A case study of topographical disorientation: behavioural intervention for achieving independent navigation.

This study introduces an intervention that enabled a man (LH) with acquired topographical disorientation (TD) to travel independently without fear of getting lost. Adapting an errorless method, LH learned to use a smartphone to find his routes accurately and reliably. A time-series design (A1-B1-A2-B2) was used: In all phases, LH was given a printed map on which city locations were indicated. He had to walk to the indicated locations while naturalistic outcomes were recorded. In Phases A, he navigated without his smartphone, and in Phases B, with it. In Phases A, LH made numerous surplus direction changes, and openly expressed his frustration. In Phases B, he did not have surplus direction changes and could calmly find his routes. Before intervention, LH and his wife were frustrated and worried about his way-finding. They rated their confidence in his navigational ability and his actual ability in way-finding to various locations as low. After intervention, they were more confident that LH could travel by himself without getting lost and rated his ability as much higher for various scenarios. As a consequence of intervention LH gained greater independence and quality of life.

Long-term maintenance of smartphone and PDA use in individuals with moderate to severe memory impairment.

In an earlier paper we described a structured, theory-driven training programme which was administered to 10 individuals with moderate-to-severe memory impairment. All individuals received an errorless-fading-of-cues protocol in the use of personal digital assistants (PDAs) or smartphones (Svoboda, Richards, Leach, & Mertens, 2012) and demonstrated generalisation of acquired skills to day-to-day memory challenges. Maintenance of intervention gains over the long-term is another indicator of successful generalisation. Here we present the maintenance of device use in the same group of individuals 12 to 19 months after programme completion. A within-subject, ABABB multi-case experimental design was used to evaluate the impact of PDA or smartphone use on day-to-day memory functioning at baseline, immediately post-intervention, at return to baseline, and at short-term and long-term follow-up. Results presented here focus predominantly on long-term follow-up. All 10 individuals showed maintenance of gains in day-to-day functioning as quantified across several ecologically valid questionnaire and task-based measures. This was corroborated by family members with whom six of the participants resided. This study further demonstrates the programme's clinical effectiveness in enabling individuals with moderate-to-severe memory impairment to function more independently and with greater confidence up to 19 months following programme completion.

Long-term benefits of the Memory-Link programme in a case of amnesia.

OBJECTIVE: To systematically evaluate the maintenance of clinical gains from a structured memory intervention programme. Efficacy of the programme was initially demonstrated in RR, a woman with moderate-to-severe memory impairment following colloid cyst removal. In the current study (Svoboda and Richards, 2009), we examined RR's day-to-day memory functioning 18 months after completion of the intervention programme. DESIGN: Within-subject A(1)B(1)A(2)B(2)B(3) single-case experimental design. SETTING: Outpatient memory rehabilitation clinic. INTERVENTION: A theory-driven training programme in the use of commercially available smartphones for individuals with moderate-to-severe memory impairment. MAIN MEASURES: A phone call task was used as an objective measure of prospective memory function. Self-report, ecologically valid questionnaires were also completed to further assess generalization of smartphone use to day-to-day memory function. RESULTS: Eighteen months after intervention, RR completed 80% of scheduled calls using the smartphone, a rate significantly higher than at baseline (40%) and comparable to her success rate immediately following intervention (90%) and at the four-month follow-up (90%). Responses to questionnaires indicated that RR felt more confident in her ability to handle memory-demanding situations and was making fewer memory mistakes. This favourable outcome was not found with the use of another smartphone brand for which training was not received. CONCLUSIONS: Results from ecologically valid measures of memory functioning demonstrated robust maintenance of independent commercial smartphone use over an 18-month period, with increases observed in independence, confidence and real-life memory functioning. The findings further suggest poor cross-device generalizability.

PDA and smartphone use by individuals with moderate-to-severe memory impairment: application of a theory-driven training programme.

We describe a structured, theory-driven training programme for individuals with moderate-to-severe memory impairment in the use of emerging commercial technology. We demonstrate its application to 10 individuals with memory impairment from a variety of aetiologies. A within-subject, ABAB multi-case experimental design was used to evaluate the impact of personal digital assistant or smartphone use on day-to-day memory functioning at baseline, immediately post-intervention, at return to baseline, and at short-term follow-up (range = 3-8 months). An errorless fading-of-cues protocol enabled all participants to acquire the skill set necessary to operate their PDA or smartphone independently. All 10 individuals showed robust improvement in day-to-day functioning post-intervention as quantified across a number of ecologically valid questionnaire and task-based measures. This was further corroborated by family members with whom six of the participants resided. These findings demonstrate that individuals with moderate-to-severe memory impairment can acquire the skills necessary to independently, flexibly and broadly apply commercial technology to support their everyday memory functioning. Moreover the findings confirm that the gap between individuals with memory impairment and potent emerging technology can be closed by the application of a systematic theory-driven training programme.

