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What Causes Memory Loss, Tiredness And Chronic Fatigue?
Question: I recently experienced explaining something to someone, and as I spoke each word, I could not remember at all what word I just said, nor anything like the word. It was public speaking, so I continued slowly with what I had to say (a complex thought that I was forming sentences for as I spoke), but felt uneasy, in that I was not certain what I had just said, or if the phrases and sentences were assembled to have meaning.
I don't recall having this experience before.
The words, my intent, the context all disappeared as soon as I said them. When I finished, I had zero recollection of what came out and asked if I made sense. They said I did. But I had zero recall of it.
It was a day when I felt a bit 'muddled' and tired. The day before had been a long day trip to nearby mountains, some short hikes, and birdwatching. I didn't drive, but I was so tired at dinner, I asked permission to sleep in dining chair while my husband ate. (Week before had symptoms of cold/cough virus which abated before complete bloom, then diarrhea for several days but stopped when I took prilosec - go figure!)
I have had 3 decades under the diagnosis of chronic fatigue, without enough control of it, to work 50 weeks a year (part time or full time), yet I had 4 years full time professional engineering work before the 'cfs' or whatever displaced me from the work force. (was exposed to strong chemical fumes during very stressful work and family months, then harsh virus, and the out of work.) Part of the cfs experience is 'brain fog', a slowness to respond, or comprehend, or recall, and decide.
I get a very thorough annual physical (MDVIP program) every year, and my doc has known me for over 20 years. Other than the CFS, hypersomnia, depression at times accepting limits in life, a couple colds a year, my health can be good, if I don't overdo, and try to run an adult life of 16 or more hours a day working. I have friends, hobbies, volunteer work, exercise classes, and outdoor sports like kayaking, like most people. I just live a 12 hour day, not 16, in general, and I take Nuvigil to stay awake.
But this mid sentence, loss of recall and context, was much worse than any brain fog I'd ever had.
All my life I have had 'recall' problems, as in not recalling what I know, when asked a question. However, later I remember, when not trying to answer a question.
I am 61 now, and it's no XXXXXXX to me, when people ask me to remember the names of people I once knew, and I don't know. I think that's typical. I am also noting that if I am asked what I was doing exactly, 4 hours ago, a day ago, or last Tuesday, I don't have an immediate answer. Most of the time, I can figure it out, just from remembering some parts, and filling in the other.
I see psychologists off and on through life (my parents died when I was 25, and then conflicts over their wills made all siblings unapproachable, though It wasn't a big deal to me). The psychologists have never used the word dissociation with me, and my husband of decades would probably say that I'm not one to 'dissociate', from what he observes (but he does limited observing).
So I am trying assess if I should be concerned. And if so, do I wait for it to happen again, or go see a Neuro now. And most of all, I am asking What Could This Be? What could be happening? If you want to call me, call 919/828-4840. Thank you.
I am female, married, no children, age 61, live near the XXXXXXXX, and XXXXXXX NC. I do bookkeeping. taxes, spreadsheets for my husbands IBM Architect job, event planning, meal planning, groceries, cooking, cleaning, scheduling my husband's social life, and anything to enable his copious talents to be distributed further.
I am well read on aging memory problems, early signs of Alzheimers (his mother got it), and I know the meaning of different kinds of aphasia. But this isn't aphasia. I do miss being able to recall a word I want to use at times, but think this is expected at this age.
My mother died of a stroke, a few years after contracting phlebitis in ICU after auto accident. My father died a few years later, of colon cancer like his father had had. ( 1975 and 1978). My mother's memory was slipping a bit in her last years. She was in her 60's. Her two sister's had Alzheimer's, and her mother had dementia possibly alzheimer's. They lived into ages like 78-83. Grandmother born 1870, died 1950-55.
My older sisters ages 78 and 74 have never had the recall problems I have had, and continue to run full lives. One continues to work full time (the older one) in her own business running swim meets all over the US, and the younger one works 35 hours a week at two volunteer positions, one as Treasurer for a church, the other as Master Garden Designer at nearby university. Her professional role had been in financial planning and PR for large universities.
