Assessing subtle memory impairments in the everyday memory performance of brain injured people: exploring the potential of the extended Rivermead Behavioural Memory Test

Memory complaints in epilepsy: An examination of the role of mood and illness perceptions

The study examined the role of mood and illness perceptions in explaining the variance in the memory complaints of patients with epilepsy.

METHOD

Forty-four patients from an outpatient tertiary care center and 43 volunteer controls completed a formal assessment of memory and a verbal fluency test, as well as validated self-report questionnaires on memory complaints, mood, and illness perceptions.

RESULTS

In hierarchical multiple regression analyses, objective memory test performance and verbal fluency did not contribute significantly to the variance in memory complaints for either patients or controls. In patients, illness perceptions and mood were highly correlated. Illness perceptions correlated more highly with memory complaints than mood and were therefore added to the multiple regression analysis. This accounted for an additional 25% of the variance, after controlling for objective memory test performance and verbal fluency, and the model was significant (model B). In order to compare with other studies, mood was added to a second model, instead of illness perceptions. This accounted for an additional 24% of the variance, which was again significant (model C). In controls, low mood accounted for 11% of the variance in memory complaints (model C2).

SUMMARY

A measure of illness perceptions was more highly correlated with the memory complaints of patients with epilepsy than with a measure of mood. In a hierarchical multiple regression model, illness perceptions accounted for 25% of the variance in memory complaints. Illness perceptions could provide useful information in a clinical investigation into the self-reported memory complaints of patients with epilepsy, alongside the assessment of mood and formal memory testing.

Everyday memory impairment in patients with temporal lobe epilepsy caused by hippocampal sclerosis

OBJECTIVE

Patients with temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS) have episodic memory impairment. Memory has rarely been evaluated using an ecologic measure, even though performance on these tests is more related to patients' memory complaints. We aimed to measure everyday memory of patients with TLE-HS to age- and gender-matched controls.

METHODS

We evaluated 31 patients with TLE-HS and 34 healthy controls, without epilepsy and psychiatric disorders, using the Rivermead Behavioral Memory Test (RBMT), Visual Reproduction (WMS-III) and Logical Memory (WMS-III). We evaluated the impact of clinical variables such as the age of onset, epilepsy duration, AED use, history of status epilepticus, and seizure frequency on everyday memory. Statistical analyses were performed using MANCOVA with years of education as a confounding factor.

RESULTS

Patients showed worse performance than controls on traditional memory tests and in the overall score of RBMT. Patients had more difficulties to recall names, a hidden belonging, to deliver a message, object recognition, to remember a story full of details, a previously presented short route, and in time and space orientation. Clinical epilepsy variables were not associated with RBMT performance. Memory span and working memory were correlated with worse performance on RBMT.

SIGNIFICANCE

Patients with TLE-HS demonstrated deficits in everyday memory functions. A standard neuropsychological battery, designed to assess episodic memory, would not evaluate these impairments. Impairment in recalling names, routes, stories, messages, and space/time disorientation can adversely impact social adaptation, and we must consider these ecologic measures with greater attention in the neuropsychological evaluation of patients with memory complaints.

Prospective and episodic memory in relation to hippocampal volume in adults with spina bifida myelomeningocele

The present study examined prospective and episodic memory in relation to age, functional independence, and hippocampal volume in younger to middle-aged adults with spina bifida myelomeningocele (SBM) and typically developing (TD) adults. Prospective and episodic memory, as well as hippocampal volume, was reduced in adults with SBM relative to TD adults. Neither memory performance nor hippocampal volume showed greater decrements in older adults. Lower hippocampal volume was associated with reduced prospective memory in adults with SBM, and this relation was specific to the hippocampus and not to a contrast structure, the amygdala. Prospective memory mediated the relation between hippocampal volume and functional independence in adults with SBM. The results add to emerging evidence for reduced memory function in adults with SBM and provide quantitative evidence for compromised hippocampal macrostructure as a neural correlate of reduced memory in this population.

