Mind Matters: Exploring Retrograde Amnesia

0:00:08 - Shane Smith Hey, I'm Shane from Shane Smith Law. I'm here today with Thomas for this episode of Mind Matters: Navigating Head Injuries and Concussions. Thomas is one of the brain and concussion attorneys here at Shane Smith Law, and Thomas we're talking about what today? Retrograde amnesia?

0:00:23 - Thomas Ozbolt Yeah, retrograde amnesia that's a term that's often used in psychology and neurology to describe a specific type of memory impairment.

0:00:32 - Shane Smith Amnesia is what everybody thinks about- you, you get hit in the head and you forget everything. It makes me think of there was an old movie Overboard with Goldie- is it Goldie Hawn who fell overboard and hit her head and forgot everything for a little while but she could still do normal stuff, but she had no memories for months. Is that retrograde amnesia? What are we talking about here?

0:00:54 - Thomas Ozbolt It's similar. There's different types and different categories of it. Retrograde talks about where someone's unable to recall past memories, experiences or events. You can have amnesia of a specific event, like if you're involved in a car accident, let's say massive impact. You might not remember even the beginning of that impact. It might be wiped out. Retrograde, I think, refers back to a varying duration of time, from weeks, even years back, depending on the severity.

0:01:21 - Shane Smith So you're losing stuff. Now does it come back or is it gone?

0:01:24 - Thomas Ozbolt I think it depends on the severity. It potentially could come back because you have neuroplasticity of the brain and its ability to regenerate itself over time. But in terms of this specific feature in retrograde amnesia, that's where more recent memories are more difficult to access than older ones.

0:01:45 - Shane Smith Okay, so the more like a week or two before the event. So I can remember all my childhood stuff, but I can't remember the last six months or the last three months or what I did the day of the accident.

0:01:58 - Thomas Ozbolt Exactly, and they talk about this in terms of a temporal gradient. Things kind of go along this spectrum. You know, if it's something that's more recent, you may have difficulty recalling it from the last few weeks, but if it's going back to a birthday party with your parents or your friends and you're probably not going to have as much difficulty with that, with this specific.

0:02:23 - Shane Smith I would imagine that causes a lot of distress in the individuals who have it, because they know things happen, they just can't remember what it is or even how they got there right? This is the thing where you wake up in the hospital and they're like how did I even get here?

0:02:30 - Thomas Ozbolt Yeah, yeah, just incredibly alarming. And you know we have more than a few clients like that. They just they wake up and they're surrounded, or they're kind of bolted down to a bed or they've got IVs running from them and they're like how did I get here? What's going on? Where has my life gone? So you know that's, I think one of the most alarming things about it is that you just it's a lack of a sense of control that goes on with it. And how do they calm those folks down?

I guess there's lots of different ways. Having friends and family around I think can be one of the best things, because you know it's much better to hear from somebody who's close to you than you know a doctor you've never seen before was just trying to explain to you what's happened to you. I mean, I'm sure there's different types of medications and things like that, you know, but I think definitely being around family and friends is going to be the best way to come, you know, to get it the best possible way.

0:03:21 - Shane Smith To get the best, just sort of acceptance, I guess. Yeah, bring yourself back. My guess is some of them probably go through almost like the grieving period. You know they continue on the grieving period where finally there's acceptance at the end and not denial and anger. I'm sure there's a ton of that associated with losing large chunks of time.

0:03:38 - Thomas Ozbolt Yeah, you got to. I mean, I feel like sometimes when I sit around, I think that would be one of my worst nightmares is not being able to remember, you know, my daughter's birthday party a couple weeks ago and not being, I know you're a father too, just not being able to remember those core memories or

those things that are just incredibly special to you. It just feel you know that's a loss that you can't ever quantify in terms of a dollar value.

0:03:59 - Shane Smith Yeah, because what is that worth, right? What if it was an event and that person's no longer with us? Or somebody who was happily married and then ended up getting divorced, but all their happy memories are gone, or some of them are gone anyway?

0:04:12 - Thomas Ozbolt Yeah, you have something taken away from you that just forms a key part of your relationship with a person.

0:04:18 - Shane Smith Yeah, that sounds bad. I mean, it sounds terrible. What else would you tell us about retrograde amnesia?

