CORNERS OF THEIR MINDS AMNESIA VICTIMS FACE AN ONGOING STRUGGLE.

Byline: Evan Henerson Staff Writer

When it comes to on-screen amnesia, Hollywood often finds it easier to be humorous or Hitchcockian than accurate.

A character awakens after a thump to the head or emerges from a coma without a clue about his identity. Sometimes his personality has undergone a transformation and, for plot purposes, he is ripe for exploitation or an identity swap - the funnier the better. And if the amnesia sufferer also happens to be a detective out trying to break a case, well, look out world!

``The movie 'Jerry Maguire' sent out an interesting warning about post- traumatic amnesia,'' says Constance Miller, managing director of the Head Injury Hotline, a resource clearinghouse based in Seattle. ``The football player couldn't recognize his own family, and that had a chilling effect on some of the other players.

``Then there was the Harrison Ford movie ('Regarding Henry') where (after getting shot in the head) he became a nice, caring person. I'm going, 'Yeah, right.' That's very unusual,'' continued Miller, who is brain injured.

For the record, say brain injury researchers, the type of ``Where am I? Who am I?'' fog known as global amnesia is real but rare, and usually it isn't caused by a blow to the head. Global amnesia is usually a psychological condition, says Dr. James Kelly, associate professor of clinical neurology at Northwestern University.

``It can lead to misunderstanding and misconception of how the brain really works,'' says Kelly, who is also in private practice at the Chicago Neurological Institute. ``Much of what is depicted in art as trauma-related injury is really psychogenic amnesia and often totally unrelated to bodily injury at all.''

However, anterograde amnesia, the condition at the backdrop of the new film ``Memento,'' is more common, though not necessarily to the degree that the film's hero, insurance investigator Leonard Shelby, exhibits. A condition that prevents the victim of a traumatic injury from recording new or short-term memories, anterograde amnesia will gradually fade, say doctors.

If you have it long-term, don't expect to be solving mysteries, no matter now many notes, tattoos or tape recordings you leave yourself (as actor Guy Pearce's character does). That kind of brain damage often would prevent a person from being able to hold down a job or live independently, much less work out a puzzle.

``I can imagine someone with enough insight into memory loss would do their best to develop some compensatory strategies,'' says Dr. Jeff Victoroff, associate professor of clinical neurology at USC's Keck School of Medicine. ``But people with severe post-traumatic amnesia (PTA) won't remember they have a refrigerator with notes on it.''

After seeing ``Memento,'' Victoroff says he had a handful of quibbles over plot points and one major problem (which we won't reveal here because it will spoil the film's plot). Overall, however, he praises the film for its accuracy in its depiction of what an amnesia sufferer might experience.

``The screenwriters deserve a great deal of credit for having been extremely clever and very true to a medical condition,'' says Victoroff. ``Despite some flaws, it provides a vivid picture of the nightmare of short-term memory loss. I would encourage people to see it.''

According to some doctors, the PTA duration is a better indicator of how a head injury sufferer's recovery is likely to progress than, say, the amount of time spent in a coma. During that time, however, your brain is the equivalent of a broken tape recorder.

When this happens, Victoroff says, there has probably been damage to the hippocampus, the seahorse-shaped region of the brain, located at the front of the temporal lobes, that is responsible for recording memories. Under normal circumstances, memories ``recorded'' by the hippocampus are later sent into the temporal lobes for processing and storage. These are the same sections of the brain that gradually deteriorate among sufferers of Alzheimer's disease, although in those cases, regions that deal with long-term memory are also affected.

``Those cells in the hippocampus are the recorder, not the tape,'' says Victoroff, who will be featured in a documentary on amnesia, ``Forgotten

Lives,'' due to air on MSNBC in June. ``Like you might have a stack of music tapes that you love, but you wouldn't keep them in the tape recorder.''

He adds, ``If you hammer your brain hard enough, the hippocampus is going to get nailed, so the tape recorder is also going to get nailed. Whatever comes to you after that time isn't going to get recorded.''

At the height of post-traumatic amnesia, a head-injury sufferer can expect to hold on to new information for about three to four minutes. To that extent, the short-term retention experienced by Leonard in ``Memento'' seems accurate. In a couple of key scenes, Leonard loses vital information allowing characters to deceive him quickly and easily.

Other parts of the film are less believable, says Victoroff. Leonard is seen driving to parts of the city that he probably never visited before his accident, yet he is never seen consulting a road map. If he had never been to these places before (a motel, a bar), short-term memory loss would prevent him from instinctively knowing how to find these places.

``New learning would be required for new routes and new information,'' says Victoroff. ``You can't navigate to places you didn't know before injury unless you're checking a map at every intersection.''

