Week 1/2/3- Assessment and Disorders of Memory

Question 1

How does a Neuropsychologist’s report differ from that of a clinical Psychologist’s?

Answer 1

Neuropsychology:

• Concerned with quantifying the effects of a brain injury (Compare within and individual before and after a brain injury)
• Measures the nature and degree of acquired cognitive impairment
• Correlate test results with behavioural change (direct and indirect effects of brain injury)
• Asses those functions known to be vulnerbable to disruption following the neurological syndrome under examination (e.g., tests different for TBI and stroke)

Clinical Psychologist:

• Concerned with describing congitive abilities relative to the population mean

Question 2

What are baserates?

Answer 2

How many normal people demonstrate disparities between scores (e.g., verbal and non-verbal intellect)

Baserates are looked up in a table, which tells you if the difference is significant and….Base rate is % of occurrence in the normal population (10% is a good rule of thumb - suggestive of acquired cognitive impairment)

For EXAMPLE 2 Patient 2:

PRI reduced relative to VCI
PSI reduced relative to VCI
deficits of the nature that typify severe TBI
Inconsistent with mild TBI incurred two year previously

Question 3

Base rates are no good enough evidence of brain impairment on their own, what else do you need?

(two questions to ask [one of which regards baserates])

Answer 3

1. Is there evidence of abnormalities (baserates)
2. Is the evidence of the abnormality related to the condition under investigation?

• If not - then can start thinking about what else could be responsible for poor performance on testing……risk factors (Alcohol etc)

Question 4

What (generally) is included in neuropsychological reports?

Answer 4

• Cognitive profile
• Likelihood that acquired impairments are due to the syndrome under investigation
• Alternative explanations (other neuropsychological risk factors.
• Comprehensive evaluation of effort (Cognitive, psychological)

Question 5

Working memory and secondary memory represent parallel processes, what does this mean in regards to the consequences of neurological damage?

Answer 5

Neurological damage can result in a disturbance of one system without impairment of the other

Question 6

Describe Baddeleys model of working memory

Answer 6

• Phonological Loop
  
  • Phonological short-term store: memory trace of ‘input register’ limited capacity
  • Subvocal rehearsal: means of prolonging the trace
• Visuo-spatial sketchpad - a workspace for holding and manipulating visuospatial information
• Central executive - control of attention and action: regulating information flow through working memory. Storage and processing capacities important in situations in which there are competing response tendencies
• Episodic Buffer (controlled by the central executive) - limited capacity system that is episodic - capable of integrating information from a range of sources into a single complex structure or episode. Combines subsystems into a unitary multidimensional representation.

Question 7

What is the phonological loop? describe its parts, its role, purpose, and its anatomical basis.

Answer 7

Comprises:

• Phonological short-term store: Memory trace or ‘input register’
• Subvocal rehearsal: Means of prolonging the trace

Role:

Language: eg holds sentences while being comprehended

Purpose:

Acquisition of language, reading etc

Anatomical Basis

• Phonological input store – Supramarginal and angular gyri of the left parietal region.
• Phonological loop: Broca’s area

phonological loop is used in auditory/verbal modalities, it is like a short term store or memory trace. The phonological loop is what allows us to hold the earlier part of a sentence in mind in order to understand the latter part of the sentence. The trace in the phonological loop normally fades after a few seconds but can be prolonged using subvocal rehearsal. Once the activity which required the rehearsal has been completed (e.g. dialled a phone number which was read to you) the memory fades. The phonological loop is very important for language acquisition and is part of how we understand language every day. The anatomical basis of the phonological input store is in the supramarginal and angular gyri of the dominant parietal region. The phonological loop is located in Broca’s area.

Question 8

What is the visuospatial sketchpad? describe its role, and its anatomical basis.

Answer 8

A workspace for holding and manipulating visuospatial information

Role:

Important in learning about new visual events (faces, new routes, layouts, unfamiliar objects) and In planning and executing spatial tasks

•Visual and Spatial Aspects

Visual – Deals with appearance of objects (the ‘what’ of an object)

Spatial – Deals with location, direction (the ‘where’ of an object)

•Anatomical Basis:

Supramarginal and Angular gyri of the nondominant (right) hemisphere

(Tasks which use the visuospatial sketchpad could ask the patient to look at a cube and two outlines designed to fold and decide which one would fold to make the cube.)