Cognitive rehabilitation of memory for mild cognitive impairment: a methodological review and model for future research

Several recent reviews have suggested that cognitive rehabilitation may hold promise in the treatment of memory deficits experienced by patients with mild cognitive impairment. In contrast to the previous reviews that mainly focused on outcome, the current review examines key methodological challenges that are critical for designing and interpreting research studies and translating results into clinical practice. Using methodological details from 36 studies, we first examine diagnostic variability and how the use of cutoffs may bias samples toward more severely impaired patients. Second, the strengths and limitations of several common rehabilitative techniques are discussed. Half of the reviewed studies used a multi-technique approach that precludes the causal attribution between any specific technique and subsequent improvement. Third, there is a clear need to examine the dose-response relationship since this information was strikingly absent from most studies. Fourth, outcome measures varied widely and frequently depended on neuropsychological tests with little theoretical justification or ecological relevance. Fifth, we discuss how the variability in each of these other four areas complicates efforts to examine training generalization. Overall, future studies should place greater emphasis on ecologically relevant treatment approaches and outcome measures and we propose a hierarchical model that may aid in this pursuit.

Ceiling and floor effects on the Rivermead Behavioural Memory Test in patients with alcohol-related memory disorders and healthy participants

OBJECTIVE

The Rivermead Behavioural Memory Test (RBMT) is a widely used measure of everyday memory performance. In the most recent revision of this test (RBMT-3) some important changes have been made compared with the RBMT. This study examines whether this revision has improved the quality of the clinical classifications using this test, as well as the frequency of floor and ceiling performances that were prominent on some subtests of the RBMT, using a heterogeneous study sample.

METHODS

Twenty-five healthy adults and 25 patients with alcohol-related memory impairment (including 15 Korsakoff patients) were examined using both the RBMT and the RBMT-3. The number of perfect scores and floor performances, as well as the percentage of individuals classified as impaired (< 5th percentile), were scored and compared.

RESULTS

Administration of the RBMT-3 results in less participants performing at or near individual subtest's ceiling, and resulted in less floor performances. Moreover, the RBMT-3 misclassifies less healthy participants as impaired than the RBMT.

CONCLUSIONS

The RBMT-3 is a substantial improvement over the original RBMT, as it reduces the problem of ceiling and floor performances and the number of misclassifications. However, more research is needed on the ecological validity of the RBMT-3.

Prospective Memory and Traumatic Brain Injury: A Review

This article aimed to review the assessment and treatment of prospective memory impairment in individuals with traumatic brain injury. The three assessment techniques reviewed included questionnaires, psychological tests, and experimental procedures. Because interest in this area is relatively new, not many assessment techniques have been specifically developed to assess the various constructs of prospective memory. Of these, most lack a firm theoretical basis, adequate norms, and strong psychometric properties. Rehabilitative techniques, based on remedial and compensatory approaches, were then evaluated. Intervention methods that show promise include a prospective memory training approach, diary or memory notebook use, and electronic aids. Nevertheless, there is a need for further controlled trials with larger sample sizes to more thoroughly evaluate these methods. Self-awareness of memory impairment and generalisation of gains from treatment are another two issues identified as important for assessing and treating prospective memory impairment.

Diffusion tensor imaging differences relate to memory deficits in diffuse traumatic brain injury

Background

Memory is one of the most impaired functions after traumatic brain injury (TBI). We used diffusion tensor imaging (DTI) to determine the structural basis of memory deficit. We correlated fractional anisotropy (FA) of the fasciculi connecting the main cerebral regions that are involved in declarative and working memory functions.

Methods

Fifteen patients with severe and diffuse TBI and sixteen healthy controls matched by age and years of education were scanned. The neuropsychological assessment included: Letter-number sequencing test (LNS), 2-back task, digit span (forwards and backwards) and the Rivermead profilet. DTI was analyzed by a tract-based spatial statics (TBSS) approach.

Results

Whole brain DTI analysis showed a global decrease in FA values that correlated with the 2-back d-prime index, but not with the Rivermead profile. ROI analysis revealed positive correlations between working memory performance assessed by 2-back d-prime and superior longitudinal fasciculi, corpus callosum, arcuate fasciculi and fornix. Declarative memory assessed by the Rivermead profile scores correlated with the fornix and the corpus callosum.

