If I were going to write an amnesia questionnaire?
By Gordon S. Johnson, Jr.
Overall considerations in assessing amnesia:
Ask open-ended questions where you can get a feel as to the communication skills of the person injured. While amnesia is the most sensitive test and most significant test of post concussion dysfunction in the brain, an open-ended question will tell you far more than a yes or no question. Does the injured person seem capable of complicated and logical thought and communication? If not, this is evidence of confusion and possibly amnesia. But confusion and amnesia are not the same thing. A person can be amnestic without being confused.
A clear memory of the event does not mean that the person does not have amnesia as brain injury is a process, not an event and the dysfunction can get worse over time. While it is always helpful to start with the event when checking a person for failure to encode continuous memory (amnesia) the amnesia may not show up until later. A number of factors could contribute to this, but keep in mind that adrenaline improves memory, so memory of the event may be an island of clarity in a sea amnesia. Keep in mind the possibility of “Swiss cheese” memory. Holes in memory can occur without any ability to predict when and where such holes will occur. The advantage of open-ended questions is you are more likely to spot the holes in memory if you demand complicated answers.
A period of amnesia does not end until the return of “continuous” memory. So remembering something of what is going on, but not all of it, is evidence of amnesia. At this point you are looking to include, rather than exclude the role of concussion in behavior and cognitive function. More evidence is better than less.
Amnesia Questions to ask of Eye Witnesses to Concussion:
- Was he/she repeating himself?
- How long did it take before he/she knew what was going on?
Amnesia Questions for Injured Person
- What is the last thing you remember before you got hurt?
- What is the next thing you remember?
- How did you get hurt?
- Do you remember the ambulance ride? Describe.
- Tell me about the intake person/process when you got the ER?
- Did you have to wait in the ER? If so describe the most unusual thing your saw there?
- Who else have you seen in the ER? Tell me about what you talked about.
Amnesia Questions for the next day.
You are trying to establish continuous memory from just before the injury up to the moment of the inquiry on the next day. If there is evidence of amnesia, it is critical that it be documented. If you are not a medical provider, video tape the discussion and show to a provider if abnormal.
- What do you remember about yesterday after your concussion?
- Do you remember the rest of the game/day?
- Do you remember any part of the game/day before you got hurt?
- Do you remember the treatment you got yesterday?
- What did you eat this morning, yesterday evening, etc.
- How did you sleep?
- Describe the worst symptoms you had yesterday?
- Describe the worst symptoms you are having right now?
Amnesia Questionnaire Needs to be in Treatment Records
If this questionaire is abnormal, missing memories, it is critical that such be made part of the official treatment record of the injured person. While most people get better quickly after a concussion, for those that don’t it needs to be clear to subsequent medical diagnosticians that this easiest and most significant symptom, is documented.