Amnestic disorders are a series of disorders that involve loss of memories formerly established, loss of the ability to construct and establish new memories, or loss of the ability to gain or grasp new information. There are various types of amnesia, including retrograde amnesia, anterograde amnesia, transient global amnesia, and infantile amnesia.
This guide explores the importance of understanding the complexities of amnestic disorder, the impact it has on patients’ daily lives, and the vital role of nurses in providing compassionate support, therapeutic interventions, and promoting strategies to enhance patients’ memory.
Table of Contents
- What are Amnestic Disorders?
- Causes of Amnestic Disorders
- Clinical Manifestations
- Assessment and Diagnostic Findings
- Medical Management
- Nursing Management
What are Amnestic Disorders?
Amnestic disorders are characterized by an inability to learn new information (short-term memory deficit) despite normal attention and an inability to recall previously learned information (long-term memory deficit).
- Amnesia refers to a specific deficit in new learning and memory.
- Retrograde amnesia refers to a loss of memory for events before the onset of lesion or condition.
- Anterograde amnesia refers to an inability to acquire new information or experiences occurring during the period of impairment.
- Transient global amnesia occurs with confusion or agitation that comes and goes repeatedly over the course of several hours.
- Infantile amnesia is a common phenomenon wherein most people can’t remember the first three to five years of life.
- Amnestic disorders can occur in isolation, but in practice, they are most commonly seen within the more global syndromes of delirium or dementia.
Causes of Amnestic Disorders
In general, amnestic disorders are caused by structural or chemical damage to parts of the brain. The DSM-V identifies the following categories as etiologies for the syndrome of symptoms known as amnestic disorders:
- Amnestic disorder due to a general medical condition. The symptoms may be associated with head trauma, cerebrovascular disease, cerebral neoplastic disease, cerebral anoxia, herpes simplex encephalitis, poorly controlled insulin-dependent diabetes, and surgical intervention to the brain; transient amnestic syndromes can also occur from epileptic seizures, electroconvulsive therapy, severe migraine, and drug overdose.
- Substance-induced persisting amnestic disorder. This type of amnestic disorder is related to the persisting effects of substances such as alcohol, sedatives, hypnotics, anxiolytics, and other medications, and environmental toxins; the term “persisting” is used to indicate that the symptoms persist long after the effects of substance intoxication or substance withdrawal has subsided.
The following symptoms have been identified with amnestic disorders:
- Disorientation. Disorientation to place and time may occur with profound amnesia.
- Inability to recall events. There is an inability to recall events from the recent past and events from the remote past.
- Confabulation. The individual is prone to confabulation. That is, the individual may create imaginary events to fill in the memory gaps.
- Other symptoms. Apathy, lack of initiative, and emotional blandness are common.
Assessment and Diagnostic Findings
Laboratory studies may be helpful for ruling in or excluding specific diagnoses that cause amnestic disorder symptoms.
- ABG. Oxygen saturation, or ABG with carbon monoxide level, may be diagnostic.
- Drug toxin levels. When alcohol, drugs and/or toxins are suspected, consider serum ethanol, salicylate, acetaminophen, carbon monoxide, and other specific drug or toxins level as indicated.
- CT scan. A head CT scan without intravenous contrast should be obtained if CNS infection, trauma, or a cerebral vascular accident is suspected.
Medical management of a patient with amnestic disorders and emergency care include:
- Patient’s safety. Prehospital care workers involved in the transport of an acutely confused, combative, or delirious patient must ensure the safety of the patient and the staff.
- Supportive care. Treat suspected overdose-induced delirium based on ingestion history and/or toxidromes; such treatment may range from simple observation and supportive care, activated charcoal, gastrointestinal lavage, sedation, specific antidotes to intoxication and life support.
- Identify underlying cause. The treatment of amnestic disorders is dependent on the identification of the underlying cause, which may not be elucidated during an ED stay.
- Consultations. Specific cases may require consultation with neurosurgery, neurology, or medicine subspecialists.
Medications typically used in the treatment of amnestic disorders include:
- Sedatives. These agents are used to calm acute agitation, to control the behavior of combative patients, and to facilitate procedures.
- Glucose supplements. Monosaccharides absorbed from intestines after PO absorption of dextrose results in rapid increase of blood glucose concentrations.
- Neuroleptics. These agents have more robust calming effects than benzodiazepines in acutely agitated patients; they act fast when given IV.
- Atypical antipsychotics. These are newer neuroleptics with a lowered risk of extrapyramidal syndrome and improved efficacy for the negative symptoms of psychosis because of their enhanced serotonergic activity as compared to older-style neuroleptics.
- Antidotes. These agents are used when the toxic agent is known and has an antidote or as a coma cocktail in patients who are stuporous or comatose.
The nursing management of a client with amnestic disorders include the following:
Assessment of a client with amnestic disorders include:
- Psychiatric interview. The psychiatric interview must contain a description of the client’s mental status with a thorough description of behavior, flow of thought and speech, affect, thought processes and mental content, sensorium and intellectual resources, cognitive status, insight, and judgement.
- Serial assessment. Serial assessment of psychiatric status is necessary for determining fluctuating course and acute changes in mental status, interviews with family members should be included and can be crucial in the treatment of infants and young children with cognitive disorders.
Nursing diagnosis for persons with amnestic disorders include:
- Risk for trauma related to chronic alteration in structure or function of brain tissue secondary to the aging process, multiple infarcts, HIV disease, head trauma, chronic substance abuse, or progressively dysfunctional physical condition.
- Chronic confusion related to alteration in structure or function of brain tissue secondary to long-term abuse of drug or toxic substances.
- Self-care deficit related to cognitive impairment.
- Low self-esteem related to loss of capacity for remembering.
Nursing Care Planning and Goals
The major nursing care planning goals for patients with amnestic disorders are:
- Client will voluntarily spend time with staff and peers in day-room activities.
- Client will exhibit increased feelings of self-worth as evidenced by voluntary participation in own self-care and interaction with others.
The nursing interventions for Amnestic disorders are:
- Encourage expression of feelings. Encourage client to express honest feelings in relation to loss of prior level of functioning; acknowledge pain of loss; support client through process of grieving.
- Assist with memory deficit. Devise methods in assisting client with memory deficit; these aids may assist client to function more independently, thereby increasing self-esteem.
- Encourage communication. Encourage client’s attempts to communicate; if verbalizations are not understandable, express to client what you think he or she intended to say.
- Reminisce events with client. Encourage reminiscence and discussion of life review; also encourage discuss present-day events; sharing picture albums, if possible, is especially good.
- Encourage group participation. Encourage participation in group activities; caregiver may need to accompany client at first, until he or she feels secure that group members will be accepting, regardless of limitations in verbal communication.
- Provide client support. Offer support and empathy when client expresses embarrassment at inability to remember people, events, and places.
- Encourage independence. Encourage client to be as independent as possible in self-care activities; provide written schedule of tasks to be performed.
Outcome criteria include:
- Client initiates own self-care according to written schedule and willingly accepts assistance as needed.
- Client interacts with others in group activities, maintaining anxiety level in response to difficulties with verbal communication.
Documentation in client with amnestic disorders include:
- Individual findings include factors affecting, interactions, the nature of social exchanges, and specifics of individual behavior.
- Cultural and religious beliefs, and expectations.
- Plan of care.
- Teaching plan.
- Responses to interventions, teaching, and actions performed.
- Attainment or progress toward the desired outcome.