Conclusions

Diffuse TBI is associated with a general decrease of white matter integrity. Nevertheless deficits in specific memory domains are related to different patterns of white matter damage.

Ecologically valid cognitive tests and everyday functioning in euthymic bipolar disorder patients

BACKGROUND

In euthymic bipolar disorder patients, scores on the Mini-Mental State Examination (MMSE) are not abnormal but general functioning remains impaired. Recent studies provide ample evidence that euthymic patients show significant impairment on more comprehensive neuropsychological test batteries. There is no definitive relationship between performance on neuropsychological test batteries and the ability to cope in everyday life. Ecologically valid tests of cognitive function aim to bridge this gap as they use everyday tasks to explore cognitive function. The aims of the study were to examine if euthymic bipolar disorder patients were impaired on ecologically valid tests of cognitive function and measures of general, social and occupational function. We examined the relationships between cognitive impairment and residual symptoms, clinical history, general functioning and employment.

METHOD

Cognitive tasks, functional assessments and mood scales were administered to 29 euthymic bipolar disorder patients and 29 matched controls.

RESULTS

Patients were impaired on ecologically valid tests of attention, memory and executive function. Patients showed impairment in general, social and occupational functioning. Unemployment was associated with impairment in attention. Memory impairment correlated with number of previous manic episodes.

LIMITATIONS

All patients were on psychotropic medication, which may affect cognition. Traditional neuropsychological tests were not performed concurrently with ecologically valid tests.

CONCLUSIONS

Ecologically valid tests of cognitive function are sensitive in detecting cognitive impairment in euthymic bipolar disorder. Clinicians should consider using these tests in the recovery phase of bipolar illness, as they may be particularly helpful in showing where rehabilitation should focus.

Comparison between Spanish young and elderly people evaluated using Rivermead Behavioural Memory Test

The first objective of this work was to compare scores obtained in the daily memory function between young and elderly people, and to check whether there are differences between the groups for each of the profile scores obtained in the memory test. A second aim of this paper is to study the relationship between everyday memory and age, while controlling for gender and educational level. The total and profile scores obtained in the Rivermead Behavioural Memory Test were compared in a sample of 60 young and 120 elderly people from Valencia (Spain). Results showed significant differences between the two groups: those between 18 and 30 years obtained a higher average than those over 65. Once the group comparison was controlled for gender and educational level, the statistical effect of age group disappeared. The non-significant effect of group can not be explained by the introduction of gender, because both its main effect and the interaction were not statistically significant. However, educational level had a statistically significant effect which may explain the non-significant effect of group in this new analysis. The main conclusion is the need to carefully control for educational level in all studies related with everyday memory and ageing, as the differences found could be due to generational differences more than to biological deterioration.

Everyday memory functioning in obsessive- compulsive disorder

Memory performance in obsessive-compulsive disorder (OCD) is discussed as a pathogenetic risk factor for the emergence of OCD, particularly checking compulsions. At present, however, findings are mixed and little is known about memory performance in tasks relevant to everyday functioning in patients with OCD. For the present study, memory performance was assessed in 31 patients diagnosed with OCD and 33 healthy controls with the Rivermead Behavioural Memory Test (RBMT), which covers a wide range of verbal and nonverbal memory components as well as prospective memory. OCD patients performed comparably to healthy controls on the memory task for verbal, nonverbal, and prospective memory (p > .1). According to norm values, memory performance was unimpaired in most OCD patients. The present findings further challenge a broad account of the "memory deficit" hypothesis of OCD and compulsive checking, respectively.

