For every reported case of TGA there are hundreds of reports of impaired memory, disorientation and confusion among an older group of patients that rarely get mentioned. Transient global amnesia is just the tip of the iceberg. Millions of patients are now taking this class of drug and are at significant risk for cognitive side effects. Imagine, cholesterol, the same cholesterol we have been led by the pharmaceutical industry to be public health enemy number one, now proven to be absolutely vital in the formation and function of the trillions of synapses in our brains. And only in the past several years have we learned the importance of cholesterol in brain function. The advent of the stronger statin drugs in the past decade has now provided a new contributory factor to the etiology of TGA, one clearly rooted in the biosynthesis of cholesterol and clearly fundamental to neurophysiologic mechanisms. However, none of these seemingly diverse trigger agents have provided useful information as to the precise cause of transient global amnesia. Occasionally, transient global amnesia episodes have occurred after routine medical procedures such as venipuncture, minor surgery or application of the Valsalva maneuver, a "grunting" expiration test commonly used to determine cardiovascular responsiveness.Īnother medical procedure identified as a trigger agent for a growing number of transient global amnesia cases is cerebral angiography. Swimming in cold water is occasionally a factor, and some individuals appear to recognize sexual intercourse as a frequent, and even consistent, trigger. Unusual emotional stresses such as newly reported cancer, a death in the family, news of a severe accident, and violent family arguments can trigger these reactions. Moderate to severe physical exertion often precedes an episode activities such as heavy digging, felling a tree, and laying concrete. Now ER doctors find themselves turning to their sometimes dusty, neurology books to identify this formerly rare condition, now seen in some statin users.ĭuring the pre-statin period a number of apparent precipitory factors had been reported. Since TGA was first identified in 1956, approximately 1000 cases had accumulated in the medical literature until the advent of the statin drugs. Gone are memories of friends and relatives, marriages and deaths, positions held and occupations learned. Many, but not all, of these people will have an extensive retrograde component to their amnesia extending back many years in their lives. Language and social skills are preserved and the ability to focus attention appears normal but, alas, despite the victim's desperate and almost pathetic desire to learn what is happening, nothing seems to register.įortunately, most are mercifully spared awareness of their memory impairment and preserve a remarkably calm demeanor, cooperating fully with their examiners. In most of these cases disorientation is profound. To the consternation and ultimate frustration of doctors, nurses and well-meaning companions, they ask the same question, over and over again, sometimes for hours. Attempts at communication are often pathetically farcical as their responses to questions are usually totally irrelevant although earnestly delivered in a normal speech manner.Ĭharacteristically, these TGA victims repetitively question those present about where they are and what is happening but are unable to remember any explanation. Anecdotal reporting from observers indicates that routine tasks such as walking or jogging, riding a bicycle or even driving a car appear to be done as usual.Īlthough they can speak in a disarmingly normal manner, victims of TGA cannot communicate for they cannot remember words just spoken. Individuals with transient global amnesia are surprisingly competent in many respects. Although consistently aware of their own identities, patients are often perplexed as to their surroundings and the identity of those around them. The onset of transient global amnesia is abrupt, without the slightest warning to the patient that a central nervous system catastrophe is about to strike. Suddenly, new memories no longer register in the victim's mind, a condition known as anterograde amnesia. Any sensory input during this time will be preserved briefly, if at all, disappearing completely and forever within seconds, as though it never happened. By Duane Graveline, M.D., M.P.H.Transient Global Amnesia (TGA) is the complete inability to formulate new memory.
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