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Chapter 8

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Zachariah Campbell

CHAPTER 8: TEST OF MEMORY FUNCTIONING INTRODUCTION Memory is our only way of keeping track of ourselves as we progress through our lives and our world. Memory is our way of understanding how things work and of not having to relearn these things once we know them. Memory is also our personal store of events that have happened to us and how things happen in the world (socially and culturally) TYPES OF MEMORY AND THEIR FUNCTIONS • According to Lezak, Howieson, and Loring there are only 3 stores of memory that need to be addressed clinically: sensory memory/registration, short term or working memory ((STM) aka intermediate memory), and long-term memory (LTM). • STM is viewed as passive form of memory while working memory is viewed as an active form  not universally agreed upon as synonymous • Within the tripartite structure, LTM is often divided into two sections: o Declarative/Explicit Memory: The aspect of human memory that deals with factual material that is conscious and can be discussed/declared  Further divided into semantic (fact memory) and episodic (personal experience/info) o Nondclarative/implicit memory: memory that tends to be nonconscious/lacks awareness.  Further divided into item specific implicit memory- unconscious memory from specific events and procedural memory – LTM of skills and procedures or ho- to-do-it knowledge • Stages of memory: encoding, storage, and retrieval • Difficulties which na individual may suffer with memory include deficits cause by illness or injury and also those that have psychogenic cause which is often due to psychological trauma Sensory Memory • Sensory memory or Registration is the first stage of the memory process. It’s the ability to retain impressions of sensory-based information after the original stimulus has ceased • It holds a large amt of sensory info for a very brief time • This isn’t a stage of memory b/c it refers to info brought in by the senses and held there until perceptions are formed • 2 major types o iconic memory if it’s a visual image  lasts 200 ms o echoic memory if it’s an auditory stimulus lasts 2000 ms • the material may then move to working memory Immediate, Short-Term or Working Memory • STM/Working memory: the second stage of memory in which several bits of info can be stored for a brief period; thought to be more active than passive STM • Immediate memory = having the capacity of 7± 2 U o Has a long enough duration to allow a person to respond to ongoing events when more enduring forms of memory have been lost • An individual may suffer from LTM difficulties but still be capable of remembering a telephone number b/c their immediate memory is intact • There is more than one system that operates in working memory  Vallar and Papagno suggest that there exist 2 subsystems: o The phonological loop which deals with sound. It’s important for processing language and consists of 2 parts:  Short-term phonological storage with auditory memory traces  An articulatory rehearsal component that can review the memory traces o The visuospatial sketch pad is the portion of working memory assumed to hold info about what we see and to be the mechanism for the temporary storage and manipulation of spatial and vidual information such as shapes, colours, or location of items in space • The research by Vallar and Papagno followed the original research of Braddeley and Hitch who suggested that the multicomponent model of working memory contained 2 salve systems that were responsible for ST maintenance of info, and a central executive which was responsible for the supervision and coordination of the slave systems • Braddeley included a fourth component to the schema, the episodic buffer – a temporary and limited storage to hold and integrate info from various modalities through connection with LTM • Hebb stated that immediate memory is maintained through reverberating neural circuits which are described as self-contained networks that sustain a nerve impulse by channeling it repeatedly through the same network o Information will completely disappear if it’s not converted into a stronger biochemical organization that allows it to be placed into LTM Long-Term Memory • LTM = acquiring of new info, inclusion of info within LTM is synonymous with learning • Consolidation= the process through which info is stored in LTM. It can happen quickly or take time. • With a greater understanding of the biochemical pathways involved in memory consolidation, an exact amt of time it takes to consolidate info can’t be clearly stated and some researchers suggest 2 periods are critical • Learning is thought to involve a more active process than consolidation – but incidental learning aka the acquiring of info w/o conscious though can happen w/o much effort PROCESS OF MEMORY FUNCTIONING Sensory Memory • Sensory info is either paid attn to and processed into working memory or it quickly decays • Attention, concentration and rehearsal appear to be the primary means for info to transfer from sensory memory to working memory Working Memory • A number of processes take place here for the info to move forward into LTM • Rehearsal: the mental repetition which causes info o remain in working memory for sufficient time until may be proceed and sent to LTM o Brain structures involved: prefrontal cortex [central executive], posterior parietal cortex, the thalamus, the caudate and the globus pallidus • the actual process by which the info moves from working memory to LTM in the aforementioned areas is through physical changes in the structures of neurons Fig 8.2: Brain Areas involved in Working Memory • Prefrontal Cortex – Central Executive • Left-Frontal/Broca’s area – Articulatory Control Process • Inferior Temporal lobe – visual cache • Occipital Lobe – Spatial tasks • Left parietal lobe – Phonological loop Long Term Memory • long term memory involves consolidation and learning - the individual must turn briefly presented info into something which has meaning and enough connections so that it can be retrieved • brain store LTM by growing additional synapses b/w neurons - experiments have shown that the cumulative amt of data stored in the brain during an avg 70 year life span is only 125 MB – much less that than 100 terabytes with 10 synapses originally hypothesized • 3 memory centres of the brain -> interconnected structures that operate LTM o Medial temporal lobes around the hippocampus o Diencephalon o Basal forebrain • Patient HM in order to treat his sever epileptic seizures, he went bilateral removal of an 8cm length of the medial temporal lobes. The surgery had no effect on his reasoning ability or his ability to repeat short series of digits o He was not able to remember a person after they left the room even though he had spent half the day with that person • Sustained both retrograde and anterograde amnesia o Similar memory deficit seen in macaque monkeys w/ bilateral medial temporal lobe lesions RETREIVAL OF INFO FROM LTM • 2 major processes to retrieve info from LTM are recall and recognition. The more connections that are able to be formed with the information to be retrieved, the easier it will be for it to be grasped from memory • recognition: easier way to obtain info from LTM. Involves presenting cues and assuming that these will aid the individual in retrieving the correct info. o Ex. an MCQ exam • Recall: the process in which an individual tries to grasp the information in LTM without any cues o Ex. an essay test DIFFICULTIES WITH MEMORY Amnesia • Amnesia: total or partial loss of memory that can be associated with brain damage, a dissociative disorder of hypnosis. It’s known as the inability to remember certain events or circumstances o Psychological trauma may also be a cause of amnesia o Dissociative amnesia = amnesia w/o any other cognitive deficits ex. case study, Joseph’s 40 year memory lapse regarding his girlfriend and child. Or clay from OTH, who couldn’t remember he had a son for 5 years after his wife died • If an individual receives trauma to the brain, there are 2 forms of memory loss that might appear o 1) Retrograde amnesia: memory loss of material learned before the trauma. AN individual may lose all or some of his declarative memory. So inability to retain old, long term memories, generally for a specific period extending back from the onset of the disorder ex. Rachel McAdams’ character from The Vow o 2) Anterograde amnesia: memory difficulty arising after some type of trauma where the person loses the ability to learn new material. In a less serious situation, learning may be slower and require a great deal of repetition • most people that suffer from brain impairment usually sustain a combination of retrograde and anterograde amnesia. • Transient global amnesia – form of amnesia that includes both retrograde and anterograde amnesia factors o Lasts for shorter period, anywhere b/w minutes to days. o Casual factors for this form of amnesia could be a concussion from a sports accident or a brief cerebral ischemia. Physical/emotional stress, effects of drugs, cold showers, sexual activity due to these factors affect cerebral blood flow thus causing transient global amnesia TESTS OF MEMORY IMPAIRMENT • Memory assessment in clinical neuropsych is often part of a broader or more in depth assessment. Occasionally an individual has circumscribed memory deficits that need to be addressed and assessed • Clinical neuropsychologist has choice in memory assessment to use a standard memory test battery or an individual test of memory ability o All these tests must be administered in a standardized fashion and the examiner must uphold the ethics of the profession. • Two most commonly used memory battery are the Wechsler Memory Scale-iV (WMS-IV) and the Memory assessment Scale (MAS) • There are many individual memory scales that can be used to test memory as a solitary deficit or that may be combined into a larger battery • Record review, evaluation of the referral question, a clinical interview, observation, and discussion with family members are also of great clinical utility • Attention, concentration, and motivations are factors in all forms of memory assessment TESTS OF ATTENTION AND CONCENTRATION Orientation • Orientation = ability to be aware of oneself in relationship to the surroundings in which one is located o Requires that an individual maintain attention and have adequate perceptual abilities and memory skills • difficulties with orientation may be one of the first neuropsychological indicators of brain impairment • Orientation difficulties for time and place  a common symptom of widespread cortical impairment (ex. Alzheimer’s type dementia) and circumscribed lesions to the limbic system (Ex. Korsokoff’s psychosis) • Contrastingly, when cognitive difficulties are mild, orientation may remain intact so good orientation is not an indication of cognitive or attentional competence • Many individual tests of memory as well as memory test batteries contain questions related to orientation, and all mental status examinations contain questions regarding an individual’s orientation to time, place, and person o there is not usually an entire section devoted to orientation specifically within a neuropsychological evaluation o there are a few tests which may be used when the individual’s orientation abilities are in question but there’s little info regarding the reliability and validity of these tests Awareness Interview • Structural interview which consists of questions pertaining to person, place, time and the patient’s awareness of any difficulties with his motor skills, thinking, speech and memory • Provides a graded scoring schedule for evaluation of overall severity of awareness problems and provides useful wording of the questions neuropsychologists should ask in evaluating orientation and awareness • 3 point ratings for each item could be subjective • High interrater reliability coefficient (r = 0.92) • High awareness score correlates with good functioning in daily living activities Temporal Orientation Test • Temporal Orientation Test detects aerror in day, month, year, day of the week, and present clock time • Scored through a system which differentially ways errors within each of the 5 categories and subtracts the total error score from 100 • Any loss greater than 5 score points indicated significant temporal disorientation • Only 4% of the elderly control subjects received an error score greater than 2 Personal Orientation Test • Evaluates a person’s ability to deal with personal body parts within space • Test asks the subject to a) touch parts of his or her body named by the examiner b) name parts of his/her body touched by the examiner c)touch parts of the examiner’s body the examiner names d) touch his/her own body in imitation of the examiner and e) touch his or her body according to numbered schematic diagrams o There can be a sixth test in which the subject is asked ot move obejcts seen and felt • Patients with left hemisphere damage had greater difficulty following verbal direction while patients with RH damage ignored the left side of their body or objects presented to their left side Finger Localization Test • Developed by Benton et al., examine finger agnosia • Difficulty with only one hand may reflect a sensory deficit whereas difficulties with both hands more often points toward finger agnosia and may occur with lesions to either side of the brain • 3 parts to finger localization test: o Part A: patient identifies his finger when touched one at a time by the examiner o Part B: shields the hand as the same task is performed o Part C involves touching two fingers simultaneously • 10 trials for hand for each of the three conditions. 7-9 errors is considered borderline performance, 10-12 = moderately defective, 13+ errors = defective Standardized Road Map Test of Direction Sense • easily administered test of right-left orientation developed by Money • consists of a practice example followed by the examiner retracing a dotted pathway w with a pencil and asking the patient to state the direction, right or left, taken at each turn • Men perform better than women on this test until the elderly years. • Control and brain impaired subjects tend to have less than 10 errors, hence more errors is a clear sign of impaired right-left orientation Mental Rotation Test • Identifies difficulties in spatial transformation
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