Assessment Of Memory In Patients Research Articles

Development and Pilot Testing of an Algorithm-Based Approach to Anticholinergic Deprescribing in Older Patients.

Adverse anticholinergic drug reactions are common, yet evidence on how to reduce exposure to anticholinergic activity and reliably measure successful deprescribing is still scant. This study proposes an algorithm-based approach to evaluate and reduce anticholinergic load, and reports the results of its pilot testing. Based on published evidence and expert opinion, a list of 85 anticholinergic drugs and 21 algorithms for reducing anticholinergic load, e.g., by recommending alternative drugs with lower risk, were developed. An accompanying test battery was assembled by focusing on instruments that sensitively reflect anticholinergic load and may be sensitive to depict changes (Neuropsychological Assessment Battery to measure memory and attention, validated assessments for constipation, urinary symptoms, andxerostomia, as well as blood biomarkers). The approach was pilot-tested in a geriatric rehabilitation unit, with clinician feedback as the primary outcome and characterization of anticholinergic symptoms as the secondary outcome. The intervention was delivered by a pharmacist and a clinical pharmacologist who used the algorithms to generate personalized recommendation letters. We included a total of 20 patients, 13 with anticholinergic drugs and 7 without. Recommendations were made for 22 drugs in nine patients from the intervention group, of which seven letters (78%) were considered helpful and 8/22 (36%) anticholinergic drugs were discontinued, reducing anticholinergic load in seven patients. In contrast to patients without drug change, memory assessment in patients with reduced anticholinergic load improved significantly after 2 weeks (6±3 vs. -1±6 points). The approach was well received by the participating physicians and might support standardized anticholinergic deprescribing.

Use of eye tracking to the assessment of memory in patients with impaired consciousness

Use of eye tracking to the assessment of memory in patients with impaired consciousness

Application of High-Tech Solution for Memory Assessment in Patients With Disorders of Consciousness.

Testing cognitive function in patients after severe brain damage is a major clinical challenge. In the absence of both verbal and motor communication, tests commonly used to assess cognitive function are completely or partially undoable for disorders of consciousness patients. The study involved 12 patients with varying degrees of impaired consciousness due to brain damage, with no verbal and motor communication. Memory was assessed in study participants using oculography. Memory tasks were presented in four categories. The total percentage of correctly completed tasks obtained across the group was 39.58%. The most difficult tasks included category C.4 with tasks involving working memory. Regardless of the subjects' level of consciousness, there was no statistically significant difference in the percentage of correct responses obtained in subgroups distinguished by CRS-R score. Eye tracking technology can be successfully used in the assessment of cognitive function, particularly when eye movements are the only channel of communication in individuals after brain damage. We suggest that the cognitive functions of people after brain damage should be further analyzed using eye tracking.

The modified Ruche visuospatial learning test (RUCHE-M) for the assessment of visuospatial episodic memory in patients with temporal lobe epilepsy: Preliminary evidence for the investigation of memory binding

Introduction The Ruche test is a visuospatial form of the Rey auditory verbal learning test (RAVLT), with initial evidence of utility in the diagnosis of temporal lobe epilepsy (TLE)-related memory disorders. Aims To present the translation to Brazilian Portuguese and modification of the Ruche test (RUCHE-M) and compare the RUCHE-M and RAVLT performance between patients with right and left TLE. Methods Twenty-five neuropsychologists participated in instrument adaptation. Thirty-seven patients with right (n = 19) and left (n = 18) TLE participated. Data were compared with the Mann–Whitney U test. Results All specialists considered the final RUCHE-M to be adequate. The RUCHE-M forgetting speed index (FSI) score and several RAVLT scores differed significantly between patients with right and left TLE. Conclusion The RUCHE-M showed limited utility for the assessment of visuospatial episodic memory in patients with TLE. The manipulation of memory binding as demonstrated by FSI score seems to be a promising paradigm for the assessment of right hippocampal function.

FV 4. Contribution of Wada test results to the prediction of change in verbal learning and memory function after epilepsy surgery in the temporal lobe