Each sister takes Estrogen for different reasons. (And now I am beginning to look older than them, because their faces have not changed since their 50's). The finance and PR sister had hormonal imbalances all her life, which were eventually managed with birth control and some other measures never shared with me. She married and had 2 children. The other begin hormone replacement regime some time post menopause under guidance of her doctor. All I know is that it's become vital to keep her working her business, which provides funds and lifestyle to sustain her now. She and her husband were basically robbed of their retirement savings, from situations out of their control.
The other 2 siblings, brothers, have also had long successful professional track records and good health, with no signs of memory problems. The oldest is 82 this month.
1. So, should I be concerned about this new kind of recall experience I had? Or do I wait for to see if it happens again?
2. Is it a sign of growing trend in my slow recall, or absence of recall ability all my life?
3. What could it be? What is it likely to be ?
4. Should I make an appointment with a Neurologist? Psychologist or Psychiatrist?
5. Are there Med Journal articles that might help me to understand what is happening? Or key words I could use for search terms, to educate myself? I read Med journals frequently through the years, to assist myself and family to understand their options.
Thank you for your help.
XXXXXX
Oh yeah, I take Effexor XR 75 mg and Nuvigil (half tablet) 75 mg each day, along with Fexofenadine (allegra) and Fluticonase for allergies, and occaisionally use Prilosec. Have history of GERD.
I don't recall having this experience before.
The words, my intent, the context all disappeared as soon as I said them. When I finished, I had zero recollection of what came out and asked if I made sense. They said I did. But I had zero recall of it.
It was a day when I felt a bit 'muddled' and tired. The day before had been a long day trip to nearby mountains, some short hikes, and birdwatching. I didn't drive, but I was so tired at dinner, I asked permission to sleep in dining chair while my husband ate. (Week before had symptoms of cold/cough virus which abated before complete bloom, then diarrhea for several days but stopped when I took prilosec - go figure!)
I have had 3 decades under the diagnosis of chronic fatigue, without enough control of it, to work 50 weeks a year (part time or full time), yet I had 4 years full time professional engineering work before the 'cfs' or whatever displaced me from the work force. (was exposed to strong chemical fumes during very stressful work and family months, then harsh virus, and the out of work.) Part of the cfs experience is 'brain fog', a slowness to respond, or comprehend, or recall, and decide.
I get a very thorough annual physical (MDVIP program) every year, and my doc has known me for over 20 years. Other than the CFS, hypersomnia, depression at times accepting limits in life, a couple colds a year, my health can be good, if I don't overdo, and try to run an adult life of 16 or more hours a day working. I have friends, hobbies, volunteer work, exercise classes, and outdoor sports like kayaking, like most people. I just live a 12 hour day, not 16, in general, and I take Nuvigil to stay awake.
But this mid sentence, loss of recall and context, was much worse than any brain fog I'd ever had.
All my life I have had 'recall' problems, as in not recalling what I know, when asked a question. However, later I remember, when not trying to answer a question.
I am 61 now, and it's no XXXXXXX to me, when people ask me to remember the names of people I once knew, and I don't know. I think that's typical. I am also noting that if I am asked what I was doing exactly, 4 hours ago, a day ago, or last Tuesday, I don't have an immediate answer. Most of the time, I can figure it out, just from remembering some parts, and filling in the other.
I see psychologists off and on through life (my parents died when I was 25, and then conflicts over their wills made all siblings unapproachable, though It wasn't a big deal to me). The psychologists have never used the word dissociation with me, and my husband of decades would probably say that I'm not one to 'dissociate', from what he observes (but he does limited observing).
So I am trying assess if I should be concerned. And if so, do I wait for it to happen again, or go see a Neuro now. And most of all, I am asking What Could This Be? What could be happening? If you want to call me, call 919/828-4840. Thank you.
I am female, married, no children, age 61, live near the XXXXXXXX, and XXXXXXX NC. I do bookkeeping. taxes, spreadsheets for my husbands IBM Architect job, event planning, meal planning, groceries, cooking, cleaning, scheduling my husband's social life, and anything to enable his copious talents to be distributed further.
I am well read on aging memory problems, early signs of Alzheimers (his mother got it), and I know the meaning of different kinds of aphasia. But this isn't aphasia. I do miss being able to recall a word I want to use at times, but think this is expected at this age.
