DRHOOK- Forget it: Anterograde amnesia makes everything new

the handsome doctor John Hong

"Forget it– it never happened!" 

How many times have we heard that from dysfunctional or unethical people? (Or at least in TV, movies, and books?)

If you're like an elephant, you never forget anything. Some people can hold onto a grudge longer than a parent who reminds a daughter how she ruined Thanksgiving in 1942 by not following great-grandmother Josephine's recipe for stuffing.

What happens if you can never, ever, remember anything new?

Something old, something new, something borrowed, something blue.

If you have Korsakoff's Syndrome, in a matter of minutes you won't remember something is new. You won't remember to return something borrowed. On the other hand, you would probably remember something old, since it's from the past, and for the same reason you could probably identify the color of something as blue.

Anterograde amnesia is the type of memory loss that occurs in Korsakoff. This means the past memory is intact– people can recall the names of their elementary school teachers (and their brown-nosing peers). However, anything in the present will be gone from memory like a leaf blown away in a November wind. 

I've seen a few people with Korsakoff, and they can certainly fool you with confabulations (making things up to cover up their memory deficits). One person with Korsakoff was very pleasant, but when I asked her what she thought of my nurse, she responded with traditional generic answers. 

"Oh, she's a doll– just a doll. Mmm, hmm...." Ah, my nurse is a man. 

"Oh, yes, he's just so sweet. Haha. I meant ‘he.' You know how it is when you meet so many new people."

Another time I had to leave the exam room to answer a phone call. When I returned, I could tell the patient didn't remember who I was. So I asked, "Have we met before?" 

He replied, "You know, I believe so, but I just– I just can't quite put your face with a name. It's on the tip of my tongue." 

When I told him my name, he responded with a smile and nodded his head as if he had known all along. 

Confabulation isn't lying. It's just what people do when they can't form new memories. In fact, they aren't aware of having anterograde amnesia. It's impossible to put it together when you can't store memories. 

It's like that movie, 50 First Dates, with Drew Barrymore and Adam Sandler. Or maybe that amazing thriller movie Memento is closer to what it's like to have anterograde amnesia, sans the guns and revenge plot. 

Korsakoff's stems from a thiamine (Vitamin B1) deficiency, usually in folks with alcohol abuse and malnutrition. It part of a larger issue, Wernicke-Korsakoff Syndrome which can show up as delirium, inability to move the eyes, and walking like they just got off the Tilt-A-Whirl (not dizzy, but unable walk a straight line). About 80 percent of people with a Wernicke's episode will have some Korsakoff's signs.

Most folks with Korsakoff will have their social abilities intact as well as their attention span. There's usually apathy, though, unlike some other forms of dementia that can make people very aggressive and "in your face." 

Recovery is rare because the memory sections of the brain are gone and gone forever. So persons with Korsakoff need supervision, social support, and often a chronic-care facility.

Having a brain like Teflon would be a curse to me. It would be like having crab cakes fried on your brains: nothing sticks, but you still get to have supper. 

The thing is, by the time dessert arrives, I want to remember how the crab cakes tasted.


Dr. Hook cracks a joke or two, but he's a renowned physician with an interesting website, drjohnhong.com. Email him with your questions.