Rini AndrianiBagian Ilmu Penyakit Saraf

FK UNTAR

Anatomy and Examination of Memory

MEMORY the focus of medical studies • Pliny (1st C)described a man who fell off a

roof and afterward could not remember his friends ,mother and neighbors

Galen (130–200) emphasis on the ventricles as the anatomical key to mental processing

David Harley (1705–1757) and Charles Bonnet viewed memory in terms of vibration waves that oscillated in the brain

Scientific measurement of memory began in the late 1800s with Ebbinghaus' monograph and turned the study of memory away from philosophers and toward experimentalists

Memory (history)Studies of dementia, brain atrophy and

memory decline, and trauma in relation to amnesia were conducted by several neurological luminaries, including Samuel Wilks, Jean Esquirol, and Alois Alzheimer.

Linkage of memory with emotional elements was presented by James Papez, whose anatomical studies form much of the basis of modern knowledge of memory circuitry.

MEMORY

Recording

Retention

Retrieval

KNOWLEDGE

ExperienceFacts

EventsSkill

Declarative memory

(Learning and remembrance)

Nondeclarative memory

(retrieved reflexively or incidentally)

Episodic memory

Semantic

memory

Declarative MemoryThe form of memory people use to recollect

facts and events consciously and intentionally and is therefore also referred to as explicit memory

Episodic memories: remembrance of personal experiences that took place at a particular place and time)

Semantic memories (knowledge of generic information, such as the meaning of a word)

Memory based on temporal propertiesShort term memory: as the ability to store

information temporarily (for seconds) before it is consolidated into long-term memory

Working memory refers to the temporary maintenance of information that was just experienced or just retrieved from long-term memory but no longer exists in the external environment. These internal representations are short-lived, but can be maintained for longer periods of time through active rehearsal strategies, and can be subjected to various operations that manipulate the information in such away that makes it useful for goal-directed behavior

Memory based on temporal propertiesLong term memory: the ability to learn new

information and recall this information after some time has passed

Remote memory:a form of long-term memory (information that was consolidated in the past)

Immediate memory: the recall of information without delay, either immediately after presentation or after uninterrupted rehearsal

Anatomy of memoryThe ability to recall and engender

memories is intimately linked to the emotional makeup of such memories

Anatomical circuit involved a number of central nervous system nuclei and pathways that are important in aspects of memory and emotion

The concept of a circuit is important in dealing with memory since lesions anywhere along the pathway may interrupt memory function

Examination of MemoryMemory assessment should be undertaken

only if a patient's level and content of consciousness and attention are determined to be unimpaired

To ascertain that memory impairment is not secondary either to a specific perceptual, motor, or cognitive disability or to a broad impairment of mental status

Testing of orientation and attention

Orientation testPerson (name,date of birth, age, color of

eyes, marital status)Time (year, season, month, day of the

week, date, time of day)Place (city, county, building, unit, floor)Situation and circumstances (reason for the

consultation, accompanying person, transport to the hospital)

Attention testDigit span (Wechsler, 1945): normal adults

can repeat five to seven digitsRepeat the series in reverse order. Reverse

digit span is normally one less than the forward digit span

Short-term retention of visuospatial material: tested by drawing 9 circles in a random fashion on a paper and to designate an irregular series of locations that the patient has to reproduce

Serial 7s test (Smith, 1967; Luria, 1973). The patient is asked to subtract 7 from 100, and then to continue to subtract 7 from the obtained results: normal if the patient succeeds in making 5 correct successive subtractions

Backward spelling of a word backward (Ettlin et al., 2000)

Enunciation of the months of the year or the days of the week.

Severe Disturbances of AttentionIn the A-test(Strub and Black, 2000), the

pts is required to tap on the table or raise their arm whenever the examiner, who reads out an irregular series of letters, says the letter A

In the go/no-go test ((Drewe, 1975; Dubois et al., 2000), the pts is asked to tap twice when the examiner has tapped once and to tap once when the examiner has tapped twice

Test for Short term Memory (Verbal)The patient learn a list of words, then to test

recall and recognition of this information after a delay: eight words of medium frequency (tulip, seventeen, belt, Toyota, cabbage, camel, goose, river) can be read & asked the pts to repeat the list. (5 times)

After 20 to 40 minutes during which other tests or the physical exam is made, the pts is asked to reproduce the list (delayed free recall)

Healthy individuals recall at least 6 items (persons aged at least 5) (Benson,1996). Giving cue+

Test for Short term Memory (visual)Having the patient produce from memory

all drawings made during the testing (Luria’s loops and alternating sequences, geometric designs)(Schnider, 2004).

Test for Long term Memoryhaving the pts recall the names of family

members (grandchildren, cousins) politicians, actors, or sport celebrities from different episodes (depending on the pts`s background and the examiner’s knowledge) and precise questions about personal events in the pts’s past (professional training, family celebration, marriage).

Test for Semantic memory disordersthe loss of general knowledge, including

the precise meaning of words, objects or other pieces of information. The pts has difficulty in defining words or understanding the similarity or differences between related words & can`t precisely name shown objects, sounds, or other perceptions(Warrington, 1975; Hodges et al., 1992

Test for Semantic memory disordersTesting of naming and visual recognition: by

asking the patient to define words or to draw objects with distinct features (draw a pyramid, a giraffe

Verbal semantics can additionally be tested with semantic fluency: the patient is asked to name as many items from a specific category as possible during one minute (Lezak, 2004).

For common categories like pieces of furniture, animals car makes or fruits, normal subjects easily produce 15–18 items per minute

Test for Non-declarative MemoryVarious forms of non-declarative memory

depend on repeated practice of an act or exposure to information and often require specific testing material; many forms are therefore not reliably amenable to bedside testing