Smartwatch aids time-based prospective memory in Korsakoff syndrome: a case study

Can Technology-Based Social Memory Aids Improve Social Engagement? Perceptions of a Novel Memory Aid for Persons With Memory Concerns

Social withdrawal and isolation are frequently experienced among people with cognitive impairment, Alzheimer's disease, and Alzheimer's disease related dementias. Few assistive technologies exist to support persons with memory concerns' (PWMC) continuing social engagement. This study aimed to understand PWMC and family caregivers' initial perspectives on the feasibility and utility of a wearable technology-based social memory aid. We recruited 20 dyads, presented the memory aid, and conducted semi-structured interviews from June to August 2020 over Zoom video conferencing. Interviews were transcribed and analyzed using thematic analysis. Overall, participants anticipated the technology could reduce socializing-related stress now and in the future for both members of the care dyad. However, certain features of the memory aid (e.g., visitors must have the app), could limit utility, and participants provided recommendations to enhance the tool. Our findings will inform future technology-enabled social memory aid development for PWMC and family caregivers.

Utility of a novel tablet computer software for memory impairment in participants with brain injuries: A randomized control trial

This study examined the effectiveness of a novel information and communication technology (ICT) tool developed for external memory compensation to improve memory function in participants with brain injuries. In this 3-month randomized control study, participants with memory impairment secondary to brain injury were randomly assigned on a 1:1 basis to either intervention (the ICT tool [ARATA]) or 3-month waitlist control groups. This study's primary outcome measure was memory-related difficulties in everyday life, assessed using the Everyday Memory Checklist (EMC). Secondary outcomes included tests for memory function and psychosocial status, all of which were administered by blinded assessors. Seventy-eight participants (53 males, 25 females; mean age, 43.5 ± 12.7 [SD] years) were enrolled and 39 participants were allocated to each group (intervention and control). There was no significant difference in EMC scores between the two groups throughout the study (mean 0.26; 95% CI: -2.55-3.07; p=0.853); however, the intervention group scored significantly higher on the Rivermead Behavioural Memory and General Self-Efficacy tests compared to the control group. While the ICT tool did not improve the primary study outcome, evidence suggests that the ICT tool can improve memory functions related to activities of daily living.

The Use of an Errorless Learning Application to Support Re-Learning of (Instrumental) Activities for People Living with Korsakoff Syndrome

Korsakoff syndrome (KS) is a severe neuropsychiatric syndrome derived from acute thiamine deficiency and concomitant alcohol use disorders. KS patients need lifelong assistance because of the severity of their cognitive problems. In clinical practice and research, errorless learning has proven to be an effective cognitive rehabilitation method for patients with KS. Our study focused on optimizing errorless learning by introducing new software technology to support the training process of errorless learning. Although the benefits of errorless learning for patients with Korsakoff's syndrome have been thoroughly investigated, it is currently unclear whether new technology could contribute to better learning and maintenance of everyday tasks. Therefore, an errorless learning application was built. This device is a web application and can be used on a tablet, laptop, or smartphone. The application allows clinicians and researchers to insert pictures, videoclips, timers, and audio fragments in the different steps of an errorless learning training plan. This way, the different steps are visible and easy to follow for patients. Moreover, it ensures as a learning method that the training is executed exactly the same way for each and every training. The aim of this study was twofold: to examine whether the use of the errorless learning application is effective, and whether it leads to better results than a regular errorless learning of everyday activities. In total, 13 patients with KS were trained in instrumental activities of daily living by means of the application, and 10 patients were trained with traditional instructions. Results showed an equal improvement for both training methods. Importantly, the technology group could better remember the training when probed at a later moment than the traditional errorless learning group. These results are promising for further development of novel technology to support errorless learning applications in clinical practice.