A Substudy Protocol of the Hypertension in the Very Elderly Trial Assessing Cognitive Decline and Dementia Incidence (HYVET-COG)

BACKGROUND AND OBJECTIVE

Randomised, controlled trials and population studies have suggested a link between hypertension and the development of dementia (vascular dementia and Alzheimer's disease) although the results are not conclusive. The very elderly are at highest risk for both hypertension and dementia but have been underrepresented in studies to date. The Hypertension in the Very Elderly Trial (HYVET), an international, randomised, double-blind, placebo-controlled trial of antihypertensive medication for those > or =80 years of age, is currently underway. The protocol for the assessment of cognitive decline and detection of incident dementia cases is described in this article. The objective of this protocol is to determine whether treatment of hypertension in this very elderly group affects the incidence of dementia and decline in cognitive function during the period of the HYVET trial.

METHODS

Cognitive function in all HYVET trial participants is assessed at baseline and annually thereafter using the Mini-Mental State Examination (MMSE). An MMSE score that decreases more than three points per year or decreases to <24 prompts further investigation for possible incident dementia. This includes use of the Diagnostic and Statistical Manual-IV criteria, the modified Hachinski scale and CT scanning. In cases where a CT scan cannot be obtained the full Hachinski scale is used. Additional information is provided when available from the clock drawing test and Geriatric Depression Scale. Data are also gathered from all trial participants with regard to education, blood pressure, alcohol use, co-morbidities and concomitant treatments. At the end of the trial, changes in cognitive function and incident dementia cases will be compared in those receiving active treatment (indapamide slow-release +/- perindopril) and those receiving matching placebo.

RESULTS

The protocol has been applied successfully and the data collection phase is underway.

DISCUSSION

Previous population studies have been unable to study antihypertensive use in a controlled manner and randomised, controlled trials suggest a positive or mixed picture regarding an association between use of antihypertensive therapy and reduction in incident cognitive decline and/or dementia. No such trial has yet been performed exclusively in subjects > or =80 years of age with hypertension. The HYVET trial is placebo controlled and while investigating the cardiovascular effect of treatment also assesses cognitive function and quality of life in both the placebo and actively treated arms of the trial. The HYVET cognitive substudy trial (HYVET-COG) design has been successfully applied and the instruments chosen appear to be appropriate, valid and pragmatic.

CONCLUSION

HYVET-COG provides the first opportunity to examine the effect of antihypertensive treatment on incident dementia in a high-risk very elderly population.

The ecological validity of neuropsychological tests: a review of the literature on everyday cognitive skills

Evaluating the ecological validity of neuropsychological tests has become an increasingly important topic over the past decade. In this paper, we provide a comprehensive review of the research on the ecological validity of neuropsychological tests, as it pertains to everyday cognitive skills. This review is presented in the context of several theoretical issues facing ecological validity research. Overall, the research suggests that many neuropsychological tests have a moderate level of ecological validity when predicting everyday cognitive functioning. The strongest relationships were noted when the outcome measure corresponded to the cognitive domain assessed by the neuropsychological tests. Several other factors that may moderate the degree of ecological validity established for neuropsychological tests are in need of further exploration. These factors include the effects of the population being tested, the approach utilized (verisimilitude vs. veridicality), the person completing the outcome measure (significant other vs. clinician), illness severity, and time from injury until evaluation. In addition, a standard measurement of outcome for each cognitive domain is greatly needed to allow for comparison across studies.

Outcome of Memory Rehabilitation in Traumatic Brain Injury Assessed by Neuropsychological Tests and Questionnaires

OBJECTIVES

To evaluate the effectiveness of a memory rehabilitation program. To compare different outcome measures.

PARTICIPANTS

Twelve patients with severe traumatic brain injury.

SETTING

Outpatient rehabilitation service.

MAIN OUTCOME MEASURES

Rey-Osterrieth Complex Figure Test (REY), California Verbal Learning Test (CVLT), Rivermead Behavioural Memory Test (RBMT), and the Memory Failures in Everyday Memory Questionnaire (MFE).

STATISTICAL ANALYSIS

Exact nonparametric procedures.

RESULTS

All patients achieved meaningful functional gains. Modest improvements were found in some of the scales of the CVLT but not in the REY, RBMT, or MFE.

CONCLUSION

Functional gains did not correlate with improvement in memory processes. Measurement of changes in independence in activities of daily living mediated by compensatory aids and educational intervention plans with relatives are proposed.