saturday 14 th may 2010 belfast the walton centre for neurology and neurosurgery

SATURDAY 14TH May 2010

Belfast

THE WALTON CENTRE FOR NEUROLOGY AND NEUROSURGERY

Introduction

Professor Gus A Baker

Overview of talkOverview of talk Models of memory

Organic Vs non-organic memory problems

Memory Rehabilitation

What is memory?

Memory difficulties in brain injury and illnessesMemory difficulties in brain injury and illnesses Memory difficulties are amongst the most

common neurological symptom, reported. (Kapur & Pearson, 1983).

They are very common after brain injury, brain disease and epilepsy as so many parts of the brain play a part in processing memories (arousal, fatigue, attention, perception, language etc) and if any system is disturbed memory will be affected.

Visual

Immediate

Prospective memoryMemory to do things

SkillsVerbal

Recent

Long termRecall

Time frameType of

remembering

Forms of information

What is beingremembered?

Personal experiences

Facts

Numbers

Recognition

Framework for conceptualizing long-term Framework for conceptualizing long-term human memoryhuman memory

Long-term Memory

Non-declarative(implicit)

Not consciousEmotional recall

Declarative(explicit)

Conscious recall

SemanticFactual learning

General knowledge

EpisodicRecall of eventspersonal events

Short term ‘working’ memoryShort term ‘working’ memory

Short termWorking memory

Phonological loopVocabulary

SpeechFollowing; Instructions

conversations

Central ExecutiveOrganisation of

visual./verbalInformation

PlanningMulti-tasking

Visuo-spatialFaces

Recognising PlacesSpatialmap

Symptoms/clinical features Symptoms/clinical features of organic memory loss (1)of organic memory loss (1)

More severe and more frequent that you would expect compared to normal everyday lapses, e.g. has problems remembering familiar routes, difficulty learning new information. Repeats himself/herself several times an hour.

Memory lapses mean that person has difficulty performing everyday living skills; work duties, cooking.

Was an avid reader before now has given up reading and has to look back over chapters to follow the plot. Struggles following soaps/films on TV has to ask partner what is going on or who characters are, or falls asleep.

Struggles remembering where things are kept in the home that have been there many years, (cutlery draw), struggling to cook or perform DIY tasks that they use to carry out

Symptoms/clinical features ofSymptoms/clinical features of non-organic memory loss (1) non-organic memory loss (1)

Most common lapses are attentional in nature e.g. washing a clean plate, putting milk in the cupboard instead of the fridge, leaving a key in the front door, going upstairs and forgetting what you have gone up for.

Can provide a detailed medical history with exact time, duration of events, names of professionals and doses of medication,

Look for factors that may affect concentration and may in part explain memory lapses such as: sleep, fatigue, pain, current/past psychiatric difficulties, depression, alcohol, medication and non-prescriptive drugs.

Current stressors e.g. increased workload, now having to multi-task, stress from partner, children, and work.

Symptoms/clinical features ofSymptoms/clinical features of organic memory loss (2) organic memory loss (2)

Has difficulty in new surroundings (on holiday) or trouble adapting to novel situations, problems using new gadgets that would previously not have been challenging.

Repeats himself/herself in interview, turns to partner for answers to questions, has difficulty following tasks instructions, may have difficulty staying on task as may forget what to do.

May struggle naming family members and providing information about them (names, ages)

Disorientated for day of week, month or year.

Symptoms/clinical features ofSymptoms/clinical features of organic memory loss (2) organic memory loss (2)

Only has memory lapses in certain settings e.g. at work but not at home,

Forgets over-learned information or skills that are rarely reported e.g forgets own name, how to sign name, date of birth, (very rare in organic disease unless in later stages of dementia).

Age of patient, (in suspected primary degenerative dementia) rare to find organic basis in a patient under 50 years of age.

Comes with a detailed written list of memory symptoms, has researched the internet about dementia, family member recently diagnosed with dementia, this has triggered anxiety

Epilepsy and memory

Brain Organisation

OutputOutput

OrganisationOrganisation

Verbal SkillsVerbal Skills Non-verbal skills Non-verbal skills

Learning and memoryLearning and memory

Attention and concentrationAttention and concentration

SensesSenses

3 stages of memory

Taking in information‘Encoding’

Storage

Retrieving information

Recognition memory

Experience of cognitive impairment

19

Respondents indicating that they experienced difficulties “very much” Respondents indicating that they experienced difficulties “very much” or “moderately”or “moderately”

n = 837n = 837

Forgetting the way round familiar placesForgetting the way round familiar places

Impaired hand-eye coordinationImpaired hand-eye coordination

Forgetting anniversaries, appointments and datesForgetting anniversaries, appointments and dates

