William B. Barr, Ph.D., ABPP Annual FACES Epilepsy ConferenceAnnual FACES Epilepsy Conference April 27, 2014April 27, 2014

Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

What is memory? Cognitive Disorders Intellectual FunctioningIntellectual Functioning Attention and VigilanceAttention and Vigilance Executive FunctionsExecutive Functions LanguageLanguage Visuospatial SkillsVisuospatial Skills Memory**Memory**

Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

What is Memory? Types of memory Processing

What is Memory? Structure of Long-Term Memory (LTM)

What is Poor Memory? What is Poor Memory? Brodaty et al., 2002

What causes poor memory? What causes poor memory?

Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

Limbic System Cerebral Cortex BRAIN 101

Study of 55 patients with temporal lobe epilepsy: Difficulties with memory reported in 77.4%.Difficulties with memory reported in 77.4%. Reports of being “extremely bothered” by their memory disturbance in 13.2%.Reports of being “extremely bothered” by their memory disturbance in 13.2%. Over half (50.9%) feel that “seizures interfere with my memory”.Over half (50.9%) feel that “seizures interfere with my memory”. Data presented at the AES Meeting, 2003 How is memory affected by epilepsy?

Questionnaire completed by 55 subjects with focal epilepsy: I forget a phone number if I don’t copy it down right away (47.3%).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%)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 have trouble with remembering names of people I met last week (41.8%). I talk to someone on the phone and don’t remember minutes later (34.5%)I talk to someone on the phone and don’t remember minutes later (34.5%) I forget what someone said to me a half an hour ago (30.9%).I forget what someone said to me a half an hour ago (30.9%). Data presented at the AES Meeting, 2003 How is memory affected by epilepsy? The most common memory complaints in patients with epilepsy

Cognitive & Behavioral Impairment in Epilepsy

Antiepileptic Drugs (AEDs)

Treating memory impairment in patients with epilepsy Step Number One Optimize Medications: - Control seizures - Minimize number of AEDs - Use AEDs with least potential side effects Address Other Medical & Psychiatric Conditions: - Mood disorder, anxiety, or stress - Blood pressure, high cholesterol, etc.

Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

Neuropsychological Exam Interview Review of Medical Records Neuropsychological Testing Self-Report Inventories Report Feedback

The Normal Curve

Neuropsychological Test Battery Intellectual FunctioningIntellectual Functioning Attention and VigilanceAttention and Vigilance Executive FunctionsExecutive Functions LanguageLanguage Visuospatial SkillsVisuospatial Skills Memory**Memory** Self-Report QuestionnairesSelf-Report Questionnaires

Memory Testing Verbal Memory -Word Lists -Word Pairs -Narrative Passages Visual Memory -Designs & Figures -Unfamiliar Faces Remote Memory -Public Episodic Knowledge -Autobiographical Memory

Learn These Words Ballet Ice Cream Pie Penguin Zebra Play Goat Opera Cupcake

Remember These Figures

1. Tell me the words from the list. Free Recall 2. Draw those figures for me.

Recognition Pie Cabinet Zebra Play Lake

Semantic Organization 1.Animals: Penguin, Zebra, Goat 2. Entertainment: Play, Opera, Ballet 3. Deserts: Pie, Cupcake, Ice Cream

Visual Memory Encoding

Memory Treatment 1. What is memory? 2. How is memory affected by epilepsy? 3. How do you evaluate memory? 4. What can I do to improve memory?

Treating memory impairment in patients with epilepsy Step Number Two

Memory Treatment 1.Biological approaches 1.Psychological approaches 2.Lifestyle approaches

Memory Treatment Biological approaches  Psychopharmacology  Neurostimulation

Memory Treatment Pharmacological Approaches (Alzheimer’s disease) Pharmacological Approaches (Alzheimer’s disease)

Memory Treatment

Neurostimulation Neurostimulation a.Transcranial Magnetic Stimulation (TMS) b.Transcranial Direct Current Stimulation (tDCS) Dayan, 2013, Nature Neuroscience

Memory Treatment Psychological approaches  Cognitive remediation  Personal mnemonics  Brain activation techniques

Cognitive Rehabilitation Major Strategies Major Strategies 1.External a)Environmental Manipulations b)Notebook, Calendar, and Checklist Systems c)Electronic Devices 2.Internal a)Mnemonics b)Bizarre imagery

A. Education Enhancing awareness of nature and severity of memory disturbance Enhancing awareness of nature and severity of memory disturbance Learning that others have the same types of problems Learning that others have the same types of problems Teaching meta-memory skills Teaching meta-memory skills B. Training in Use of Mnemonic Strategies Visualization Visualization Association A. Education Enhancing awareness of nature and severity of memory disturbance Enhancing awareness of nature and severity of memory disturbance Learning that others have the same types of problems Learning that others have the same types of problems Teaching meta-memory skills Teaching meta-memory skills B. Training in Use of Mnemonic Strategies Visualization Visualization Association Cognitive Rehabilitation Memory rehabilitation groups Memory rehabilitation groups

Improving Memory Cognitive 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 Memory Cognitive Enhancement Techniques

Improving Memory Cognitive Enhancement Do these programs work? If so, which is better?

Memory Treatment Lifestyle approaches  Nutrition  Exercise  Relaxation strategies  Sleep

Memory Treatment Lifestyle Approaches Lifestyle Approaches

Memory Treatment Lifestyle Approaches Lifestyle Approaches

Memory Treatment Nutritional Supplements Nutritional Supplements

Memory Treatment Lifestyle Approaches Lifestyle Approaches

Memory Treatment Lifestyle Approaches Lifestyle Approaches Sleep and Consolidation

Memory Improvement

William B. Barr, Ph.D., ABPP NYU Comprehensive Epilepsy Center Departments of Neurology & Psychiatry NYU School of Medicine Phone: Contact Info: