Abnormal Psychology

700 CHAPTER 15

The challenge with memory aids is to overcome the pa-

tient’s diffi culty in remembering to use the strategies and de-

vices in real-life settings. To facilitate such generalization, the

clinician may teach family members or others how to use

the strategies and devices and how to help the patient use them

in his or her home environment.

Targeting Social Factors: Organizing the

Environment

One way to reduce the cognitive load of someone with amnes-

tic disorder is to enlist others to structure the patient’s environ-

ment so that memory is less important. For instance, family

members can place labels on the outside of cupboard doors

and room doors at home or at a residential facility; each la-

bel identifi es what is on the other side of the door (for exam-

ple, “dishes,” “kitchen,” “Sally Johnson’s room”). In some rehabilitation centers,

the doors to bathrooms are painted a distinctive color, and arrows on the walls or

fl oors show the direction to a bathroom, so patients don’t need to rely as much on

memory to get around the facility (Wilson, 2004).

Key Concepts and Facts About Amnestic Disorder

• Amnestic disorder is characterized by signifi cant defi cits solely in
  memory—other cognitive functions remain relatively intact. Peo-
  ple with amnestic disorder may confabulate to fi ll in memory gaps,
  and they may not be able to report their history accurately during
  a clinical interview. Amnestic disorder can be transient or chronic.


• When trying to determine whether amnestic disorder is the most
  appropriate diagnosis for a patient with memory problems,
  the clinician must rule out other disorders that can give rise to
  memory problems, including delirium and dissociative amnesia;
  the clinician must also determine that the memory impairment
  is more severe than would be expected from normal aging.


• Amnestic disorder is caused exclusively by two types of neuro-
  logical factors: (1) substance use (leading to substance-induced
  persisting amnesia, which most frequently occurs with severe
  and chronic alcohol dependence), or (2) a medical condition,
  such as stroke, head trauma, or the effects of surgery.
  
  
  • Rehabilitation focuses on helping amnestic patients learn to use
    organizational strategies (such as mnemonics or writing down
    information) and memory aids (such as diaries and PDAs). A pa-
    tient’s environment can be structured in order to minimize the
    amount of information that needs to be remembered to func-
    tion in daily life—for example, by putting identifying labels on
    doors.
  
  
  
  

Making a Diagnosis

• Reread Case 15.3 about Ms. A., and determine whether or not
  her symptoms meet the criteria for amnestic disorder. Specifi -
  cally, list which criteria apply and which do not. If you would
  like more information to determine her diagnosis, what infor-
  mation—specifi cally—would you want, and in what ways would
  the information infl uence your decision?

This man has signifi cant memory problems.

The notes on his dresser drawers label the type

of items in each drawer. Such modifi cations to

his environment can reduce the impact of his

memory problems, and make his experience

getting dressed each morning less confusing or

frustrating.

John Livzey/Getty Images

Dementia

Mrs. B. seemed to have some memory problems, but memory was not the only

aspect of her cognitive functioning that had declined. During neuropsychological

testing, “the principal areas of diffi culty on [certain] tests were in mental control,

as evidenced by tangential and repetitive speech; psychomotor slowing [in this case,

slow movements based on mental processes, not refl exes]; and reduced fl exibility in

thought and action” (LaRue & Watson, p. 9). Some of these diffi culties are charac-

teristic of dementia. Could Mrs. B. have dementia?

In this section we focus on dementia: what it is, what neurological factors give

rise to it, and what treatments are available for it.