Question 9

What is the Central Executive? describe its role, and its anatomical basis.

Answer 9

Characteristics:

Akin to Shallice’s SAS (Supervisory Attentional System) a flexible but limited processing resources coordinates operation of the two ‘slave’ subsystems

eg. switching attention, switching retrieval plans

Functions:

• Control of attention and action: regulating information flow through working memory
• Storage and processing capacities: important in situations in which there are competing response tendencies

Anatomical Basis:

• Frontal Lobe – hence the term ‘dysexecutive syndrome”

Question 10

What is the Episodic Buffer? describe its role.

Answer 10

Limited capacity system that is episodic and controlled by the central executive – capable of integrating information from a range of sources into a single complex structure or episode

Buffer in the sense of acting as an intermediary between the subsystems that use different codes, combining them into a unitary multi-dimensional representation

Also used as a mental modelling space, allowing one to set up representation that might guide future action (eg. planning a route)

A temporary store that can be preserved in densely amnesic patients

Question 11

List some measures of memory

Answer 11

• Digit span (forwards and backwards) - hold and manipulate verbal memory
  
  • forward = strings of digits starting short and getting longer (how many bits of info someone can hold in mind).
  • Backward = manipulating the information.
    Sequencing, repeat numbers back from highest to lowest or vice versa and include duplicate numbers (manipulating).
• Visual Memory span (forwards and backwards) - same as above but for VISUAL system
• Mental control - get them to do tasks which are not automatic (e.g., reciting, spelling or counting backwards)
• Figural memory
• Tower of London
• Letter-number-sequencing
• WAIS-IV working memory index (Digit span and arithmetic)
• WMS-IV - visual working memory (spatial addition and symbol span)

Question 12

How do disorders indicated that memory is a multidimensional concept? What consequence does this have for neuropsychological assessment?

Answer 12

Because different components of memory can be affected whilst other components of memory remain intact.

You want to ask and measure people with memory complaints/referral questions to determine the specific kind of memory impairment (And underlying brain structures) that are impaired.

Question 13

Are the brain areas of verbal and visual memory an example of single or double dissociation and why?

Answer 13

Double dissociation

lesion to areas that deal with verbal memory do not affect visual memory

and lesions to areas that deal with visual memory do not affect verbal memory.

Question 14

Detailed knowledge of neuroanatomy is necessary to:

Answer 14

1. Conduct an appropriate examination.
2. Interpret failures, e.g. why would an inability to recognise someone happen.
3. Extrapolate from test results because a doctor won’t understand what it means that the patient performed badly on specific tests, you need to be able to extrapolate to tell a doctor what it means.
4. To determine the validity of the test results, for example is this a new problem or is it due to existing learning difficulties or drug use etc.

Question 15

What are the three main types of memory?

Answer 15

1. working memory (recent)
2. Secondary memory (learning)
3. Long-term Memory

Question 16

What is working memory?

Answer 16

Working memory is the ability to hold and manipulate information in your mind. Originally considered as a single unit, we now know that working memory is actually a multifactorial process.

Question 17

What is the typical hemispheric specialisation of verbal and visual memory?

Answer 17

Verbal typically left hemisphere (dominant)

visual typically right hemisphere

Question 18

What are some tests used to determine verbal working memory ability?

Answer 18

• WAIS-IV
  
  • Digit Span (forward and backward) - forward = hold in mind, backwards = manipulate
  • Arithmetic - Hold and manipulate numbers to do mental calculations
• Letter-number sequencing

Question 19

What is the tower of london task, what does it test?

Answer 19

Test of working memory (visual planning).

requires patients to rearrange blocks on pegs to match a picure. You have a limited number of moves, can not hold one block while moving another and you can’t move two blocks at a time. It is used as a test of planning but also requires the patient to hold and manipulate the plan in their mind in order to execute it successfully.

Question 20

What are some tests of visual working memory?

Answer 20

• WMS-IV (tests visual working memory)
  
  • Symbol span (forward and backward)
  • Spatial addition
• Tower of London

Question 21

What are 3 common disorders of working memory?

Answer 21

1. Conduction aphasia
2. Learning disability
3. Alzheimer’s disease (DAT = Dementia of the Alzheimer type)

Question 22

What is conduction aphasia and what are the working memory symptoms of it?