User Interface (UI) Design and User Experience Questionnaire (UEQ) Evaluation of a To-Do List Mobile Application to Support Day-To-Day Life of Older Adults

Because of the spread of smartphones, older adults enjoy the assistance of smartphones. However, fewer mobile applications are designed for older adults. Smartphone user interface (UI) serves as an external brain to capture information, and older adults may have memory complaints that affect self-confidence and lead to memory decline. Non-declarative memory requires more effort. Therefore, this study aims to design and evaluate a to-do list application to help older adults encode, store, and retrieve non-declarative memory, such as tasks they plan to do. We recruited 15 participants (5 men and 10 women) aged 60 to 75 years old (SD = 5.32). They were asked to complete nine usability tasks, and to answer a user experience questionnaire (UEQ) and a few interview questions. Sixty percent of users completed with only one or two attempts (median = 2.80, SD = 1.63). We found three usability issues and proposed an iteration plan. The application has attractiveness, efficiency, dependability, stimulation, novelty, and good perspicuity for older adults. The product was rated excellent except for perspicuity, which met the users’ expectations. This indicates that the user is satisfied with the application prototype. The results of this measurement can be utilized as a benchmark for the next model for developing mobile to-do list applications on user experience.

Smartwatch reminders are as effective as verbal reminders in patients with Korsakoff's syndrome: three case studies

Korsakoff's syndrome (KS) is a neurocognitive disorder caused by severe malnutrition. KS patients typically show severe impairments in prospective memory (PM), thus, have difficulties with remembering to perform delayed intentions. The current study investigated the possible benefits of a smartwatch aid for PM tasks in patients with KS and compared its efficacy with verbal in-person reminders. Three patients participated in the present study and were asked to complete everyday PM tasks. The results of each patient were analyzed as a single-case study. The results highlight the great potential of using smartwatches as external memory aids in KS patients in everyday life.

Identifying, Assessing, and Treating Korsakoff Syndrome Patients: Updated Perspectives

ABSTRACT

Objectives consist of updating published reports on the recognition, assessment, and care of patients with Wernicke-Korsakoff syndrome (WKS). Methods included defining relevant terms, describing core clinical phenomena, conducting meaningful reviews for latter-day WKS publications, and selecting instructive case examples. Findings covered epidemiology, precipitants, neuroimaging studies, alternate learning strategies in WKS, adjunctive treatments, and promising research. In conclusion, patients, their family members, clinicians, and public health experts should benefit from this updated knowledge. Countries with substantial alcohol consumption should consider emulating Holland in designating WKS research centers, founding regional clinical facilities, and funding multidisciplinary expert teams.

Case Report: Intensive Inpatient Neurorehabilitation Achieves Sustained Real-World Benefits in Severe Alcohol-Related Wernicke-Korsakoff Syndrome: A Case Study With 7-Years Follow-Up

About 85% of survivors of acute Wernicke's Encephalopathy (WE), a frequent and serious consequence of thiamine deficiency and alcohol misuse, sustain chronic neurocognitive deficits also known as chronic Wernicke-Korsakoff syndrome (WKS). If alcoholism is combined with smoking, tobacco alcohol optic neuropathy (TAON) may occur which leads to visual impairment. In contrast to WKS, TAON may be treated successfully by early vitamin substitution and detoxification. Little research has been conducted on WKS longterm outcomes. Existing literature suggests poor prognosis. Symptoms remaining beyond the acute treatment with thiamine are thought to be irreversible. Whether neurorehabilitation may be an effective route to help recovery of those persistent symptoms is an open question. At our neurorehabilitation center, which specializes in the treatment of severe chronic deficits after brain injury, the opportunity arose to treat a 35 year old male with WKS, and to conduct follow-up assessments 3- and 7-years post discharge, respectively. Initially MK was admitted to emergency care with suspected postconcussive syndrome, alcohol-related thiamine deficiency, and TAON. Thiamin, cobalamin, and folate substituion improved TAON but major cognitive deficits remained. When admitted to our center 4 months later, he was fully reliant on care staff for all activities of daily living (ADL). Through intensive neurocognive training and psychological treatment he improved gradually and, after 26 months, was well enough to be discharged into the community and pursue work in a sheltered setting. Neuropsychological tests, as well as patient reports obtained at the follow-ups showed that the benefits apparent at discharge had been sustained, and for some scores, improved further. This was particularly evident in the Rey-Osterrieth Complex Figure Test which improved from percentage ranges <1 for immediate recognition and recall at discharge to rank 16 for immediate recognition and rank 5 for recall at the 7-year follow-up. This case study illustrates the immense benefits neurorehabilitation can have for WKS induced by alcohol misuse. It further demonstrates how skills and strategies, learned in the inpatient setting, translate into living well and independently, and how the latter promotes further improvement long after discharge.

