Introduction

Transient global amnesia (TGA) is a sudden, temporary episode of memory loss that cannot be attributed to more common neurological conditions.¹ During an attack of TGA, patients experience an abrupt onset of anterograde amnesia—difficulty in making new memories—and occasionally retrograde amnesia, affecting immediate memories. Despite these memory deficits, patients are alert, can recognise familiar faces, and preserve personal identity. Episodes typically last between one to ten hours and resolve within 24 hours without medical intervention.

TGA is a presumed rare illness with an estimated yearly incidence of 5 to 11 cases per 100,000 individuals in the general population.² There is a notable increase in incidence among patients aged 50 years or older, so it affects about 23 to 32 cases per 100,000 patients annually in this age group. The syndrome most frequently disables patients aged between 50 to 80 years, with the mean age of onset of illness being 62.

The reversible and acute character of TGA might have a dramatic psychological impact on the patient.³ When the attack happens, patients are confused and anxious due to the fact that they cannot recall recent experiences or form new memories. This confusion may lead to repeated questioning and immense emotional distress. Although TGA is often benign and self-limiting in nature, the process might be scary, and recurring fear or undiagnosed illness might remain.

Understanding transient global amnesia

Clinical features and typical presentation

Transient global amnesia (TGA) is characterised by the sudden onset of memory loss, predominantly affecting the ability to form new memories (anterograde amnesia). Patients may also have difficulty remembering past events (retrograde amnesia). Despite the memory deficits, patients are oriented, are able to recognise familiar faces, and retain personal identity.⁴ They often engage in repetitive questioning, for example, continuously asking, "What am I doing here?" or "How did we get here?" because they are unable to retain new information. The other mental functions, like language skills, self-awareness, and the capacity to perform complicated activities like driving, remain intact throughout the episode.⁵

Duration and prognosis of TGA episodes

TGA attacks usually last four to six hours but may be of variable duration, always resolving within 24 hours.⁶ In a few cases, it has been noted that the cases last less than an hour. During the attack, patients usually recover full memory function afterward. Even though the time of the attack is experienced as amnesia, studies have found that patients also recover normal memory function some months after the attack.

Potential triggers and risk factors, including stress-related events

The exact aetiology of TGA remains unclear, but certain events have been implicated as potential precipitants:

• Emotional stress: Incidents such as receiving bad news, interpersonal conflicts, or a stressful day at work have been associated with the onset of TGA⁵
• Physical effort: Activities like gardening, housework, or strenuous exercise have been associated with TGA attacks
• Acute pain: Sudden severe pain has been reported as a potential precipitating cause
• Temperature changes: Sudden exposure to cold or hot water, such as sitting in a warm bath or engaging in a cold swim, has been reported prior to TGA attacks⁶
• Sexual intercourse: Sex has been included as a possible precipitant⁷
• Valsalva-associated maneuvers: Straining maneuvers, such as forceful coughing or heavy lifting, have been associated with the initiation of TGA⁸

Regarding risk factors, TGA predominantly affects individuals aged 50 and older. A history of migraines has also been identified as a significant risk factor, with individuals experiencing migraines having a higher likelihood of developing TGA.²

Understanding these clinical features, typical presentations, and potential triggers is crucial for recognising TGA and differentiating it from other neurological conditions.

Psychological reactions during transient global amnesia (TGA) episodes

Having an unexpected transient global amnesia (TGA) attack can lead to a range of intense psychological reactions.

Anxiety

Unanticipated memory loss is likely to trigger immediate anxiety because the individual cannot understand his or her status and accepts losing control over mind functions. The resulting excessive anxiety can, in turn, generate repeated questioning as to where they are and what is happening as they are agonised by worry and yearning for relief.⁹

• Emotional stress: Individuals with heightened anxiety could be more susceptible to TGA, and therefore, underlying emotional stress may have the potential to cause the condition⁸
• Ineffective coping mechanisms: Patients who experience TGA might cope with stress less efficiently and less healthily than other people, which could potentially lead to heightened anxiety levels during attacks

Confusion

During a TGA episode, a person often experiences disorientation. The patient may be unable to recall where they are, how they came there, and what they have done until the onset of symptoms. They repeatedly question and are observed with obvious confusion in attempts to interpret things that happen around and about them.¹ Despite the widespread loss of memory, the patients typically maintain awareness of their personal identity. However, since they cannot remember recent experiences, things appear unreal and interfere with their sense of reality and continuity. The interruption can be alarming because they are disconnected from their immediate past and uncertain about the present situation.