My mother died of a stroke, a few years after contracting phlebitis in ICU after auto accident. My father died a few years later, of colon cancer like his father had had. ( 1975 and 1978). My mother's memory was slipping a bit in her last years. She was in her 60's. Her two sister's had Alzheimer's, and her mother had dementia possibly alzheimer's. They lived into ages like 78-83. Grandmother born 1870, died 1950-55.
My older sisters ages 78 and 74 have never had the recall problems I have had, and continue to run full lives. One continues to work full time (the older one) in her own business running swim meets all over the US, and the younger one works 35 hours a week at two volunteer positions, one as Treasurer for a church, the other as Master Garden Designer at nearby university. Her professional role had been in financial planning and PR for large universities.
Each sister takes Estrogen for different reasons. (And now I am beginning to look older than them, because their faces have not changed since their 50's). The finance and PR sister had hormonal imbalances all her life, which were eventually managed with birth control and some other measures never shared with me. She married and had 2 children. The other begin hormone replacement regime some time post menopause under guidance of her doctor. All I know is that it's become vital to keep her working her business, which provides funds and lifestyle to sustain her now. She and her husband were basically robbed of their retirement savings, from situations out of their control.
The other 2 siblings, brothers, have also had long successful professional track records and good health, with no signs of memory problems. The oldest is 82 this month.
1. So, should I be concerned about this new kind of recall experience I had? Or do I wait for to see if it happens again?
2. Is it a sign of growing trend in my slow recall, or absence of recall ability all my life?
3. What could it be? What is it likely to be ?
4. Should I make an appointment with a Neurologist? Psychologist or Psychiatrist?
5. Are there Med Journal articles that might help me to understand what is happening? Or key words I could use for search terms, to educate myself? I read Med journals frequently through the years, to assist myself and family to understand their options.
Thank you for your help.
XXXXXX
Oh yeah, I take Effexor XR 75 mg and Nuvigil (half tablet) 75 mg each day, along with Fexofenadine (allegra) and Fluticonase for allergies, and occaisionally use Prilosec. Have history of GERD.
Brief Answer:
Requires Neurological Examination
Detailed Answer:
Good evening. My name is Dariush Saghafi, MD and I am a neurologist in the XXXXXXX OH region of the world. I have read with interest your experience and your concerns and would like to throw in some opinions for you to consider based upon your questions.
My understanding is that you are a 61 year old, actively engaged and "into life" married woman without children who has experienced an unusual, indeed unique experience for yourself recently when you were speaking before a crowd and suddenly found yourself generating and forming words, phrases, and sentences but without any recall of what had just been said.
It was as if your brain was on automatic pilot and apparently performed satisfactorily knowing what you needed to say and saying it, however, not forming any recall of what you just uttered to be able to check that against what you wanted to say to be sure that the 2 things matched. On the day this happened you were feeling "muddled and tired." You do not mention any weakness in an arm, a leg, and you did not make mention of your speech being unintelligible in any way such as garbled, slurred, halting, or otherwise, not its usual "self."
The week before this occurred you suffered and recovered from what you believe was a viral infection accompanied by several days of diarrhea. You mention that you do not feel entirely recovered from that episode and feel "tired." You have a 3 decade longstanding diagnosis of Chronic Fatigue syndrome which stopped you from continuing in the work force which to that point had included 4 years as a professional engineer. You describe your diagnosis of CFS as suffering from and having "brainfog" meaning that you have trouble with recalling things, responding or reacting to situations, making decisions, and having a general slowness about yourself.
Aside from a diagnosis of CFS you also refer hypersomnia, depression, and a long standing problem with not being able to recall things (mental block) which later come to you. However, what happened more recently to you is far more intense and worse in severity level than any episode of "brain fog" you had experienced before. When asked about events or happenings from a specific time in the recent past such as hours or days ago you have trouble putting your finger exactly on that particular time period but can usually "figure it out" by remembering things around the period and then, logically filling the blanks.
Your mother died from a stroke as a complication of phlebitis while your father died of colon CA. You believe that your mother did suffer from "memory slippings" in her 60's but you do not say she may have had or had Alzheimer's dementia. You believe that both of your older sisters remain very active and either do professional or volunteer work of a detailed and complex nature. Neither seem to experience the same recall difficulties which you've always seemed to have throughout your life.
