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New Technologies for Improving New Technologies for Improving MemoryMemory
Stella Karantzoulis, Ph.D.Clinical NeuropsychologistAssistant Professor of NeurologyAssistant Professor of Neurology
New York University School of MedicineNew York University School of Medicine
December 2, 2011
Outline
• Cognitive Intervention Goals• Strategies: Compensatory, Restorative• Cognitive Intervention in Epilepsy, Examples• New Technologies• Our Memory Training Study• Key Points
Goals of Cognitive Training Programs
• To enable people to function as independently as possible in their own most appropriate environment
• No standardized cognitive training program for use among individuals with epilepsy
Cognitive Intervention Strategies
Compensatory Strategies– Learn to 'work around' one’s cognitive deficits– Emphasizes the use of strategies (e.g., visual imagery,
organization) & external (e.g., electronic memory aids) strategies
Restorative Strategies– ‘Working on’ the actual problem– To enhance functioning in specific cognitive domains, with the
goal of returning cognitive function to premorbid levels
Compensatory Cognitive Strategies
• Combination of compensatory and restorative may be most effective for improving memory among individuals with epilepsy
• Restorative strategies may be better choice for patients with mild-to-moderate Alzheimer’s disease than compensatory approaches
Factors to Consider
• Age• Educational history• General intellectual functioning• Cognitive strengths and weaknesses (attention skills)• Diagnosis (time since injury)• Medical history • Psychological factors• Aids used premorbidly• Social support system
External Memory Aids
• One of the most efficient ways to compensate
• Most people without neurological memory deficits use aids
Memory Aids: People with Acquired Brain Injury
• Wall calendar 72%• Notebook 64%• Lists 63%• Appointment diary 54%• Asking others 49% • Mental retracing 48%• Alarm clock 41%• Notes in special places 34%• Repetitive Practice 30%
• Writing on hand 24%• Watch with date 18%• Daily routine 18%• Personal organizer 17%• Journal 16%• Daily timetable 16%
Evans et al. JINS, 9, 925-935. 2003.
Current age; time since injury; number of aids used premorbidly,; measure of attentional functioning best predicted use of memory aids
Internal Strategies: Mnemonics
• Systems that enable us to remember things more easily
• Mainly refers to internal strategies that are consciously learned and require considerable effort to put into practice
Repetition
• At first, repeat the information over short intervals
• Eventually, repeat the information over long intervals
Spaced Repetition
Meaningfulness
• Think of what something means• Visualize a picture
– Image-name method
• Associate it with something else– make a meaningful connection or relationship
between things
Meaningfulness
Preview: preview the material
Question: ask key questions about the text
Read: read the material carefully to answer questions
State: state the answers
Test: test regularly for retention of the information
Restorative Approaches: Prevent Errors
• Errorless learning– prevent mistakes – avoid trial and error– provide written instructions, guide someone through
a task, model the steps of a procedure
•Two groups of post-surgical patients (N = 55 treatment group, N = 57 controls, 27-46 yrs), mixed left and right cases•Broad training program - compensation + psychoeducation, counseling, occupational therapy sessions•Short program, Mean = 29 days•78% seizure-free postoperatively, seizure outcome did not affect scores on memory tests•Significant positive effect on verbal learning and memory, greater for right-sided surgical cases
Cognitive Interventions: Temporal Lobe Epilepsy Surgery
Helmstaedter et al. Epilepsy & Behavior. 12, 402-409 (2008).
Memory Rehabilitation + Brain Training: Left Temporal Lobe Epilepsy Surgery
• 20 Left TLE patients (25-37 yrs); 10 pre-op; 10 post-op (3-6 months); 22 Healthy Controls
• 10 training sessions + 4 booster sessions• 4 hours over three sessions• psychoeduation + use of external aids + memory
strategies + homework• computer training for half of sample; 40 sessions of
Lumosity, at least 15 mins/day – memory, concentration, mental flexibility, processing speed
• Subjective ratings of memory skills, moodKoorenhof et al. Seizure 21, 178-182 (2012) .
Memory Rehabilitation + Brain Training: Left Temporal Lobe Epilepsy Surgery
• Improvements in verbal memory for both groups• Pre-operative training not more effective than post-
operative training• LTLE group showed significant reduction in memory
nuisance ratings and overall mood ratings• Computer training associated with gains in verbal
learning; no effect on verbal recall
Koorenhof et al. Seizure 21, 178-182 (2012) .
Sample case: Mild to Moderate AD
• Individual having difficulty recalling names of individuals in his social club
• Decreased confidence, at risk for social isolation
• Goal: learn names of 11 individuals • Training at home with photos, later
generalized to club
Clare et al. Neurocase, 5, 37ff. 1999
• Identified individual item for training: Caroline• Discussed semantic association: Caroline with the
curl on her forehead• Learned with vanishing cues
– CAROLIN_– CAROLI_ _– CAROL_ _ _– etc.
• Consolidated using spaced retrieval– Tested after 30s, 1m, 2m, 5m, 10m
• Tested with all face/name pairs
Clare et al. Neurocase, 5, 37ff. 1999.
Improvement in Memory with Adaptive Plasticity-based Cognitive Training
The IMPACT Study• Largest clinical trial to examine a computerized cognitive
training program• Multi-center: Mayo Clinic, USC, and Posit Science
• N = 242 Computer Training • N = 245 Auditory Training • Age M = 75 yrs.; Education M = 16 yrs.; Male: 47%• 8-week program
Smith et. al., J. of Amer. Ger. Soc. 2009
The IMPACT Study: Results
• Improvement on the exercise tasks• Improvements “generalized” (or extended) to
multiple standard memory tests• People who used the program reported
positive changes in their everyday lives– remembering a shopping list – hearing conversations in noisy restaurants more
clearly– feeling more self-confident
Smith et. al., J. of Amer. Ger. Soc. 2009
Key Points
• Evidence to support use of cognitive interventions in epilepsy
• Program goals can vary – no standardized programs yet available
• Several ways to compensate for memory difficulties – some require considerable effort and practice
• Combination of compensatory and restorative approaches may be best for epilepsy patients
• Goals should be appropriate• Not a one-size fits all approach