0:04:25 - Thomas Ozbolt Yeah, I mean one of the things that I think is maybe the silver lining of it we don't know yet that it steals away from you something in terms of your procedural memory. You know your ability to do certain tasks, skills that you learn before the onset of the amnesia. And even if somebody doesn't, you know maybe they forgot hey, I forgot how jump shot. Or you know hitting a baseball. I forgot how I learned to do that, but I still know how to do it. You still know how to do it. Procedural memory is there.

0:04:53 - Shane Smith You just don't remember, like you say, how you learned it. Right. So this is sort of the thing where people start to do something that, like holy cow, I can do this.

0:05:01 - Thomas Ozbolt Right. Yeah, I just kind of you don't know how you got there, but you know that you can still do it and I guess that's one of the good things about it.

0:05:11 - Shane Smith Ok, because a different part of the brain remembers that part, basically? Right. How often does this happen in car wreck cases?

0:05:19 - Thomas Ozbolt Yeah, I think it's hard to put a number on it and I think the big reason for that is because we're really at the infancy of learning about TBI in the context of anything. Diagnostic tools that we have today are light years beyond what they were three or four years ago, and we're coming out with more and more ways of detecting what's going on. In terms of our clients, we see it pretty frequently, in terms of forgetting things or having memory concentration problems. Just certain memories or people's names is a big thing. I mean, it also comes up in the context of neurodegenerative diseases. You might think about Alzheimer's or another disease like that. This TBI can help make well, not help, but TBI can contribute to making those things worse or bringing them about when they weren't ever really going to come about. Maybe you had an early trigger for those things.

0:06:11 - Shane Smith So you didn't have it. And then boom, you're in the car, wreck, you get a TBI and now suddenly you go from you know, limited retrograde amnesia now into full blown Alzheimer's, or at least that slippery slope of dementia.

0:06:24 - Thomas Ozbolt Yeah, could bring about or trigger that happening before it was ever going to happen or much earlier than what was going to happen.

0:06:35 - Shane Smith And it's a question along those same lines: the elasticity of the brain, is that impacted a lot by your age and how old you are?

0:06:41 - Thomas Ozbolt I think we're still learning that. I think definitely a younger brain, healthier body can definitely bring about the ability to rehab from a brain injury. But I think that's still one of those things that we're learning a lot about. But it would be hard to imagine that somebody younger wouldn't be able to rebound from something like this versus a 30-year-old, versus a 75-year-old.

0:07:08 - Shane Smith Yeah, ok, and I just think in an older person you steal those memories, sometimes that's all they have left, right?

0:07:22 - Thomas Ozbolt Yeah, those precious memories, or memories of things with your family. That's, I know even for me now, that's something that I treasure, and I just can't imagine what it would be like to be older, and almost in the twilight of your life, you might say, and not having those treasures to hold onto.

0:07:36 - Shane Smith So what else are they talking to us about retrograde amnesia about?

0:07:39 - Thomas Ozbolt So retrograde amnesia, individuals with that, they might struggle with remembering what's happened in the past, but they can still function in their daily lives, so it might look for them like they're just going on. Nothing has happened in terms of not having a real impact on their lives. They're involved in a significant car accident that causes TBI, but this can definitely affect things that they've had in the past. It can affect memories, can affect again these treasured moments that we talked about.

0:08:06 - Shane Smith Well, let me ask you this: if you have retrograde amnesia, is it normally like, ok, I lost this time period here, but now that I'm here and I'm awake, all the new stuff is building on, or do I continue to lose time basically?

0:08:20 - Thomas Ozbolt That gets into a different category, which is what we call interograde amnesia. That can be something that can happen in a collision as well, or through traumatic brain injury, and that's where a more debilitating disorder. Yeah, because that impairs your ability to learn new information and that's obviously essential for day-to-day activities. So you could have one or the other, you could have both. I don't think there's anything that, having one limits having the other being caused by TBI.

0:08:50 - Shane Smith Okay, so you could be unlucky and have both. But retrograde is a specific type. Just for some time you lost in the past.

0:08:59 - Thomas Ozbolt Yes.

0:09:00 - Shane Smith But it's not going to continue to impact you. That's something else.

0:09:03 - Thomas Ozbolt Yeah, yeah, you might have that as well. They might go along with each other, but you know that's definitely its own specific category. And then you have an anterograde which is looking forward.

0:09:15 - Shane Smith So what, I mean, we talked a little about car wrecks. What causes retrograde amnesia?

0:09:20 - Thomas Ozbolt Yeah, I think it can be, you know, as we talked about, a number of different things. Genetics, you know different neurodegenerative disorders, but traumatic brain injury and to any significant impact in terms of direct blow to your head or those acceleration deceleration forces that you know basically cause your brain to smash against the hardest thing in your body, the inside of your skull.

0:09:41 - Shane Smith So car wrecks definitely can cause it. That's where we see it the most in our, in our act, you know, in our cases. But it makes me think about it like sports, the football. Has it happened in football, or I know, boxers a lot of times have issues. I watch UFC and I've seen multiple of those people talk about you know, when they get knocked out, they'll wake up and they lose the whole fight. Yeah, and that's what we're talking about here retrograde amnesia, right, that's, they've got it.

It's just confined to a very short window when they're talking about not, not remembering the fight at all.

0:10:09 - Thomas Ozbolt Exactly. And sometimes, like you hear, with football players: I don't remember, you know, from the second quarter on, you know, I just took that big hit, went down and, you know, woke up in the hospital and just completely wiped out.

0:10:27 - Shane Smith So for our purposes that would be pretty limited, retrograde amnesia, you know, short impact, but I guess that would also be then, you know, those people who you know they've been in a car wreck. They're sitting on the curb, which happens sometimes. You know they get out of the car and then you know, when the EMT gets there, they're like what happened? Like I don't know. You know, they just don't remember anything. They don't remember passing out, they don't remember getting out of the car.

You know they just find them on the side of the road right?

0:10:50 - Thomas Ozbolt Yeah, one of the interesting things that can happen too is, you know, I've had clients where I've talked to them a couple days after a car accident and they remember, you know somewhat what happened. But as we get farther away and we talk about it some more, so that memory has kind of been faded or wiped. So it degrades and it's gone.

Yeah, because when you have that concussion that you know disrupts the function of your brain and disrupts how signals are being sent different, you know, hormones, responses throughout your body that can take some time to unfold in terms of how you know things, that kind of going to degenerate in terms of your system.

0:11:24 - Shane Smith So you know, I've always heard, you know, back injuries get worse over the first three to five days. Right, you know, if you feel it the first day, it's going to be terrible by day three. That's one reason why we say, if you aren't in a lot of pain, you go right to the ER, because it's going to get worse. So these are the same way, they get worse over a shorter time period afterwards, I guess the head injury stuff just comes to light, basically, is that what it is?

0:11:46 - Thomas Ozbolt Yeah, well, I think one of the important ways to think about it and conceptualize it is, it's not an event, right? It's not, I got in a car accident, boom, I had a traumatic brain injury. It's an ongoing disease process. It's something that unfolds over time and can still be unfolding, you know, years after the fact, really, and it might even be the lesser traumatic brain injury, a mild traumatic brain injury, not one where you're getting your skull stoved in, but one where you've, you know, got some pretty bad headaches for a couple weeks after. That can be the one that lingers with somebody longest, and why? We don't really know. But you know the brain's kind of like the ocean. You know we're just kind of scraping the surface.

0:12:25 - Shane Smith Figuring stuff out as we go. I know, you know it's been exciting for me to see the evolution of this over my career. You know, because when I first took it on brain injuries, we didn't have any of this science stuff. There were no DTIs, there was no blood tests to show it. I mean, it was really just almost all visual. Or the old MRIs that really are not great at showing brain injury. They show blood but not an injury to the brain. That was really about all we had.

And now in the last five years it's just accelerated. We have so much more medical information and knowledge.

0:13:01 - Thomas Ozbolt Yeah, I think it's a field that's exploding, and when we're talking to the doctors and the scientists that are involved with this, they're just incredibly excited. Which makes me excited because they're saying, hey, we're just in the infancy of this. They're working with the Department of Defense, they're working with different federal agencies to figure out how we can bring this to the public and kind of expand what we know about how traumatic brain injuries are affecting people and that can do tremendous things for our clients, which I'm really excited about.