Other siblings, the oldest being 82 and male also lead full and active lives.
As a neurologist what initially struck me as I began reading your symptoms was the story of a possible stroke in evolution or TIA since there was no permanent deficit or other localized type of symptom such as limb weakness. However, in light of the history of a viral illness, diarrhea and the fact that the nature of what you suffered was similar to what you have always experienced save for the intensity of the event as well as the fact you had no immediate recall of what you had just said steers me away from acute stroke and sounds more consistent with some form of exaggerated response of your baseline recall slowness in response to the recent viral illness and possible dehydrated status. One could hypothesize something akin to a viral encephalopathy of a mild to moderate degree.
You've not mentioned anything about your metabolic parameters such as complete blood cell count, thyroid levels, B12, folate, Vitamin D, and there are other tests that I think are worth knowing. Of course, an imaging study such as an MRI would be on the list of items I'd vote on having you obtain and almost certainly I think an EEG of the brain (electroencephalogram) in a sleep deprived state would be worthwhile getting. as well as a sleep study looking for things such as narcolepsy and other parasomnias. I'd also order a urinalysis.
There is an entity called TGA (Transient Global Amnesia) which shares some features with what happened to you, namely your inability to lay down an immediate memory or immediately recall what you just said within seconds. Some people believe it is potentially a type of epilepsy while others believe it is a type of temporal ischemia or even stroke. Its duration is about 24hrs. on average and it generally leaves no sequelae.
If the labs and imaging studies were unremarkable and I still didn't have a good clinical feel for what were happening then, I would recommend neuropsychological testing of a detailed nature to see if we could localize any organic substrate that could be linked to the memory/recall issues.
Now to your questions:
1. So, should I be concerned about this new kind of recall experience I had? Or do I wait for to see if it happens again?
>>>>>> I always tell patients who ask me the famous question of being "concerned" that I never quite know how to answer that type of question since the word is vague to me. If by concerned you mean to be aware and give enough credibility to the problem that you are moved to seek some type of help then, ABSOLUTELY YES! If by "concerned" you mean unduly worried that imminent disaster is about to strike then, ABSOLUTELY NOT! Right now we should be in an informational gathering phase and that means that things such as worry, angst, fear, and any other limbic system based emotion that does nothing but cause good functioning people to forget their names or the name of the first girl they kissed at the Spring Dance NEED NOT APPLY.
How's that for an answer. Like Detective Friday always said, "The facts ma'am, just the facts."
2. Is it a sign of growing trend in my slow recall, or absence of recall ability all my life?
>>>>> I'm not able to decipher this question precisely. Let me answer by saying that in my opinion what happened to you looks extremely similar to the problem you feel you've had all your life...except a few notches worse than usual because of the sudden inability to lay down new memories in your head of an entire speech/conversation you had with an audience at a public speaking event. Now, that is clearly something important that needs to be investigated (and I would not "wait until it happens again") diligently, methodically, and with resolve to leave no stone unturned. However, at the end of the day, I believe there is a better than average chance that what we are really looking for is not necessarily what happened RECENTLY but what HAS BEEN HAPPENING TO YOU all your life for which you've always felt less than perfectly centered...at least to the same extent as your siblings.....yes, you are in reality going down a road that hopefully will elucidate what you've grown used to having but now which has simply exacerbated on the basis of something.....something....
3. What could it be? What is it likely to be ?
>>>>>virus? Seizure? TIA? PTSD? Other Psychological stressors which have reached a limit beyond which no further personal reserve exists? I think the differential list can contain all these as possibilities and score points from me if it were a medical resident putting it together for rounds in the morning.
I will also say this that I am not necessarily impressed with the diagnosis of CFS unless I can see exactly how that entity was arrived at. You see, that is a diagnosis of EXCLUSION which means every other reasonable type of problem would've had to have been thought about and ruled out with appropriate tests and consultations with other specialists before settling on it. You mention hypersomnia for which you are taking Nuvigil but I haven't heard anything about the sleep study you took in order to look for sleep apnea, narcolepsy, nightmares, or other parasomnias.
