The distribution of the transient global amnesia in the province of Ferrara, Italy, a clue to the pathogenesis?
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ORIGINAL ARTICLE
The distribution of the transient global amnesia in the province of Ferrara, Italy, a clue to the pathogenesis? Vittorio Govoni 1,2
&
Edward Cesnik 3 & Caterina Ferri 1 & Elisa Fallica 3
Received: 27 April 2020 / Accepted: 28 August 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract The pathophysiology of transient global amnesia (TGA) is still uncertain. In the province of Ferrara (Fe-province), Italy, given the health organization and the alarming clinical features, the cases of TGA in the resident population virtually correspond to the resident outpatients diagnosed as TGA cases in the ER of the University Hospital of Ferrara. Thanks to this, a retrospective survey identified 35 (14 men, 21 women) first-ever TGA cases in the resident population in 2018 (346,975 inhabitants) giving a crude incidence rate of 10.10/100,000 (95% CI 7.00–14.00), 8.40/100,000 (95% CI 4.60–14.10) for men, and 11.60/100,000 (95% CI 7.20–17.80) for women, a non-significant gender difference. The incident cases of TGA were evenly distributed according to both season and month. The monthly cases of TGA followed the Poisson distribution (goodness-of-fit test: λ = 2.9, χ2 = 2.557, 5 degrees of freedom, p > 0.70). The incidence of TGA in the Fe-province was higher in the highest level of urbanization (21.40/100,000 95% CI 13.10–33.00) than in the lowest one (4.20/100,000 95% CI 1.92–8.00). The incident cases of TGA increased with the level of urbanization (χ2 trend test = 19.940, p < 0.001) and the population density (inhabitants/km2) level (χ2 trend test = 46.684, p < 0.001). Since urbanization is likely involved in stress-related disorders, these findings achieved in a well-defined homogeneous population seem to support the hypothesis of the involvement of stress, maybe in vulnerable individuals, in TGA. Keywords Transient . global . amnesia . distribution
Introduction Transient global amnesia (TGA) is characterized by the sudden inability to encode new memories (anterograde amnesia) accompanied by repetitive questioning, sometimes with a retrograde component, without impairment of other neurological functions lasting up to 24 h [1–4]. The pathogenesis of TGA is still uncertain. TGA case series in which diffusion-weighted imaging (DWI) was performed showed focal areas of restricted diffusion in the CA1 area of the hippocampus [5]. Several pathophysiologic mechanisms have been proposed such as
* Vittorio Govoni [email protected] 1
Neurological Clinic, Biomedical and Specialized Surgery Sciences Department of the University of Ferrara, Ferrara, Italy
2
Clinica Neurologica, Sant’ Anna Hospital, via Aldo Moro 8, 44124 Ferrara, Italy
3
Neurology Unit, University Hospital of Ferrara, Ferrara, Italy
migraine [6], focal ischemia [7], venous flow abnormalities [8, 9], and epilepsy [10] but definitive proof supporting any of these is lacking and the TGA pathogenesis remains uncertain [4, 11, 12]. Seasonal variations of the incidence of TGA [13, 14] and an association between TGA and low ambient tempera
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