And wouldn't Leonard's oft-repeated explanation to people he encounters that ``I have this condition'' (the condition is never named) be a bit of a stretch? If he truly suffered from anterograde amnesia as severely and for as long a duration as the movie suggests, would Leonard remember that he even had a condition?

Not necessarily, says Victoroff, since habits formed by classical conditioning are handled by a different function of the brain than fact-finding and retention.

Jenny Houston, a brain injury advocate in Fairfax, Calif., hasn't seen the film, but she can certainly accept the idea of a brain-injury victim who exhibits Leonard's post-injury doggedness.

``People can become very obsessed after a brain injury,'' she says. ``I would question whether he would be able to continue to check things out and keep every day together. Hollywood takes such license.''

Twenty-seven years ago, Houston's son, Mark Kisbey, was thrown from a car during a drunken driving accident. Kisbey, then 19, hit his head and suffered a frontal lobe injury. He has lived with Houston practically ever since.

Her son is alive, but his life - and the lives of his family members - has been irrevocably changed. Families break up over head injuries as do relationships, says Houston, and no insurance carrier in the world will pay for the months or years that brain injury rehabilitation can require.

She estimates that 10 percent of the people who suffer serious head injuries die and another 10 percent recover enough to create a life for themselves independently. In between are people like Kisbey who will need varying degrees of home care. Only 5 percent receive the care they need, Houston says.

Kisbey doesn't drive and no longer has an ear for music even though he was a drummer before his accident. Houston is afraid to bring her grandchild - Kisbey's nephew - to the house because her son gets jealous for her attention.

``We're desperate for services, and there are no affordable residential services for brain injury sufferers,'' says Houston. ``We are an incredibly underserved population.''

Nearly 20 years after the car accident that caused her closed-wound head injury, Miller, of the Head Injury Hotline, says there are still days when she feels like she's ``starting all over.'' Over the years, devices like Palm Pilots and audible alarms have replaced Post-It notes, and she has to keep things in the same place or risk losing them.

``Early on, I could look at things written in my own hand, and if I didn't recognize my own handwriting, I would have sworn I never wrote it,'' says Miller, author of the head-injury self-advocacy guide ``From the Ashes.'' ``Some memories disintegrated before my amazed eyes as I studied to retrieve them.''

She adds with a laugh, ``There are lots of things I'd love to forget. Unfortunately they won't go away. It's not something that you can do by will.''

Movies worth a second thought

Stuck for a plot device? Throw in a little brain fog and everything will be just fine. The Internet Movie Database lists 212 movies and TV shows with amnesia as a key element. Here's a sampling:

``Desperately Seeking Susan'' (1985): Rosanna Arquette is a bored New York housewife who answers a personal ad, thumps her head, and wakes up thinking she's a streetwise hustler named Susan (Madonna in one of her first roles). Intrigue and romance follow.

``Overboard'' (1987): This time it's Goldie Hawn who is rich, bored, and in great need of a personality change after a boating accident leaves her memory-free. Kurt Russell is only too happy to oblige. He needs a ``mom'' for his unruly brood.

``Regarding Henry'' (1991): Harrison Ford is a lawyer even more in need of a new personality transplant than Goldie. He gets shot, then gets better, largely free of the memories of his previous selfish life.

``American Dreamer'' (1984): JoBeth Williams knocks herself out and wakes up believing she's a fictional spy.

``The Long Kiss Goodnight'' (1997): Geena Davis actually was a spy before she lost her memory and became a cookie-baking housewife.

``Total Recall'' (1990): Arnold Schwarzenegger can't remember his life as a resistance fighter on Mars, but he has an excuse - he was a victim of brain tampering. Based on the Philip K. Dick short story ``We Can Remember It for You Wholesale.''

``Clean Slate'' (1994): Dana Carvey is a detective trying to solve a case, no easy task since each day he wakes up with total amnesia.

``Spellbound'' (1945): Psychiatrist Ingrid Bergman tries to solve the mystery of amnesiac Gregory Peck. Director Alfred Hitchcock also played around with amnesia in ``Marnie'' (1964).

- Evan Henerson

CAPTION(S):

5 photos, box

Photo:

(1 -- cover -- color) YOU MUST REMEMBER THIS

New film `Memento' presents a fairly accurate depiction of anterograde amnesia

(2) Madonna

(3) Peck

(4) ``Some memories disintegrated before my amazed eyes as I studied to retrieve them.''

- Constance Miller

(5) ``Regarding Henry'' (1991)

Box: Understanding Anterograde Amnesia

This condition prevents the victim of a traumatic injury from recording new or short-term memories. It is usually caused by damage to the hippocampus, the seahorse-shaped region of the brain, located at the front of the temporal lobes, reponsible for recording memories.

SOURCE: Dr. Jeff Victoroff, associated professor of clinical neurology at USC's Keck School of Medicine; Head Injury Hotline.