1. 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

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

3. Has This Happened to You?

4. 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

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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 %
Writing on hand %
Watch with date 18%
Daily routine 18%
Personal organizer %
Journal %
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,
Stella Karantzoulis, PhD

14. More is Not Always Better

15. 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

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

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

18. Repetition Spaced Repetition
At first, repeat the information over short intervals
Eventually, repeat the information over long intervals
Spaced Repetition

19. 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

20. 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

21. 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

22. 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, 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, (2008).
Stella Karantzoulis, PhD

23. 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, (2012) .

24. 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, (2012) .

25. 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

26. 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

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

28. New Developments in Memory Training
Computer Technology
Stella Karantzoulis, PhD

29. 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

30. 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

31. 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

32. 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

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

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

35. 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

36. Any Questions?