New Technologies for Improving Memory New Developments in Memory Training New Technologies for Improving Memory Stella Karantzoulis, Ph.D. Clinical Neuropsychologist Assistant Professor of Neurology New York University School of Medicine December 2, 2011 Stella Karantzoulis, PhD

Outline Cognitive Intervention Goals Strategies: Compensatory, Restorative Cognitive Intervention in Epilepsy, Examples New Technologies Our Memory Training Study Key Points

Has This Happened to You?

Epilepsy and Memory Subjective Complaints 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

Goals of Cognitive Training Programs New Developments in Memory Training 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 Stella Karantzoulis, PhD

New Developments in Memory Training If only it were that easy…. Stella Karantzoulis, PhD

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

New Developments in Memory Training 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 Stella Karantzoulis, PhD

New Developments in Memory Training External Memory Aids One of the most efficient ways to compensate Most people without neurological memory deficits use aids Stella Karantzoulis, PhD

Memory Aids: People with Acquired Brain Injury New Developments in Memory Training 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% 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. Stella Karantzoulis, PhD

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 New Developments in Memory Training First-Letter Mnemonics Stella Karantzoulis, PhD

New Developments in Memory Training Memory tools Attention Writing Organization Repetition Meaningfulness Stella Karantzoulis, PhD

Repetition Spaced 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

New Developments in Memory Training 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 Stella Karantzoulis, PhD

Restorative Approaches: Prevent Errors New Developments in Memory Training 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 Stella Karantzoulis, PhD

Cognitive Interventions: Temporal Lobe Epilepsy Surgery New Developments in Memory Training 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 Memory + attention training (1 month), compensatory + restorative approaches, psychoeducation, counseling component Helmstaedter et al. Epilepsy & Behavior. 12, 402-409 (2008). Stella Karantzoulis, PhD

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 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.

Baseline Intervention Post-Intervention Clare et al. Neurocase, 5, 37ff. 1999.

New Developments in Memory Training Computer Technology Stella Karantzoulis, PhD

New Developments in Memory Training 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 Stella Karantzoulis, PhD

The IMPACT Study: Results New Developments in Memory Training 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 Stella Karantzoulis, PhD

Stella Karantzoulis, PhD Computerized Cognitive Training and Psychoeducation for Patients with Temporal Lobe Epilepsy   Stella Karantzoulis, PhD William Barr, PhD Steven Pacia, MD Supported by FACES

Our Memory Training Program New Developments in Memory Training Our Memory Training Program Computer testing (Brain Fitness or Lumosity) 1 hour of computer testing per day/8 weeks programs are given to participants at no cost 2. Control Group can go through program at study end, no cost First research study to compare two computer memory training programs in epilepsy Stella Karantzoulis, PhD

New Developments in Memory Training Brain Fitness Program Lumosity Program Story Teller Memory Matrix Stella Karantzoulis, PhD

Our Memory Training Program New Developments in Memory Training Our Memory Training Program To find out more about this program: Call 646-558-0950 leave your contact information Stella Karantzoulis, PhD

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

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