Introduction . Although the Wada test was initially established as the gold standard for determining hemispheric language and memory lateralization, in recent years its application in the presurgical evaluation of epilepsy surgery candidates has decreased due to the development of noninvasive alternatives [1]. While some studies questioned the predictive value of Wada test results for possible postsurgical cognitive impairment, others supported its usefulness [2]. Thus, this study was designed to contribute to the solution of this issue continuously debated among researchers in the field. Methods. Data from 56 patients with temporal lobe epilepsy who received Wada tests and underwent epilepsy surgery was analyzed retrospectively. Pre- and postsurgical verbal learning and memory function was assessed using a standard neuropsychological test battery. Hierarchical linear regression analyses were performed to determine the incremental value of Wada test results over socio-demographic, clinical, and neuropsychological characteristics in predicting postsurgical change in verbal learning and memory function. Results. Adding Wada test results significantly improved the prediction models of postsurgical change in verbal learning function ( ΔR2 = 0.291, p = .028), and postsurgical change in verbal memory function ( ΔR2 = 0.373, p = .001). Presurgical performance, age, and Wada scores accounted for 47.8% of variance in postsurgical change in verbal learning function, and 61.0% of variance in postsurgical change in verbal memory function. Discussion. Our findings confirm that Wada test results are of significant incremental value for the prediction of postsurgical change in verbal learning and memory function. Thus, the Wada test contributes to balancing out the risks and benefits of epilepsy surgery, and therefore remains an important part of the presurgical work-up of selected patients with clear indications. [1] Baxendale, S., Thompson, P. J., & Duncan, J. S. (2008). The role of the Wada test in the surgical treatment of temporal lobe epilepsy: an international survey. Epilepsia , 49 (4), 715-720. [2] Parra-Díaz, P., & García-Casares, N. (2019). Memory assessment in patients with temporal lobe epilepsy to predict memory impairment after surgery: A systematic review. Neurología (English Edition) , 34 (9), 596-606.

A Functional MRI-Based Model for Individual Memory Assessment in Patients Eligible for Anterior Temporal Lobe Resection.

Title:A functional (f) MRI-based model for individual memory assessment in patients eligible for temporal lobe resection.Aim:To investigate if pre-operative fMRI memory paradigms, add predictive information with regard to post-surgical memory deficits.Methods:Fourteen pharmacoresistant Temporal Lobe Epilepsy (TLE) patients accepted for Anterior Temporal Lobe Resection (ATLR) were included. A clinical risk assessment score (RAS 0-3) was constructed from structural MRI, neuropsychological testing and hemisphere dominance. fMRI lateralization indices (LIs) over frontal language and medial temporal regions were calculated. Predictive value from clinical risk scoring and added value from fMRI LIs were correlated to post-surgical memory change scores (significant decline -1 SD). Verbal memory outcome was classified either as expected (RAS 2-3 and post-operative decline; RAS 0-1 and intact post-operative verbal memory) or as unexpected (RAS 2-3 and intact post-operative verbal memory post-surgery; RAS 0-1 and post-operative decline).Results:RAS for verbal memory decline exhibited a specificity of 67% and a sensitivity of 75%. Significant correlations were found between frontal language LIs and post-operative verbal memory (r = -0.802; p = 0.017) for left (L) TLE and between medial temporal lobe LIs and visuospatial memory (r = 0.829; p = 0.021), as well as verbal memory (r = 0.714; p = 0.055) for right (R) TLE. Ten patients had expected outcome and four patients had an unexpected outcome. In two MRI-negative RTLE patients that suffered significant verbal memory decline post-operatively, fMRI identified bilateral language and right lateralized medial temporal verbal encoding. In two LTLE patients with MRI pathology and verbal memory dysfunction, neither RAS nor fMRI identified the risk for aggravated verbal memory decline following ATLR.Conclusion:fMRI visualization of temporal-frontal network activation may add value to the pre-surgical work-up in epilepsy patients eligible for ATLR. Frontal language patterns are important for prediction in both L and RTLE. Strong left lateralized language in LTLE, as well as bilateral language combined with right lateralized encoding in RTLE, seems to indicate an increased risk for post-operative verbal memory decline.

Different effects of anterior temporal lobectomy and selective amygdalohippocampectomy on verbal memory performance of patients with epilepsy.

The advantage of selective amygdalohippocampectomy (SAH) over anterior temporal lobectomy (ATL) for the treatment of temporal lobe epilepsy (TLE) remains controversial. Because ATL is more extensive and involves the lateral and medial parts of the temporal lobe, it may be predicted that its impact on memory is more important than SAH, which involves resection of medial temporal structures only. However, several studies do not support this assumption. Possible explanations include task-specific factors such as the extent of semantic and syntactic information to be memorized and failure to control for main confounders. We compared preoperative vs. postoperative memory performance in 13 patients with SAH with 26 patients who underwent ATL matched on side of surgery, IQ, age at seizure onset, and age at surgery. Memory function was assessed using the Logical Memory subtest from the Wechsler Memory Scales - 3rd edition (LM-WMS), the Rey Auditory Verbal Learning Test (RAVLT), the Digit Span subtest from the Wechsler Adult Intelligence Scale, and the Rey-Osterrieth Complex Figure Test. Repeated measures analyses of variance revealed opposite effects of SAH and ATL on the two verbal learning memory tests. On the immediate recall trial of the LM-WMS, performance deteriorated after ATL in comparison with that after SAH. By contrast, on the delayed recognition trial of the RAVLT, performance deteriorated after SAH compared with that after ATL. However, additional analyses revealed that the latter finding was only observed when surgery was conducted in the right hemisphere. No interaction effects were found on other memory outcomes. The results are congruent with the view that tasks involving rich semantic content and syntactical structure are more sensitive to the effects of lateral temporal cortex resection as compared with mesiotemporal resection. The findings highlight the importance of task selection in the assessment of memory in patients undergoing TLE surgery.

