Presentation on theme: "Epilepsy and Memory Mary Lou Smith Department of Psychology"— Presentation transcript:
1Epilepsy and Memory Mary Lou Smith Department of Psychology University of Toronto at MississaugaHospital for Sick Children
2Goals To review: Memory problems in epilepsy AdultsChildrenFactors that contribute to memory problemsStrategies for dealing with a poor memory
3Acknowledgements and Cautions Contributions of Irene Elliott and Dr. Suncica LahGreat variability / individual differences in experiences of memory difficultiesMost likely to apply in more severe epilepsy
4Memory One of most common complaints of adults with epilepsy Thompson and Corcoran, 1992“Everyday memory failures in people with epilepsy”.Epilepsy n = 760Non epilepsy n = 146Asked respondents to comment on the frequency of 18 everyday memory failuresHow frequently do you forget where you have put things? Losing things around the house?How freuently do you have to go back to check if you have done something you meant to do?How frequently do you find a word on the tip-of-your-tongue, you know what it is but cannot find it?Rate freqency ranging from “not at all in the last 3 months” to “more than once a day”Rate the nuisance arising from their memory difficulties.
5Frequency of Everyday Memory Failures Epilepsy n = 760Non epilepsy n = 146Asked respondents to comment on the frequency of 18 everyday memory failuresHow frequently do you forget where you have put things? Losing things around the house?How freuently do you have to go back to check if you have done something you meant to do?How frequently do you find a word on the tip-of-your-tongue, you know what it is but cannot find it?Rate freqentyc ranging from “not at all in the last 3 months” to “more than once a day”Rate the nuisance arising from their memory difficulties.Thompson & Corcoran, 1992
6Rating of Nuisance Arising From Their Memory Difficulty Thompson & Corcoran, 1992
7Daily Rating of Memory Failure Underestimation of the frequency of memory failuresWe forget how much we forget!
8What about children? 42 children with intractable epilepsy 70% self-reported memory problemsSmith, Elliott & Lach, 2006
9to repeat it to me over and over so finally I would get it “My memory … I forgetthings ... The teacher hasto repeat it to me over andover so finally I would get itand remember it … they have to teachthe same thing tomorrow so I wouldn’tforget it.” [12 year old boy]Acknowledgement: Irene Elliott
10Quality of Life in Pediatric Epilepsy (Arunkumar et al., 2000) ParentsAED side effectsCognitive effectsFutureInjuryIndependenceBrain damageDependence+ othersChildrenSocial problemsCognitive effectsDrivingSports restrictionsAED side effectsSchoolDependence+ others
11The Extent of the Problem: Example of Story Recall Smith, Elliott & Lach, 2002
12What are the kinds of memory problems that people report?
13Retention of learned material “A lot of times when I’m talking I will know what I’m going to say to you and then for some odd reason I’ll tell you the first part of the story and then I just forgot the second part and that would be the important part. I won’t remember it for a long time or I’ll go home and go ‘that’s what it was’… so that drives me insane”.Smith, Elliott & Lach, 2006
14Short-term / working memory “…my short-term memory is very bad…if my mom tells me to do a chore in the house or something and she leaves, I’ll forget…unless she writes it down on a paper”.Smith, Elliott & Lach, 2006
15Word retrieval (semantic memory) “I can’t just spit out a word, a proper word. I know what I’m want to explain to you but I can’t think of a proper word and I know the word and I’m so used to the word and it could be the easiest word. I can’t get it out. I’ll have to wait and it’ll make me really aggravated”.Smith, Elliott & Lach, 2006
16Autobiographical memory “I don’t remember any of my childhood… because of these seizures I don’t remember a lot of my life… I can get bits and pieces but not anything really… it’s not very good ... I’m not happy about it”.Smith, Elliott & Lach, 2006
19What contributes to the memory problems? Biologic factors – related to causes and nature of seizuresPsychological factors
20Biologic Factors Seizure type and etiology Neuropathology - Structural cerebral damageAge at seizure onsetSeizure frequencySeizure durationSeizure severityInterictal dysfunctionPart of the brain affected by seizures
22MedicationsAnti-epileptic drugs produce global changes in the excitation levels in the brainEffects vary and must be considered independently in every patientNumber of AEDsBlood levelsAgeAEDs produce global changes in the excitation levels in the brain and often lead to cognitive and behavioural deficitsDeficits vary and must be considered independently in every patientA number of consistent risk factors have been establishedPolypharmacyHigh blood levelsElderly are more susceptible to AED side effects because of pharmacokinetic and pharmacodynamic reasons
23Psychosocial FactorsPsychiatric and psychological morbidity may contribute to memory problemsDepressionAnxietyPsychosisAttention-deficit disorder
24What to do? Optimize physical health Optimize mental health Nutrition, sleep, exerciseOptimize mental healthDeal with stress
25Strategies Pay attention and concentrate Repeat, repeat, repeat Make it meaningfulOrganize information while you are learning itUse external memory aidsOrganize your environment and keep a regular routine
26Special Considerations for Children Keep in mind the child’s ageYoung children need a lot of external supportAs they get older, can introduce strategies for them to implement on their ownWork with the schoolRecognize that variability is typicalStrategies for learning: