Research Tuesday: Comprehensive Memory Assessment

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The article I read for this month’s Research Tuesday was a bit of a surprise. The title of the article is “Memory Assessment on an Interdisciplinary Rehabilitation Team: A Theoretically Based Framework”. I was expecting to see how memory assessment functionally impacts the work our colleagues in OT and PT do. While you can draw some of those conclusions from reading the article, it isn’t explicitly stated.

The value in the article is the review (from the SLP and neuropsychology perspectives) of memory models, tasks, and assessment. The stated purpose of the article is “to provide a framework to improve clarify and consistency in the description of memory impairments within the interdisciplinary team.”

First, let’s look at the theoretically based model of memory as described in the article.

Stage Model
Encoding: “refers to the early processing of the material that is to be learned.”
Storage: “refers to the way that information is held in the memory for future use.”
Retrieval: “refers to the act of pulling information from storage, typically from the long term store.”

Encoding, storage, and retrieval are interactive processes. One aspect can affect the others.

Systems Models of Memory
This looks at the short term (working memory) and long-term memory. The Baddeley model is often used to explain the working memory model.

One of the things that I’m interested in is how memory and attention intersect. The authors state the central executive system is responsible for attention to desired task by reducing attention to competing information. This explains how impaired attention impacts memory.

Application of the Memory Model to Assessment
The authors discussed screening measures (which I imagine to be the MoCA, SLUMS, and MMSE quick screens we use) as being inadequate for assessing memory function. They do not tap into the different types of memory tasks, which doesn’t allow us to determine what aspect memory is impaired and may result in missing some impairment. They also cautioned against using subtests from test batteries, as they may not be individually normed and standardized.

Memory Tasks

Task Example Aspect of Memory Utilized
Span Tasks (Serial Recall) Repeat a series of items -Processing by working memory

-Phonological loop for verbal information

-Visuospatial sketch pad for visual information

-For tasks over 9 items the episodic buffer would be used to chunk it for temporary storage

Verbal List Learning Recall a string of related or unrelated words (usually more than 10 words) -Information is encoded in long-term memory

-Episodic buffer to organize information

Immediate Recall Tasks Recall stimulus materials immediately after presentation -Storage aspects of working memory (episodic buffer, phonological loops, and visual sketch pad depending on type of information)
Delayed Recall Tasks Recall information presented after a 15+ minute delay -Long term store, especially declarative memory episodic store

-Central executive allocates attention and uses encoding and retrieval strategies

Recognition Memory Tasks Select the previously presented items out of a mixed selection with distracter items. Results the product of positive and false positive responses. -Long term episodic store

-Episodic buffer

-Central executive

Prospective Memory Tasks Retention of instructions over time in order to complete a task at a specific time later -Working memory to continuously rehearse the information

-Episodic buffer and central executive to monitor passage of time and to initiate a response

 

Choosing an Assessment
When choosing a memory assessment it is important to consider these various memory tasks. When having someone complete memory assessment tasks will help clinicians determine where in the memory process the impairment exists.

The authors caution that most memory tests focus on impairments rather than function in daily life. It’s important to utilize formal and informal assessments. Information assessments or observations will allow us to determine how environmental supports and strategies benefit a patient’s function.

Reference:

Memory Assessment on an Interdisciplinary Rehabilitation Team: A Theoretically Based Framework. American Journal of Speech-Language Pathology, Vol. 16, (November 2007), pp. 316-330, doi: 10.1044/1058-0360

Rachel Wynn
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Rachel Wynn

Speech-Language Pathologist at Gray Matter Therapy
Rachel is a speech-language pathologist and creator of Gray Matter Therapy. She started making noise as a patient-centered care advocate in 2013. She believes great care happens when patients are informed and engaged.
Rachel Wynn
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