Understanding Memory & Cognitive Problems in Epilepsy
William B. Barr, Ph.D., ABPPChief of Neuropsychology
NYU Comprehensive Epilepsy CenterAssociate Professor of Neurology and Psychiatry,
New York University School of Medicine
Limbic SystemCerebral Cortex
BRAIN 101
Cognitive & Behavioral Impairment
in Epilepsy
Epilepsy and BehaviorCognitive Disorders
• Intellectual Functioning• Attention and Vigilance• Executive Functions• Language• Visuospatial Skills• Learning and Memory**
Attention and Concentration
• Arousal and alertness• Span of attention• Processing speed• Vigilance• Sustained attention
Executive Functions
• Initiation• Response Inhibition• Set Shifting• Concept Formation• Sequencing • Organization & Planning• Insight & Awareness
Language
• Expressive Speech• Repetition• Auditory Comprehension• Naming• Reading• Writing• Higher Conceptual Functions
Epilepsy and Memory
1. What is memory?
2. How is memory affected by epilepsy?
3. What can I do to improve memory?
Study of 55 patients with temporal lobe epilepsy:
• Difficulties with memory reported in 77.4%.
• Reports of being “extremely bothered” by their memory disturbance in 13.2%.
• Over half (50.9%) feel that “seizures interfere with my memory”.
Data presented at the AES Meeting, 2003
Epilepsy and Memory
Most Common Memory Complaints Questionnaire completed by 55 subjects:• I forget a phone number if I don’t copy it down right away
(47.3%). • A word goes on the “tip of my tongue” but I can’t get it out
(43.7%)• I have trouble with remembering names of people I met last
week (41.8%).• I talk to somebody on the phone and don’t remember it
minutes later (34.5%)• I forget what someone said to me a half an hour ago (30.9%).
Data presented at the AES Meeting, 2003
Epilepsy and Memory
Epilepsy and Memory
1. What is memory?
2. How is memory affected by epilepsy?
3. What can I do to improve memory?
Memory Processing
Epilepsy and Memory
1. What is memory?
2. How is memory affected by epilepsy?
3. What can I do to improve memory?
Epilepsy and Memory
1. What is memory?
2. How is memory affected by epilepsy?
3. What can I do to improve memory?
Memory Treatment
1. Pharmacological Approaches
2. Psychological Approaches
3. Neurostimulation
Memory Treatment
Direct Pharmacological Approaches:1. Psychostimulant Medications• Developed for treatment of ADHD or Narcolepsy.• Ritalin, Provigil,
2. Acetylcholinesterase Inhibitors• Developed for treatment of dementia.• Aricept, Reminyl, Memantine
Memory Treatment
Memory Strategies
1. External Strategiesa) Environmental Manipulations
b) Notebook, Calendar, and Checklist Systems
c) Electronic Devices
2. Internal Strategiesa) Mnemonics
b) Outlining Techniques
Improving MemoryCognitive Enhancement Techniques
1. Cognitive enhancement is the improvement or strengthening of mental skills including attention, memory, processing speed, and problem solving.
2. Cognitive enhancement programs or ‘brain-training’ interventions can target any of these core cognitive skills.
3. Usually, repetition of targeted activities is involved with the assumption that doing so will improve targeted cognitive domains and improve general mental faculties by enhancing neural connections and networks.
From Jak, Seelye, & Jurik, 2013
Improving MemoryCognitive Enhancement
Do these programs work?
If so, which is better?
FACES StudyBrain Activation Techniques
1. Cognitive testing at baseline.2. Participants are randomly assigned to Posit Science or 3. One hour of computer training, 5 days/wk for 8 wks.4. Repeat cognitive testing at completion of trial.5. Programs provided to participants at no cost.
Improving MemoryIndirect Methods
Epilepsy- Control Seizures
- Minimize Number of Medications
Depression/Anxiety- Pharmacological Management
- Psychotherapy
- Stress Reduction
Other Medical Conditions
Improving MemoryIndirect Methods
1. Exercise
2. Healthy Diet
3. Good Sleep Habits
FACES StudyBrain Activation Techniques
Investigators:
Stella Karantzoulis, Ph.D.William B. Barr, Ph.D.
Steven Pacia, M.D.
To see if you qualify, call:
646-558-0950
