The patient with an amnestic state is almost always disoriented, especially to time. Accurate temporal orientation and accurate knowledge of current news rule out a major amnestic state. The anterograde component of an amnestic state can be tested with a list of four to five words read aloud by the examiner up to five times or until the patient can immediately repeat the entire list without intervening delay. In the next phase of testing, the patient is allowed to concentrate on the words and to rehearse them internally for 1 min before being asked to recall them. Accurate performance. | Chapter 027. Aphasia Memory Loss and Other Focal Cerebral Disorders Part 12 The patient with an amnestic state is almost always disoriented especially to time. Accurate temporal orientation and accurate knowledge of current news rule out a major amnestic state. The anterograde component of an amnestic state can be tested with a list of four to five words read aloud by the examiner up to five times or until the patient can immediately repeat the entire list without intervening delay. In the next phase of testing the patient is allowed to concentrate on the words and to rehearse them internally for 1 min before being asked to recall them. Accurate performance in this phase indicates that the patient is motivated and sufficiently attentive to hold the words online for at least 1 min. The final phase of the testing involves a retention period of 5-10 min during which the patient is engaged in other tasks. Adequate recall at the end of this interval requires offline storage retention and retrieval. Amnestic patients fail this phase of the task and may even forget that they were given a list of words to remember. Accurate recognition of the words by multiple choice in a patient who cannot recall them indicates a less severe memory disturbance that affects mostly the retrieval stage of memory. The retrograde component of an amnesia can be assessed with questions related to autobiographical or historic events. The anterograde component of amnestic states is usually much more prominent than the retrograde component. In rare instances usually associated with temporal lobe epilepsy or benzodiazepine intake the retrograde component may dominate. The assessment of memory can be quite challenging. Bedside evaluations may only detect the most severe impairments. Less severe memory impairments as in the case of patients with temporal lobe epilepsy mild head injury or early dementia require quantitative evaluations by neuropsychologists. Confusional states caused by toxic-metabolic