Difficulty paying attention to a speech or news broadcastDifficulty paying attention to a speech or news broadcast

Forgetting names of familiar peopleForgetting names of familiar people

Difficulty following instructionsDifficulty following instructions

Difficulty understanding something you have heard or readDifficulty understanding something you have heard or read

Impaired ability to do mental arithmeticImpaired ability to do mental arithmetic

Retaining a telephone number`Retaining a telephone number`

Lethargy, sluggishnessLethargy, sluggishness

Difficulties learning something newDifficulties learning something new

Slowness of thoughtSlowness of thought

Sleepiness, tirednessSleepiness, tiredness

Neuropsychological ProblemsAttention and concentration

Memory

Speed of information processing

Learning

Language

Executive functioning

Attention and Concentration

Language and Speech

Word finding

Speed

Clarity

Speed of Information Processing

Factors that may contribute to memory problems

Underlying lesion

Seizures - frequency and severity

Antiepileptic drug treatment

Emotional functioning

Memory problems in people with epilepsy

How you remember things can be disturbed by epileptic seizures

An underlying disorder in the brain that is causing seizures may also be interfering with the memory process

Medication used to control the seizures can also affect memory

Preliminary Results I: Memory

TEST

Rivermead

immediate

Rivermead

delayed

AVLTTrial 5

WordsSerial

Recognition

WordsSimultaneou

s Recognition

ShapesSerial

Recognition

ShapesSimultaneo

us Recognition

Control Mean 9.84 8.48

13.15

19.06 21.15 15.87 17.94

PatientMean 8.19 6.61

10.62

14.24 14.98 12.25 13.76

p value <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01

n =175

How do your memory How do your memory problems affect your problems affect your

thoughts and feelings?thoughts and feelings?

Memory and mood

Increased emotions

Less likely to pay

attention or think clearly

about task

Experience memorydifficulty

Vicious circleHow mood can affect memory

Vicious cycle

The vicious cycle of mood and memory problems can develop.

Feel embarrassed, anxious, depressed or angry because of memory problems.

Leads to poorer concentration, which in turn leads to more emotional distress and so the cycle continues.

Other factors affecting memory

Memory problems can also be affected by: An attention or concentration problem A language problem A visual/spatial problem Anxiety and depression Sleep disturbances

Volunteer

Memory assessment

Auditory immediate

Visual immediateImmediate

memoryAuditory delayedVisual delayed

Auditory recognition delayed

General memoryWorking

memory

Memory and What You AreLikely to Forget

Richard?? Richard?? Steven??Steven??

Specific memory problems

The most common difficulties are: Remembering to do something Remembering people’s names Remembering where you put something Remembering what people tell you Remembering what you are reading Remembering how to get somewhere

Remembering in pictures or words?

We all have natural strengths and weaknesses.

Try to use what you are best at to your advantage.

Using different ways to remember information will strengthen the memory.

LUNCH

Group task

Brain Training miracle cure or Brain Training miracle cure or Mirage?Mirage?

11,000 participants (18-80) from general population assigned to; General brain trainingReasoning trainingAnswering trivia questions10 mins training 3X a week for 6 weeksWas improvement in trained tasks but NO effects on similar tasks – could not be generalised to other skills.Quote “you’re not going to get better at playing the trumpet by practising the violin”(Owen, 2010).

Working memory tasksWorking memory tasks WM training in children with ADHD showed

improvement on all executive tasks, parents rated significant improvements in attention.

Repeated methodology in adults after stroke = significant effect digit span, no effect stroop, declarative memory, no strong generalisation.

Case study 45 year old man, 2 years post-stroke, problems with WM, and executive functioning. 25 sessions WM training, assessment then another 25 sessions WM training. Digit span increased from 4 to 5!!

Overall majority of improvement were seen in children but test yourself: Cambridge Brain sciences.com

Memory techniques (1)Memory techniques (1)

Who is going to benefit?Younger people compensate better.Severely impaired people compensate less wellPremorbid use of strategies, those who used some compensatory aids premorbidly appear to be betterPeople with focal deficits do better than people with generalised deficits.

Memory rehabilitationMemory rehabilitationGroups and individual PsychoeducationInternal strategiesExternal strategiesMind mapsDiaries, pagers, Voice recordersMotivators - vibrateMobile phones are brill!New technology

SensecamSensecam A new wearable digital

camera worn around neck, switch on and it automatically takes pictures due to sensory changes (light, movement etc).

Research use of sensecam significantly improved recall of events, patients reported memories flooded back.

www.virconrevue.com

That’s All FolksThat’s All Folks