4. Should I make an appointment with a Neurologist? Psychologist or Psychiatrist?
>>>>>>>> I would choose the Neurologist first (because of course, that's MY bias) but aside from that I believe the neurologist is best equipped to think this problem through cerebrally and decide if there could possibly be any organic substrate to the problem in which case they would likely call in the Neuropsychologist
5. Are there Med Journal articles that might help me to understand what is happening? Or key words I could use for search terms, to educate myself? I read Med journals frequently through the years, to assist myself and family to understand their options.
>>>Plenty of keywords just in what I've presented in my answers above.
I am unable to know which resources of information are most suited for extra reading on your part since we both lie in wait for the diagnosis.
Please don't forget that your written feedback as well as a STAR RATING to this question is GREATLY appreciated if you've found the information of value. And also, CLOSING THE QUERY on your end so that the network may process, archive, and properly credit this case for future reference is much appreciated.
Please do not hesitate to contact me directly in the future by looking me up on this network and sending questions to my specific attention (Dariush Saghafi, M.D.). You may also get to my specific webpage at:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474
This case required 130 minutes physician specific time for review, research, and final draft documentation for envoy.
Requires Neurological Examination
Detailed Answer:
Good evening. My name is Dariush Saghafi, MD and I am a neurologist in the XXXXXXX OH region of the world. I have read with interest your experience and your concerns and would like to throw in some opinions for you to consider based upon your questions.
My understanding is that you are a 61 year old, actively engaged and "into life" married woman without children who has experienced an unusual, indeed unique experience for yourself recently when you were speaking before a crowd and suddenly found yourself generating and forming words, phrases, and sentences but without any recall of what had just been said.
It was as if your brain was on automatic pilot and apparently performed satisfactorily knowing what you needed to say and saying it, however, not forming any recall of what you just uttered to be able to check that against what you wanted to say to be sure that the 2 things matched. On the day this happened you were feeling "muddled and tired." You do not mention any weakness in an arm, a leg, and you did not make mention of your speech being unintelligible in any way such as garbled, slurred, halting, or otherwise, not its usual "self."
The week before this occurred you suffered and recovered from what you believe was a viral infection accompanied by several days of diarrhea. You mention that you do not feel entirely recovered from that episode and feel "tired." You have a 3 decade longstanding diagnosis of Chronic Fatigue syndrome which stopped you from continuing in the work force which to that point had included 4 years as a professional engineer. You describe your diagnosis of CFS as suffering from and having "brainfog" meaning that you have trouble with recalling things, responding or reacting to situations, making decisions, and having a general slowness about yourself.
Aside from a diagnosis of CFS you also refer hypersomnia, depression, and a long standing problem with not being able to recall things (mental block) which later come to you. However, what happened more recently to you is far more intense and worse in severity level than any episode of "brain fog" you had experienced before. When asked about events or happenings from a specific time in the recent past such as hours or days ago you have trouble putting your finger exactly on that particular time period but can usually "figure it out" by remembering things around the period and then, logically filling the blanks.
Your mother died from a stroke as a complication of phlebitis while your father died of colon CA. You believe that your mother did suffer from "memory slippings" in her 60's but you do not say she may have had or had Alzheimer's dementia. You believe that both of your older sisters remain very active and either do professional or volunteer work of a detailed and complex nature. Neither seem to experience the same recall difficulties which you've always seemed to have throughout your life.
Other siblings, the oldest being 82 and male also lead full and active lives.
As a neurologist what initially struck me as I began reading your symptoms was the story of a possible stroke in evolution or TIA since there was no permanent deficit or other localized type of symptom such as limb weakness. However, in light of the history of a viral illness, diarrhea and the fact that the nature of what you suffered was similar to what you have always experienced save for the intensity of the event as well as the fact you had no immediate recall of what you had just said steers me away from acute stroke and sounds more consistent with some form of exaggerated response of your baseline recall slowness in response to the recent viral illness and possible dehydrated status. One could hypothesize something akin to a viral encephalopathy of a mild to moderate degree.
You've not mentioned anything about your metabolic parameters such as complete blood cell count, thyroid levels, B12, folate, Vitamin D, and there are other tests that I think are worth knowing. Of course, an imaging study such as an MRI would be on the list of items I'd vote on having you obtain and almost certainly I think an EEG of the brain (electroencephalogram) in a sleep deprived state would be worthwhile getting. as well as a sleep study looking for things such as narcolepsy and other parasomnias. I'd also order a urinalysis.