0:13:39 - Shane Smith I was going to say in a lot of the work we have to do on the case is, once we get the diagnosis of the brain injury, then it's, how does it impact that client right? And what are some ways we dig into that, or people, even somebody watching it, could dig into it a little bit and be able to explain it to their family members.

0:13:45 - Thomas Ozbolt Yeah, I think some of the tools that we can use with that, it's a videonystagmus test, which is going in and evaluating this balance and posture test in terms of how your eye will respond to a stimuli and what that tells us about what's going on inside your inner ear and inside your brain and the areas of your brain that are responsible for the balance and the movement of your eye. So that's something that can give us evidence, can tell you, look, if you're going to be at elevated fall risk over time, if you're going to have cognitive issues. There's also diffusion tensor imaging, which lights up your brain like a Christmas tree in terms of the way that you can look at it and see, hey, that bulb isn't working there. Maybe this particular chain of white and gray matter is what has been affected here in this accidnet. That's what you're lost. And blood tests that's kind of the new frontier is, you know, blood tests can tell you what part of your brain or how your brain has been injured.

0:14:38 - Shane Smith And that's something we're going to get into in another episode, because that sounds crazy, cool, exciting, and one part of it is like I don't see even how they can do that. The other part of it is like well, of course, they can see changes in everything, so we're going to dig into that on another episode of Mind Matters. So if that's something you're interested in, watch out for that episode as me and Thomas dig into that. So how do they explain the amnesia to their friend and family members?

Is it just like hey, I don't remember that, or is there anything else that can sort of help with that? Because, to be quite honest, I know we've run into clients and family members where when somebody's suffered a head injury, they're like I just don't remember anything. But a little while people are like, yeah, come on, really? What? You know, why can't you remember it? You know? Does that make sense? How do you deal with that?

0:15:20 - Thomas Ozbolt Yeah, I think you know, another way to think about it is, you know, it's not just them explaining it to their friends and family members. A lot of times they're alerted to it by their friends and family members. It's like hey, bro, we just did this the other day, you don't remember?

0:15:39 - Shane Smith So it's the opposite of what I was talking about, that friends and family members notice it and the person themselves does not.

0:15:44 - Thomas Ozbolt Yeah, and that's why you know, having community, friends and family around you in these cases, that's some of the most valuable, it's the most valuable network you can have to really help you find out what's going on, get you to the doctors that you need to go to and then help you get back to yourself. There's different therapies, different neuro rehabilitation therapies that are out there, cognitive behavioral therapies that are recommended, and then some other really kind of neat stuff that I'm sure we could talk about on a different one, because I don't know about it now.

0:16:17 - Shane Smith What I would, you know, what I take from that is you know it's so important to listen to those people you know, your friends and family, when they raise one of those issues and tell your doctors or tell your lawyer so we can dig into it and, like you say, try to get you the right doctor, the right specialist to figure it out, because you may not know yourself. And if you minimize that, oh it's nothing, it's nothing, it's nothing. You know you're not going to get the treatment you need, for certain, and obviously you're not going to get that involved, that part of a case, but more importantly, you're not going to get the treatment you need. So it's going to continue to be a problem.

0:16:53 - Thomas Ozbolt Yeah, I think you know being able to talk with your lawyer about it and get, have them, get you connected to somebody, because if you look at it in a way, we're kind of like almost like a general contractor. We have a pretty broad base of knowledge and information and we work with a lot of doctors over, you know, years and years and you know, we know, you know, we know what types of doctors that we can send people to, and a lot of times if you're just a regular person going to the hospital, going to your doctor, you just feel like you're not heard, like you're not listened to, and I think that's really one of the most valuable things that an attorney can do.

It's like hey, we know we're trying to help you. We're not burdened by the constraints of having, you know, 9,000 people in the waiting room and, you know, having to worry about billing and all the Medicaid, Medicare and all those things that are going on is, we can listen to you and we can help you with information that you might never have and you might never be given by, you know, your set of doctors or your insurance company.

0:17:50 - Shane Smith All right. Thomas I think we've learned a lot. We've talked about a lot today For a lot of listeners. If you're interested in Mind Matters or injuries and concussions, like and subscribe and hit the bell for notifications and also remember if you're in pain, call Shane 980-999-9999. If you've had a brain injury or concussion in your car accident case and have questions and concerns, feel free to call our office and ask for Thomas or the brain injury group.