hard and this was very upsetting for her. If asked, she could have explained why these things were so difficult. No one tested her and no one asked her about it.
No one gave her any tests at all. No one asked her about not remembering how to work. If asked for details, she would have said that her memory for how to do her job was suddenly gone. She would have said she could not count up her overtime because she could not do basic arithmetic. She would have said that she suddenly did not remember how to converse with her husband .
She begged her doctor to give her a mental status screening test; he refused. He thought that she was depressed not amnesic. He was wrong.
If given the chance, she would have said that one day she was fine and the next she was unable to remember ordinary and routine factual tasks. One day she had normal social skills and the next she had no social skills; none. So she stayed mostly quiet, not knowing what to do.
I still do not think that anyone would have understood that she had a sudden attack of retrospective memory loss [that lasted over a year] or why she had this attack.
No one knew that she had a lifelong [most likely] depressed breathing rate and that this might be a result of chronic COPD [chronic obstructive pulmonary disease] which manifests itself as a reduction of respiratory rate or a decrease in tidal volume resulting in inadequate air exchange. Acute attacks due to infections, asthma, viruses, inflammation and such, could cause an acute on chronic exacerbation and might cause impaired memory and cognitive dysfunction.
No one asked her about her about her medical history. In this case her birth history, her paediatric history and her early exposure to toxins and pollutants, would have been pertinent. . [chances are that she would not have remembered , but a family member could have been brought in to answer these questions]. Knowing her entire medical history and exposure history would have explained her COPD, even though she’d never smoked.
When doctors focus only on mood they often take a psychological history and neglect a full medical examination and medical history. This is partly how they missed the correct diagnosis of exacerbation of a late stage COPD with retrospective amnesia and cognitive impairment.
Also, the doctors would have been horrified to learn that this was what was wrong with her and they would have held out very little hope for recovery of her mental status.
And they would have been wrong.
Paula’s acute exacerbation of her COPD lifted after more than a year, and she regained her normal self and behavior.
Over the past few decades, chronic obstructive lung disease (COPD) has been considered a disease of the lungs, often caused by smoking. Nowadays, COPD is regarded as a systemic disease. Both physical effects and effects on brains, including impaired psychological and cognitive functioning, have been demonstrated. Patients with COPD may have cognitive impairment, either globally or in single cognitive domains, such as information processing, attention and concentration, memory, executive functioning, and self-control. Possible causes are hypoxemia, hypercapnia, exacerbations, and decreased physical activity. Cognitive impairment in these patients may be related to structural brain abnormalities, such as gray-matter pathologic changes and the loss of white matter integrity which can be induced by smoking. Cognitive impairment can have a negative impact on health and daily life and may be associated with widespread consequences for disease management programs. It is important to assess cognitive functioning in patients with COPD in order to optimize patient-oriented treatment and to reduce personal discomfort, hospital admissions, and mortality. Biomed Res Int. 2014; 2014: 697825. Published online 2014 Mar 16. doi: 10.1155/2014/697825 COgnitive-Pulmonary Disease Fiona A. H. M. Cleutjens, 1 ,*Daisy J. A. Janssen, 1 , 2 Rudolf W. H. M. Ponds, 3 Jeanette B. Dijkstra, 3 and Emiel F. M. Wouters 1 , 4
No one measured Paula’s basic vital signs at rest. The doctors were too fixated on mood. The main vital signs to check are respiratory rate RR] and effort, blood pressure, heart rate and body temperature.
Abnormal patterns of vital signs, especially when they involve abnormal RR at rest, can explain sudden cognitive and memory impairment and impairment of tasks at work and in daily life.
Mental health depends on normal physiological function. Measuring vital signs is simple. Vital signs are physical signs of normal or abnormal physiological function. Abnormalities of basic vital signs can often impact brain function, especially if abnormal ventilation [the motor part of breathing] is involved.
How many so-called psychiatric patients are suffering from retrospective amnesia, including basic autobiographical memory loss? How many have cognitive and memory impairment from their unknown and undiagnosed COPD ?
How many so called psychiatric patients, especially depressed patients, have depressed respiratory rates and probable exacerbation of their chronic COPD ?