Autobiographical memory in Korsakoff syndrome: A review

Autobiographical memory (AM) (i.e., memory for personal information) is a unique form of memory that goes beyond recalling information such as what, where and when of an event, to include what that event means and why it is important to our life story. This paper therefore reviews the available literature on AM in Korsakoff syndrome (KS). It summarizes the characteristics of AM disorders in KS patients. These disorders are mainly characterized by the difficulties that patients with KS have in retrieving and reliving specific AMs and in retrieving recent and remote memories. Another core characteristic of AM disorders in KS is confabulations. This paper hypothesizes that patients with KS may produce autobiographical confabulations to support their objectives and beliefs or even to answer a social demand or simply to share personal experiences with others. Although the current evidence demonstrates disorders of AM in KS, there is a need for more research about the characteristics of these disorders. This review thus proposes several perspectives for theoretical and clinical research.

Introducing a Computerized Figural Memory Test Based on Automatic Item Generation: An Analysis With the Rasch Poisson Counts Model

An automatic item generator for figural memory test items called figumem was developed. It is available in R. A cognitive model allowed the generation of hypothetically parallel items within three difficulty levels determined by visual information load. In a pilot study, participants solved three items for each level of visual load. Within an item response theory approach, the Rasch Poisson counts model and modifications of it were fitted to the data. Results showed overall satisfying fit. Visual information load explained most of the variance in item difficulty. Differences in difficulty between items of the same family were comparatively low, displaying the utility of the item generator for the creation of parallel test forms. Implications, limitations, and suggestions for the use and extensions of figumem are discussed.

Episodic future thinking together with observational learning benefits prospective memory in high-functioning Korsakoff's syndrome patients

Objective

Patients with Korsakoff’s syndrome (KS) have difficulty carrying out tasks which rely on prospective memory (PM). Since remembering to carry out an action in the future is crucial for living independently, it is of primary interest to develop strategies that improve PM performance in KS patients.

Design

The study employed a computer categorization task as an ongoing activity into which a PM task was embedded. We included episodic future thinking (EFT) and observational learning (Experiment 2) to boost PM.

Methods

Experiment 1 evaluated the efficacy of EFT following written PM task instructions in ten KS patients. Due to floor‐level PM performance in Experiment 1, Experiment 2 included an instructional video demonstrating the PM intention. In Experiment 2, twenty‐six KS patients performed both conditions (EFT and no‐EFT) at least 1 week apart, while twelve controls with alcohol use disorder without KS performed the no‐EFT condition. In Experiment 2, the PM instructions were also shown through video (observational learning component). Mild cognitive impairment was assessed in a short test battery.

Results

Experiment 1 showed overall floor performance in both conditions. Experiment 2 showed that KS patients performed PM tasks less accurately than the control group in the no‐EFT condition. In Experiment 2, where the observational learning component was included, EFT improved PM performance in KS patients. This effect was driven by a sub‐group of high‐functioning KS patients.

Conclusions

This study showed the value of an observational learning component together with EFT in improving PM performance, in relatively high‐functioning KS patients.

Practitioner points

KS patients performed the PM task less accurately than non‐KS controls with alcohol use disorder, confirming PM impairment in this patient population.

Controls with alcohol use disorder performed the PM task at ceiling level.

Showing an instructional video demonstrating the PM intention improved PM performance and later recall of PM task instructions in KS patients.

Episodic future thinking strategy improved PM performance in KS patients with relatively intact cognitive functioning.