A theory-driven training programme in the use of emerging commercial technology: Application to an adolescent with severe memory impairment.

We describe a theory-driven memory intervention programme for training individuals with moderate to severe memory impairment in the use of emerging commercial technology. Here we demonstrate the application of the programme to training MK, an 18-year-old woman with severe memory impairment following treatment for a suprasellar germinoma, to autonomously use a smartphone to support her day-to-day memory. A within-subject A(1)B(1)A(2)B(2) single-case experimental design was used to evaluate the impact of smartphone use on MK's real-life functioning. Following intervention MK showed increased confidence in dealing with memory-demanding situations and generalised smartphone use across all aspects of her life as quantified by several and varied ecologically valid measures including a phone call schedule, behaviour memory observations and questionnaires. Moreover the intervention also benefited her family as indicated by a sustained reduction in caregiver strain and an increase in reported quality of life. These findings suggest that individuals with severe memory impairment, particularly young adults with potentially life-long dependence on their families, are able to capitalise on emerging commercial technology to function more autonomously. The findings also suggest that the gap between individuals with severe memory impairment and potent emerging technology can be closed by provision of a theory-driven structured training programme.

Compensating for anterograde amnesia: a new training method that capitalizes on emerging smartphone technologies.

Following a neuropathological event, individuals left with moderate-to-severe memory impairment are unable to reliably form new memories. The most common challenges involve the capacity to perform a task in the future and to consciously recall a recent event. Disruption of these memory processes leaves the individual trapped in the present, unable to stay on track, and alienated from ongoing events. Memory research has demonstrated that implicit memory is often preserved despite severe explicit memory impairment and that preserved memory systems can provide avenues for acquiring new skills and knowledge. A within-subject single-case A1-B1-A2-B2 experimental design was used to introduce an established theory-driven training program of technology use for individuals with moderate-to-severe memory impairment. We describe its application to enabling RR, an individual with memory impairment postcolloid cyst removal, to independently support her memory using a commercial smartphone. RR showed successful outcome on both objective and qualitative measures of memory functioning. Moreover, she demonstrated consistent and creative generalization of acquired smartphone skills across a broad range of real-life memory-demanding circumstances. Our findings suggest that individuals with moderate-to-severe memory impairment are able to capitalize on emerging commercial technology to support their memory.

The effects of rehearsal on the functional neuroanatomy of episodic autobiographical and semantic remembering: a functional magnetic resonance imaging study.

This study examined the effects of rehearsal on the neural substrates supporting episodic autobiographical and semantic memory. Stimuli were collected prospectively using audio recordings, thereby bringing under experimental control ecologically valid, naturalistic autobiographical stimuli. Participants documented both autobiographical and semantic stimuli over a period of 6-8 months, followed by a rehearsal manipulation during the 3 d preceding scanning. During functional magnetic resonance imaging scanning, participants were exposed to recordings that they were hearing for the first, second, or eighth time. Rehearsal increased the rated vividness with which information was remembered, particularly for autobiographical events. Neuroimaging findings revealed rehearsal-related suppression of activation in regions supporting episodic autobiographical and semantic memory. Episodic autobiographical and semantic memory produced distinctly different patterns of regional activation that held even after eight repetitions. Region of interest analyses further indicated a functional anatomical dissociation in response to rehearsal and memory conditions. These findings revealed that the hippocampus was specifically engaged by episodic autobiographical memory, whereas both memory conditions engaged the parahippocampal cortex. Our data suggest that, when retrieval cues are potent enough to engage a vivid episodic recollection, the episodic/semantic dissociation within medial temporal lobe structures endure even with multiple stimulus repetitions. These findings support the multiple trace theory, which predicts that the hippocampus is engaged in the retrieval of rich episodic recollection regardless of repeated reactivation such as that occurring with the passage of time.

Behavioral and functional neuroanatomical correlates of anterograde autobiographical memory in isolated retrograde amnesic patient M.L.