Over the past few decades, chronic obstructive lung disease (COPD) has been considered a disease of the lungs, often caused by smoking. Nowadays, COPD is regarded as a systemic disease. Both physical effects and effects on brains, including impaired psychological and cognitive functioning, have been demonstrated. Patients with COPD may have cognitive impairment, either globally or in single cognitive domains, such as information processing, attention and concentration, memory, executive functioning, and self-control. Possible causes are hypoxemia, hypercapnia, exacerbations, and decreased physical activity. Cognitive impairment in these patients may be related to structural brain abnormalities, such as gray-matter pathologic changes and the loss of white matter integrity which can be induced by smoking. Cognitive impairment can have a negative impact on health and daily life and may be associated with widespread consequences for disease management programs. It is important to assess cognitive functioning in patients with COPD in order to optimize patient-oriented treatment and to reduce personal discomfort, hospital admissions, and mortality. This paper will summarize the current knowledge about cognitive impairment as extrapulmonary feature of COPD. ………………………………………………….Mechanisms linking cognitive impairment to COPD : Patients with COPD have cognitive deficits that seem to correlate with the degree of hypoxemia. Abnormalities are not limited to neuropsychological testing, as these patients have structural and functional brain abnormalities as well. Postulated mechanisms for cognitive deficits and structural and functional brain abnormalities in COPD may involve hypoxemia,47,48 hypercapnia,48,56 cigarette smoking,57inflammation,58 vascular disease,8,59 sleep disturbance,60 lack of activity,45 and depression. Biomed Res Int. 2014; 2014: 697825. Published online 2014 Mar 16. doi: 10.1155/2014/697825 COgnitive-Pulmonary Disease Fiona A. H. M. Cleutjens, 1 ,*Daisy J. A. Janssen, 1 , 2 Rudolf W. H. M. Ponds, 3 Jeanette B. Dijkstra, 3 and Emiel F. M. Wouters 1 , 4
There is increasing evidence demonstrating an association between chronic obstructive pulmonary disease (COPD) and cognitive impairment. We present a narrative review of published studies on the subject and a cross-sectional study investigating domain-specific cognitive impairment in people with COPD compared to people with known Alzheimer’s dementia, and controls without known COPD or cognitive impairment. The aim of the study was to compare prevalence and pattern of cognitive impairment between the three groups using the Addenbrooke’s Cognitive Examination (ACE)-III tool…..………Our result suggest that the COPD group were significantly more likely to have cognitive impairment than the healthy control group. This was supported by the results of a narrative review of the published literature. Our results show that the pattern of impairment in the COPD group is different to the pattern of impairment shown in the known Alzheimer’s dementia group, with significant differences in the cognitive domains affected. These results are in keeping with the findings of other previously published studies included in the narrative review.
The cross-sectional study demonstrates a high proportion of cognitive impairment in patients with COPD. This is in keeping with our findings in the literature review. The cognitive domains of attention, memory and fluency seem to be predominantly affected in our cohort. We cannot conclude that there is evidence of a specific, discrete type of cognitive impairment unique to COPD based on the results of this cross-sectional study and literature review alone; however, our findings further our understanding of the pattern of cognitive impairment in patients with COPD and may help explain the poor treatment adherence seen in this population. Further studies should seek to elucidate the underlying neurobiological mechanisms explaining this association.…..We did not conduct blood gas analyses on patients involved in the study. This is a limitation as hypercapnia and hypoxia were found to be correlated with cognitive impairment in previous studies included in our narrative review. In further, larger studies into this area, it would be useful to conduct blood gas analyses at the time of data collection, and investigate whether there is any association between these and ACE-III scores. ERJ Open Res. 2019 Apr; 5(2): 00229-2018. Published online 2019 May 28. doi: 10.1183/23120541.00229-2018 Memory, attention and fluency deficits in COPD may be a specific form of cognitive impairment. Charlotte Morris,1,6James W. Mitchell,1,6Hannah Moorey,1Helen-Cara Younan,2George Tadros,3,4 and Alice M. Turner1,5
Does treating and improving blood gases bring back or improve autobiographical memory and retrospective memory ? There is evidence that it might.
Since Dr Emile Kraepelin noted that attacks lifted spontaneously without treatments, although it might take decades to recover, I think that it is safe to hypothesize that modern supportive medical treatments would restore baseline mental status, since the body often heals slowly on its own.
The patients cannot tell you what is wrong. You must investigate thoroughly and ask them pointed questions about their memory and you must measure their vital signs….The Devil is in the Details.
to be continued…….