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