There is an entity called TGA (Transient Global Amnesia) which shares some features with what happened to you, namely your inability to lay down an immediate memory or immediately recall what you just said within seconds. Some people believe it is potentially a type of epilepsy while others believe it is a type of temporal ischemia or even stroke. Its duration is about 24hrs. on average and it generally leaves no sequelae.
If the labs and imaging studies were unremarkable and I still didn't have a good clinical feel for what were happening then, I would recommend neuropsychological testing of a detailed nature to see if we could localize any organic substrate that could be linked to the memory/recall issues.
Now to your questions:
1. So, should I be concerned about this new kind of recall experience I had? Or do I wait for to see if it happens again?
>>>>>> I always tell patients who ask me the famous question of being "concerned" that I never quite know how to answer that type of question since the word is vague to me. If by concerned you mean to be aware and give enough credibility to the problem that you are moved to seek some type of help then, ABSOLUTELY YES! If by "concerned" you mean unduly worried that imminent disaster is about to strike then, ABSOLUTELY NOT! Right now we should be in an informational gathering phase and that means that things such as worry, angst, fear, and any other limbic system based emotion that does nothing but cause good functioning people to forget their names or the name of the first girl they kissed at the Spring Dance NEED NOT APPLY.
How's that for an answer. Like Detective Friday always said, "The facts ma'am, just the facts."
2. Is it a sign of growing trend in my slow recall, or absence of recall ability all my life?
>>>>> I'm not able to decipher this question precisely. Let me answer by saying that in my opinion what happened to you looks extremely similar to the problem you feel you've had all your life...except a few notches worse than usual because of the sudden inability to lay down new memories in your head of an entire speech/conversation you had with an audience at a public speaking event. Now, that is clearly something important that needs to be investigated (and I would not "wait until it happens again") diligently, methodically, and with resolve to leave no stone unturned. However, at the end of the day, I believe there is a better than average chance that what we are really looking for is not necessarily what happened RECENTLY but what HAS BEEN HAPPENING TO YOU all your life for which you've always felt less than perfectly centered...at least to the same extent as your siblings.....yes, you are in reality going down a road that hopefully will elucidate what you've grown used to having but now which has simply exacerbated on the basis of something.....something....
3. What could it be? What is it likely to be ?
>>>>>virus? Seizure? TIA? PTSD? Other Psychological stressors which have reached a limit beyond which no further personal reserve exists? I think the differential list can contain all these as possibilities and score points from me if it were a medical resident putting it together for rounds in the morning.
I will also say this that I am not necessarily impressed with the diagnosis of CFS unless I can see exactly how that entity was arrived at. You see, that is a diagnosis of EXCLUSION which means every other reasonable type of problem would've had to have been thought about and ruled out with appropriate tests and consultations with other specialists before settling on it. You mention hypersomnia for which you are taking Nuvigil but I haven't heard anything about the sleep study you took in order to look for sleep apnea, narcolepsy, nightmares, or other parasomnias.
4. Should I make an appointment with a Neurologist? Psychologist or Psychiatrist?
>>>>>>>> I would choose the Neurologist first (because of course, that's MY bias) but aside from that I believe the neurologist is best equipped to think this problem through cerebrally and decide if there could possibly be any organic substrate to the problem in which case they would likely call in the Neuropsychologist
5. Are there Med Journal articles that might help me to understand what is happening? Or key words I could use for search terms, to educate myself? I read Med journals frequently through the years, to assist myself and family to understand their options.
>>>Plenty of keywords just in what I've presented in my answers above.
I am unable to know which resources of information are most suited for extra reading on your part since we both lie in wait for the diagnosis.
Please don't forget that your written feedback as well as a STAR RATING to this question is GREATLY appreciated if you've found the information of value. And also, CLOSING THE QUERY on your end so that the network may process, archive, and properly credit this case for future reference is much appreciated.
Please do not hesitate to contact me directly in the future by looking me up on this network and sending questions to my specific attention (Dariush Saghafi, M.D.). You may also get to my specific webpage at:
http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68474
This case required 130 minutes physician specific time for review, research, and final draft documentation for envoy.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
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