Answer 22

It is a specific impairment of repetition due to damage to the white matter connecting the receptive language areas and the spoken language areas.

• Presents as an inability to repeat information that is heard.
• Patients will do poorly on spoken language tests.
• Comprehension is normally intact except for complex syntactic structures.
• Speech is usually fluent although sometimes phonemic errors can occur.
• New learning and general intellectual functioning tend to be intact.

Question 23

How might a learning disability affect working memory performance?

Answer 23

Patients with specific parietal dysfunction in their dominant hemisphere (usually right, i.e., auditory side) will perform poorly on digit span and sequenced working memory tasks but may perform normally if information does not need to be remembered sequentially.

(When conducting an initial interview it is very important to ask the patient if they ever had a learning disability. With an older patient this term might not be understood so ask if they ever had difficulty learning to read or doing maths as a child. Working memory is often used to test for incomplete effort, but this is not appropriate if there is a history of a learning disability. )

Question 24

How does alzheimers typically impact on working memory?

Answer 24

Presents with an impaired central executive but an intact phonological loop.

Question 25

What background/history information should you garner from people (or consider) prior to a working memory assessment?

Answer 25

• History of any learning difficulties (can imapct on sequential auditory working memory/working memory and devaluate use of WM tests as tests of effort
• Whether the person is experience pain (can impact WM)
• Drug use (can impact WM, especially within 24-48 hours)
• Sleep patterns/schedules/getting enough sleep (can impact WM)
• Mood disturbances can also affect results; these can be screened for using the DASS.

Question 26

Describe the model of Secondary (Recent) memory.

Answer 26

1. Procedural (knowing ‘how’, includes skill and motor learning, emphasis on implicit learning, expressed via skills, can’t be consciously learned)
   
   1. skills
   2. priming
   3. classical conditioning
2. Declarative (knowing ‘that’, explicit knowledge)
   
   1. semantic (knowledge common to a culture, enables mental representation of the world, context free)
   2. episodic (knowledge specific to an individual, depend on temporal/spatial/contextual cues in order to retrieve, knowledge of personal experience, remembering specific events in the context within which they occured.)

Question 27

What type of secondary memory is typically disrupted in amnestic conditions? (And which is not)

Answer 27

Declarative memory - specifically episodic memory (and NOT procedural memory)

Question 28

What are some neuropsychological tests used to assess semantic memory?

Answer 28

• **COWAT (verbal Fluency) Controlled Oral Word Association Test **- give person a letter of the alphabet and ask them to tell you things starting with that letter (F, A, S), more developed vocab = better should do at test BUT frontal lobe dysfunction can also affect scores as the test requires strategy development.
• Boston Naming Test - pictures of drawings, just have to name the item, a test of being able to retrieve words, cueing mechanisms built into the test (e.g., providing the first letter)
• WAIS-IV - vocabularly, information, comprehension, and similarities (because these require intact semantic memory)

Question 29

What are the consequences of a Left Temporal lobe resection? (And why?)

Answer 29

Secondary verbal memory deficit (logical memory, word lists)

partial removal of the left hippocampus - implicated in memory.

Question 30

What are some neuropsychological tests used to assess episodic memory?

Answer 30

• WMS-IV: paired associates, logical memory, visual reproduction, family pictures
• **Rey Complex Figure **(the order that they draw the figure is important, as is how well they can draw it when looking at it, and later/delayed drawing recall).
• RAVLT (CVLT or SRT)
  
  • Rey Auditory and Visual Learning Test (5 x trials of remembering a list of 15 words [should see practice/learning effect], 1x trial of interferance list, 2x more trials of original list, delayed recall of original list, recognition list with half non-target words).
  • Californian Visual Learning Test
  • Selective Reminding Test (remember a list of words, only remind them words that they have missed each trial, poor episodic memory means person will return/favour the words that they were most recently reminded of [assuming intact working memory])

Question 31

What are the consequences of a Right Temporal lobe resection? (And why?)

Answer 31

Secondary Nonverbal Memory Deficit (maze learning, design recall, recall of faces)

Hippocampus thought to be the important structure and is partially removed during this resection.

Question 32

What are 3 common disorders of secondary memory?

Answer 32

1. Temporal lobe epilepsy
2. Cerebrovascular disorders of memory
3. Frontal Amnesia