MEMORY Declarative Episodic Semantic Procedural Skills Simple Other

מבנים בזיכרון MEMORY Declarative Episodic Semantic Procedural Skills Simple Other Priming Classical Conditioning Larry R. Squire, (1987) 2

מבט מלמטה על אזורים לימביים ופאראלימביים Amygdala Perirhinal cortex Entorhinal cortex Parahippocampus 5 Hippocampalformation

מבנים בזיכרון – מבט ניורואנטומי MEMORY Declarative Episodic Semantic Procedural Skills Simple Priming Classical Other Conditioning Medial Temporal Lobe diencephalon Anterior Neo-cortex Striatum Reflexive mechanisms Amygdala Cerebellum 6

החולה האמנסטי 9 …. gives the impression of a person in complete possession of his faculties; he reasons about everything perfectly well, draws correct deductions from given premises, makes witty remarks, plays chess or a game of cards, in a word, comports himself as a mentally sound person. Only after a long conversation with the patient [you] may note that at times he utterly confuses events and that he remembers absolutely nothing of what goes on around him: he does not remember whether he had his dinner, whether he was out of bed. On occasion the patient forgets what happened to him just an instant ago: you come in again and the patient has absolutely no recollection that you had been with him. [The patient] may read the same page over and over again sometimes for hours, because [he is] absolutely unable to remember what [he has] read. In conversation [he] may repeat the same thing 20 times, remaining wholly unaware that [he] is repeating the same thing. (Korsakoff, 1889)

סוגי אמנזיה amnesia psychogenic organic permanent transient global amnesia progressive multiple fugue personality transient post ECT post-traumatic epileptic amnesia stable material specific 13 selective amnesia global frontal amnesia amnesic syndrome

Spared (implicit) learning in anterograde amnesia Claparede study (1911). Patient never remembered having met Claparede (doctor) before Claparade offers handshakes with pinprick Next time, no explicit memory of event (or doctor) Still, patient refuses to shake hands and offers explanation: “sometimes pins are hidden in people’s hands” 20

לפי דו"ח הניתוח 21 ig. 6. 1, Corkin et al. , “H. M. ’s medial temporal lobe lesion: Findings from magnetic resonance imaging, ” The Journal of Neuroscience 17: 3964– 3979, (1997). Adapted with permission of The Society for Neuroscience. ? HM היכן נפגע

MRI ממצאי HM HM EC (control) Amygdala Enthorhinal Cx. Perirhinal Cx. Hyppocampal G. 22

MRI לפי Bilateral Amygadaloid complex Bilateral anterior Hippocampus Bilateral Enthorhinal Cortex. 23 ig. 6. 1, Corkin et al. , “H. M. ’s medial temporal lobe lesion: Findings from magnetic resonance imaging, ” The Journal of Neuroscience 17: 3964– 3979, (1997). Adapted with permission of The Society for Neuroscience. ? HM היכן באמת נפגע

KS בחולים עם PI- שחרור מ Cermak et al. , 1974 33

ברירת מחדל לעיבוד מידע ב KS- Mc. Dowall, 1979 Biber et al. , 1981 34

על זיכרון ECT השפעות Disorientation Anterograde amnesia Retrograde amnesia

Acute memory disturbance Postictal

על זיכרון ECT השפעות Large inter-individual variability in: Severity Persistence (Reversibility) Subjective tolerance / discomfort

ECT גורמים המשפיעים על חומרת הפרעות הזיכרון אחרי Number of treatments Frequency Stimulus intensity Electrode placement

Immediate / short-term memory (working memory) Prefrontal cortex involved; Medial temporal lobe lesions spare this subtype Dysfunctions after course of ECT (patients learn OK but forget fast) Returns to baseline after a few weeks Old patients more sensitive plus difficulty to learn new material. In 6 months no difference with younger.

Declarative memory New learning (anterograde amnesia) Transitory difficulties in retaining new information and in recognizing or retrieving information learned some time previously Increases with increasing number of treatments Not associated with global cognitive dysfunction Recovers within a few weeks after ECT

Declarative memory Remote memory (Retrograde amnesia) Deficits in recall of autobiographical facts and events learned before ECT Temporal gradient ( more so for events within the year prior to ECT) Worse with bilateral Worse with sinewave treatments Reversible by 3 -6 months

SUMMARY ECT affects selectively memory parameters There is large inter-individual variability Memory disturbance is not related to clinical effects on depression

SUMMARY Memory disturbance is in general reversible In some cases some retrograde amnesia for sporadic events (public mainly) may persist Both mesial temporal lobe and prefrontal cortex (lowest seizure threshold in brain) have been implicated in memory trouble

Huntington במחלת Retrograde amnesia 47 Albert et al. , 1981