Language and memory lateralization and localization using different fMRI paradigms in Arabic speaking patients: Initial experience

PurposePresurgical assessment of memory in patients with temporal lesions is essential to evaluate the effect of treatment on cognitive functioning (1). In recent years, there has been an increasing interest in the utility of functional MR imaging (fMRI) for presurgical evaluation of memory (2). There is no established fMRI protocol to evaluate memory functions presurgically (3). The identification of language areas in patients undergoing brain surgery is a major clinical challenge, the gold standard for the identification of essential language areas in neurosurgical patients is intraoperative mapping (IOM) by direct cortical stimulation as used by various groups but other techniques, such as functional imaging, are rapidly evolving (4). Language and also memory paradigms designed for patients speaking languages other than Arabic are not totally applicable for examining Arabic speaking and illiterate patients except after some modifications, theaim of this study is to test the applicability of these modified western designed paradigms for lateralization and localization of cortical brain centres concerned with language and memory in Arabic speaking patients. Materials and methodsUsing a 1.5 T Philips scanner, multiple modified western designed language and memory fMRI paradigms were used to assess the eloquent cortical brain areas in Arabic speaking patients of different levels of education having different lesions mainly brain tumors and epilepsy. These modifications consist mainly of providing simpler paradigms in an easy common Arabic language not in high level traditional Arabic, choosing simplified topics for the less educated patients, avoiding any written paradigms and depending on auditory paradigms in easy common Arabic language and simple pictures for illiterate patients. Images were analyzed using Philips extended MR work space release 2.5.3.0. The results were analyzed and compared to each other as regarding the patient cooperation and the ability to give robust fMRI signal. ResultsMultiple fMRI paradigms are efficient in lateralization and localization of cortical centres of language and memory yet they are variable in their ability to give robust fMRI signal clusters, also patients with different levels of education and culture differ in their ability to cooperate with the fMRI paradigms thus also affects the results. ConclusionLanguage and memory fMRI paradigms reported in the western literature are applicable to Arabic speaking patients with brain lesions undergoing an fMRI exam for language and/or memory but need some modifications according to background and level of education to get more robust identification of eloquent language and memory cortical centres.

Ecological prospective memory assessment in patients with traumatic brain injury

Primary objective: Prospective memory (PM) impairments are often observed after traumatic brain injury (TBI). Although PM is crucial for daily functioning, few sensitive, valid and ecological clinical tests are available. To address these concerns, the authors developed a PM task, the TEMP, using naturalistic stimuli, in which each PM phase and component is evaluated independently in time- and event-based conditions.Main outcomes and results: The results show that moderate and severe TBI patients (n = 30), evaluated after spontaneous neurological recovery, experienced problems in learning the delayed intentions content and retrieving these intentions in the right context (prospective component), especially in the time-based condition. They also recalled fewer associated actions (retrospective component), but only in the time-based condition. Correlations revealed that the retrospective component was mainly supported by episodic retrospective memory processes, while the prospective component was supported by episodic retrospective memory processes, along with attentional and executive functions. Moreover, there was a significant correlation between performance on the TEMP and results on a questionnaire assessing PM functioning in daily living completed by participants’ relatives.Conclusions: The TEMP therefore appears to be a sensitive tool for assessing PM problems that combines internal and ecological validity.

Assessment of memory in patients with rheumatoid arthritis

BACKGROUND/AIM. The diagnosis of emotional and cognitive dysfunction in patients with rheumatoid arthritis is often not noticed, regardless of their importance and frequency. The aim of this research was to assess memory function in patients with rheumatoid arthritis with respect to its emotional manifestation, pain intensity, the duration and degree of disease activity, and functional and anatomical stages of the disease. METHODS. The study involved 60 patients with rheumatoid arthritis and 30 healthy subjects of both sexes, aged up to 55, who were examined and tested in the Special Hospital for Rheumatic Diseases in Novi Sad. Depression was diagnosed by using the Beck's scale for depression (Beck Depression Inventory--BDI), anxiety by using the Spielberger Trait Anxiety Inventory--State and Traite; we evaluated the cognitive status (by the Wechsler scale-based memory -WBsp), the functional status (Health Assesment Questionnaire, HAQ) and disease activity by analyzing the index of disease activity (DAS 28). Depressive symptoms were registered in 38 (63.33%) patients, and anxiety symptoms in 22 (36.67%) patients. The average values of the memory coefficient were significantly lower in the group of patients with rheumatoid arthritis compared with the control group. High frequency of emotional dysfunction and damaged memory abilities in patients with rheumatoid arthritis requires in time diagnosis and adequate treatment.

Assessment of emotional memory in patients with Alzheimer's disease

Assessment of emotional memory in patients with Alzheimer's disease