New Technologies for
Improving Memory
Stella Karantzoulis, Ph.D.
Clinical Neuropsychologist
Assistant Professor of Neurology
New York University School of Medicine
December 2, 2011
Outline
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Cognitive Intervention Goals
Strategies: Compensatory, Restorative
Cognitive Intervention in Epilepsy, Examples
New Technologies
Our Memory Training Study
Key Points
Has This Happened to You?
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
If only it were that easy….
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
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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
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Wall calendar
Notebook
Lists
Appointment diary
Asking others
Mental retracing
Alarm clock
Notes in special places
Repetitive Practice
72%
64%
63%
54%
49%
48%
41%
34%
30%
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Writing on hand
Watch with date
Daily routine
Personal organizer
Journal
Daily timetable
24%
18%
18%
17%
16%
16%
Current age; time since injury; number of aids used premorbidly,; measure of
attentional functioning best predicted use of memory aids
Evans et al. JINS, 9, 925-935. 2003.
More is Not Always Better
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
First-Letter Mnemonics
Memory tools
Attention
Writing
Organization
Repetition
Meaningfulness
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
P
Q
R
S
T
review: preview the material
uestion: ask key questions about the text
ead: read the material carefully to answer questions
tate: state the answers
est: 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
Cognitive Interventions: Temporal Lobe
Epilepsy Surgery
• 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
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, mood
Koorenhof 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 postoperative 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
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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.
Baseline
Intervention
Post-Intervention
Clare et al. Neurocase, 5, 37ff. 1999.
Computer Technology
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
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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
Any Questions?