Patient M.L. [Levine, B., Black, S. E., Cabeza, R., Sinden, M., Mcintosh, A. R., Toth, J. P., et al. (1998). Episodic memory and the self in a case of isolated retrograde amnesia. Brain, 121, 1951-1973], lost memory for events occurring before his severe traumatic brain injury, yet his anterograde (post-injury) learning and memory appeared intact, a syndrome known as isolated or focal retrograde amnesia. Studies with M.L. demonstrated a dissociation between episodic and semantic memory. His retrograde amnesia was specific to episodic autobiographical memory. Convergent behavioral and functional imaging data suggested that his anterograde memory, while appearing normal, was accomplished with reduced autonoetic awareness (awareness of the self as a continuous entity across time that is a crucial element of episodic memory). While previous research on M.L. focused on anterograde memory of laboratory stimuli, in this study, M.L.'s autobiographical memory for post-injury events or anterograde autobiographical memory was examined using prospective collection of autobiographical events via audio diary with detailed behavioral and functional neuroanatomical analysis. Consistent with his reports of subjective disconnection from post-injury autobiographical events, M.L. assigned fewer "remember" ratings to his autobiographical events than comparison subjects. His generation of event-specific details using the Autobiographical Interview [Levine, B., Svoboda, E., Hay, J., Winocur, G., & Moscovitch, M. (2002). Aging and autobiographical memory: dissociating episodic from semantic retrieval. Psychology and Aging, 17, 677-689] was low, but not significantly so, suggesting that it is possible to generate episodic-like details even when re-experiencing of those details is compromised. While listening to the autobiographical audio diary segments, M.L. showed reduced activation relative to comparison subjects in midline frontal and posterior nodes previously identified as part of the autobiographical memory network. Reductions were also evident in M.L. in association with personal semantic stimuli (e.g., recordings describing personal habits and routines). These data suggest an association between M.L.'s impoverished recollection of autobiographical material and reduced activation in midline sectors of the autobiographical memory network that support the autonoetic, first-person element of episodic memory.

The functional neuroanatomy of autobiographical memory: a meta-analysis.

Autobiographical memory (AM) entails a complex set of operations, including episodic memory, self-reflection, emotion, visual imagery, attention, executive functions, and semantic processes. The heterogeneous nature of AM poses significant challenges in capturing its behavioral and neuroanatomical correlates. Investigators have recently turned their attention to the functional neuroanatomy of AM. We used the effect-location method of meta-analysis to analyze data from 24 functional imaging studies of AM. The results indicated a core neural network of left-lateralized regions, including the medial and ventrolateral prefrontal, medial and lateral temporal and retrosplenial/posterior cingulate cortices, the temporoparietal junction and the cerebellum. Secondary and tertiary regions, less frequently reported in imaging studies of AM, are also identified. We examined the neural correlates of putative component processes in AM, including, executive functions, self-reflection, episodic remembering and visuospatial processing. We also separately analyzed the effect of select variables on the AM network across individual studies, including memory age, qualitative factors (personal significance, level of detail and vividness), semantic and emotional content, and the effect of reference conditions. We found that memory age effects on medial temporal lobe structures may be modulated by qualitative aspects of memory. Studies using rest as a control task masked process-specific components of the AM neural network. Our findings support a neural distinction between episodic and semantic memory in AM. Finally, emotional events produced a shift in lateralization of the AM network with activation observed in emotion-centered regions and deactivation (or lack of activation) observed in regions associated with cognitive processes.

Diazepam-induced prospective memory impairment and its relation to retrospective memory, attention, and arousal.

The amnestic effects of benzodiazepines are well documented on a variety of memory tasks. However, prospective memory (PM), or remembering to execute an action at a future time, has not been studied previously. This study examined the effect of diazepam on word list recall, PM, sustained attention, and subjective ratings of arousal. Forty-eight healthy participants, aged 19-35, received an average of 0.19 mg/kg oral diazepam or placebo in a double-blind manner. Retrospective memory and PM were assessed by free recall of unrelated word lists and by instructing participants to request a hidden belonging at the end of the session, respectively. Sustained attention was measured by multiple trials of a digit cancellation task, and subjective arousal was assessed by self-ratings of drowsiness. Diazepam impaired performance on all measures, including PM. Reduced PM performance was associated with decreased subjective arousal in the diazepam group but was unrelated to sustained attention. This is the first report of the effects of benzodiazepines on prospective remembering, and further supports the view that the arousal/attentional system is composed of partially independent subsystems that have differential relationships to memory.

Aging and autobiographical memory: dissociating episodic from semantic retrieval.

Cognitive aging research documents reduced access to contextually specific episodic details inolder adults, whereas access to semantic or other nonepisodic information is preserved or facilitated. The present study extended this finding to autobiographical memory by using a new measure; the Autobiographical Interview. Younger and older adults recalled events from 5 life periods. Protocols were scored according to a reliable system for categorizing episodic and nonepisodic information. Whereas younger adults were biased toward episodic details reflecting happenings, locations, perceptions, and thoughts, older adults favored semantic details not connected to a particular time and place. This pattern persisted after additional structured probing for contextual details. The Autobiographical Interview is a useful instrument for quantifying episodic and semantic contributions to personal remote memory.