Roger is a 56-year-old man, fully right-handed (+100), with 16 years of education. All of his first-degree relatives are also fully right-handed. The original report of Roger's case was briefly described in a book chapter. The following report represents an extensive addition to the details contained within the initial case description. In previous studies, Roger was usually identified as "RH-1951." In this article, by written consent and preference of both the patient and his family, the name "Roger" was specifically chosen as the subject identifier and this name will continue to be used in future studies.
Life for Roger began in 1952 with no health complications and no delays in achieving developmental milestones. Based on his parents' report, Roger lived a normal childhood, attained average grades throughout school, had a good social network of friends, and enjoyed playing sports, especially baseball and football. During his early teenage years, Roger developed insulin-dependent diabetes mellitus (Type 1 diabetes). He learned to adjust his lifestyle around his diabetes and his family reports that he has always effectively monitored his glucose levels, self-administered insulin, and maintained a strict diet. Following high school, Roger attended college and earned a BA in business administration. Uncertain of what career path to pursue, Roger spent his time enjoying outdoor activities. He was an avid skier and spent the winters helping with the day to day operations at a local ski resort. During the summers, Roger worked at Yellowstone National Park and spent much of his free time hiking and enjoying the tranquility of his surroundings. During this time period, Roger's family describes him as being a "friendly, easy-going guy" who was "quiet, reserved, and usually kept to himself." While at Yellowstone, Roger met a woman who motivated him to pursue a career capable of supporting a family. He enrolled in a manager training program and became an assistant manager for a large department store. A few months later, at the age of 28, Roger developed a high fever, nausea, and an intense headache. The emergency room physician sent him home with a diagnosis of influenza. When Roger failed to show up to work later in the week, his coworkers became worried and went to his apartment where they found him lying unconscious. He was rushed to the hospital where he was diagnosed with herpes simplex virus type 1 encephalitis and administered the antiviral agent vidarabine (ara-A). Roger's prognosis looked bleak and his family was told there was a strong likelihood he would not survive. After a nine day coma, Roger's condition stabilized and he slowly emerged from the coma, completely disoriented. A few weeks later he was discharged from the hospital with normal vision and hearing, sufficient strength and motor coordination, and a severe amnesia, anosmia, and ageusia.
Since the encephalitic attack in 1980, Roger has literally lived another lifetime. However, for Roger, not much has changed over the past 28 years. He has virtually no episodic memories for any events which have transpired over the past three decades. For example, he has no recollection of 9/11 and when shown pictures of the planes crashing into the World Trade Center he often responds with bewilderment, speculating that Russia must be attacking America. At times, Roger confabulates, although his confabulations are generally non-bizarre and are usually provoked by memory-related questioning. He has no idea how many years have passed since the encephalitis, and when asked, his answers range from a few years to a few decades. His insight into his own condition is markedly impoverished. For example, Roger exhibits a complete anosognosia for his anosmia and ageusia. On occasion, only when directly asked, Roger might admit to having some problems with his memory. However, these problems are always downplayed and do not seem to disturb or upset him even though their severity has entirely precluded him from living an independent life and obtaining any sort of gainful employment. It could be said that he "doesn't remember that he doesn't remember."
Up until 2003, Roger lived under the close supervision of his parents. Due to his parents' aging, he has moved into an assisted-care facility specialized for patients with brain injury. One element of Roger's behavior that must be closely supervised is his voracious appetite. Without monitoring, Roger will eat to the point of purging, showing no signs of satiation or fullness, and no memory for how much food has already been consumed. Interestingly, his appetite is still discriminative, as he will fastidiously avoid foods with high sugar content such as non-diet soft drinks and candy. Roger also has a compulsive tendency to collect objects of questionable value (e.g., matchbooks, pens, shiny metal objects, cottonballs, napkins, etc.) and hold onto them for no reason or particular purpose ( - subject AP1). During his free time, Roger frequently plays solitaire or listens to his extensive collection of 1960's rock n' roll vinyl albums (he has an impressive ability to hear a song from this time period and produce the name of the song, the name of the artist, as well as the name of the B-side song). He is also an excellent bowler and participates in a competitive weekly bowling league.
Roger appears remarkably unconcerned by his condition. He hardly ever complains, and in general, shows little worry for anything in life. Both of his parents and his sister fervently claim that "Roger is always happy," an observation that is consistent with our own impression. Moreover, based on his family's report, Roger is paradoxically happier now than he was before his brain damage. This profound personality and affect change has also altered his social behavior. His premorbid disposition of being somewhat reserved and introverted has shifted to being outgoing and extraverted. In everyday life, Roger will often approach complete strangers, with no hesitation, and with no regard for social signals and contextual cues indicating otherwise. Consistent with these observations, Roger was found to rate pictures of complete strangers as significantly more trustworthy and approachable than healthy comparison participants ( - subject RH). During all social encounters, Roger has a strong proclivity towards jocularity and routinely recites jokes that are haphazardly handwritten in a notebook he keeps in his pocket. A quote found in this notebook has become Roger's life motto: "A good time to laugh is anytime you can." Roger is also a master of puns and has an uncanny ability to produce rich commentary about trivial aspects of his immediate environment. Indeed, a clinical psychologist who saw Roger in 1988 noted in his report that "Roger plays creatively and artistically with the nuances of language as if language was his toy." In many ways, Roger's loquacious speech and jocoseness is a form of vocal disinhibition, where his inner thoughts often appear to be freely spoken without a filter and without reflection.
Roger's condition is stable. Since his referral to our laboratory in 1994, we have tested him on numerous occasions. Over the course of the past 14 years, we have not observed any changes in his personality or affect. Indeed, if it were not for his receding hairline, one would wonder whether Roger was aging at all. Roger's complacent and easy-going nature makes him a very pleasant and straightforward patient to test. He happily complies with all testing procedures, always puts forth his best effort, stays alert and attentive, and has excellent cognitive stamina.