Fear

The sudden onset of memory loss will necessarily cause immediate alarm about potential serious underlying illnesses, such as stroke or brain tumor. Both patients and their families are likely to believe that the TGA attack signifies a terminal illness, with consequent heightened fear and sense of urgency in seeking medical attention.¹ Even after they recover, the individuals can be plagued by ongoing fear of another TGA attack in the future. This fear impacts their confidence in their mental well-being and can impact their daily functioning, as they may fear the uncertainty of another attack occurring.

Impact on family and caregivers

Witnessing members of a family during a TGA attack will typically evoke a combination of powerful emotions. Shock and inability to act could result from the event's unexpectedness, observing the loved one struggle with disorientation and memory loss.³ Fears about the potential for a dangerous underlying illness, such as a stroke or head trauma, might amplify fear and anxiety.

Supporting a loved one during the acute phase of a TGA episode poses some challenges to caregivers:

• Limited information and uncertainty: The sudden nature of TGA means that family members are often unprepared and lack knowledge about the condition
• Emotional overwhelm: Being required to control their own emotional response while also trying to stay calm and supportive is stressful for caregivers
• Communication difficulty: The patient's repeated questioning and uncertainty about events are challenging to handle, requiring patience and reassurance

Education of caregivers about TGA, its benign nature, and the minimal risk of recurrence is valuable in minimising long-term anxiety. Support groups and counselling services can also play a critical role in helping family members cope with the emotional impact of witnessing a TGA event.

Coping strategies post-episode

Experiencing a transient global amnesia (TGA) attack may be alarming for patients and their relatives. Coping mechanisms have to be efficient enough to minimise residual anxiety and prevent recurrence.

For patients

After a TGA attack, patients may experience ongoing anxiety, particularly regarding recurrence. Psychological interventions such as cognitive-behavioural therapy (CBT) are beneficial. CBT allows the patient to identify and challenge irrational thinking, develop coping mechanisms, and effectively manage symptoms of anxiety.¹⁰

Identifying the nature of TGA aids in removing fear. Education sessions provided by medical professionals can inform patients that TGA is often a harmless condition with minimal risk of recurrence.⁴ This can empower individuals, reduce unnecessary fear, and enhance feelings of health control.

For family members

Family members who witness a TGA attack can be seriously distressed. Having access to support systems, such as counselling or support groups, can provide a venue for issues to be resolved, stories to be exchanged, and emotional support to be gained.³ Such support systems can help family members relieve their worry and communicate more effectively with their loved ones. 

Educating relatives about TGA is important in relieving their anxieties. Instructing them with reliable information describing the condition, its manifestations, and its usually benign course can be reassuring.⁴ The reassurance that TGA is unrelated to more complex neurological abnormalities can alleviate fear and facilitate a favorable environment for recovery.

Summary

Transient global amnesia (TGA) refers to temporary and sudden forgetfulness of recent memories, lasting in most cases for 24 hours. In case of an attack, an individual may have lost memory of recently happened things but cannot form any new memory, yet remains aware of his/her own identity and remains capable of engaging in usual behaviours.

While TGA is generally considered benign, its abrupt onset can be distressing for both patients and their families. Psychologically, TGA patients may experience anxiety due to unplanned memory loss, disorientation-induced confusion, and apprehension about potential underlying medical conditions or recurrence. Family members who witness these attacks tend to experience emotional distress, inability to provide immediate aid, and ongoing concern for the well-being of their loved ones.

Psychological interventions, such as cognitive-behavioural therapy, can be offered to patients to assist in coping with leftover anxiety, as well as education about TGA to reassure them of the fear of recurrence. Family members also require coping strategies to manage their anxiety and resources to understand the benign nature of TGA.

In summary, although TGA is a temporary and non-life-threatening condition, its unexpected presentation is likely to have serious psychological effects. Extensive counselling and education of patients as well as their families are needed to reduce anxiety and induce effective coping mechanisms.