Memory Assessment

February 8, 2005

Presented by:

Monika Cameron

Vanessa Hawes

Tatum Wilson

Scope of Presentation

Brief overview of Memory Why Memory Assessments & OT Review of Commonly Used Assessments

Contextual Memory Test (CMT) Rivermead Behavioural Memory Test (RBMT)

Occupational Performance Issues Grocery Shopping Subway Ride

Immediate Recall

Tell me everything you saw

Information Processing Model

Types of Memory - Declarative

Explicit - person’s knowledge base, conscious awareness, “learning that”

Working - ability to hold information while working with it (eg. math calculations)

Semantic - general knowledge of concepts, rules, principles & meanings (eg, knowing that a cat is an animal)

Episodic - remember specific personally experienced events (eg, holiday taken last year)

Types of Memory – Non-Declarative

Implicit - without conscious awareness, “learning how”

Procedural - skills becomes automatic through practice (eg, riding a bike)

Priming - cues prompt accurate recall without awareness (eg, name starting with M)

Types of Memory - Prospective

Remembering to do something in the future or carry out intentions

Remembering to remember Most practical aspect of everyday memory

Eg. pick children up after school

Why Should OTs Assess Memory?

Memory impairments can cause great difficulty in occupational performance of everyday tasks

Memory impairments can be a major barrier to rehabilitation - individual is unable to learn or carry over the techniques taught in the therapy sessions

                                                                                                                     

             

Delayed Recall

Tell me everything you saw

Commonly Used Assessments

Contextual Memory Test, 1993 Joan P. Toglia, OTReg

Rivermead Behavioural Memory Test, 1985 Thames Valley Test Company

Contextual Memory Test (CMT)

Purpose/Focus - created to assess awareness of memory capacity (metamemory), strategy use, and recall

Population - adults 18 + years, tested on a wide variety of diagnoses

Approach – structured interview & assessment Unique Feature - tests a person’s insight into the

knowledge of their memory limitations

CMT – Process Part 1

Step #1 - Administer memory questionnaire (#1-9)

Step #2 - Present picture card non-contextual method

Step #3 - Immediate recall of pictures

Step #4 - Administer memory questionnaire (#10-20)

Step #5 - Delayed recall of pictures (after 15-20 min)

Step #6 - Repeat administration of 2nd part of memory questionnaire

CMT – Process Part 2

Perform with people who fall below norms in Part I, 2 to 36 hours after

Steps #1-6 same as Part I, however, present alternate picture card, context method (Eg. as you study objects, think of what you do in the morning)

If during step #5 (delayed recall) person has difficulty recalling items, may use retrieval cues. Recall cuing first (Eg. What do you eat with?) If poor performance with recall, use recognition cards (Eg.

Do you remember seeing this on the Picture Card?)

CMT – Scoring

Various scores with norms Immediate Recall (IR) Delayed Recall (DR) Total of IR + DR Strategy score Predicted score Discrepancy score

CMT – Analysis of Test

Information Processing: Short term - Immediate recall Long term – Delayed recall (recognition)

Types of Memory: Episodic (medial temporal lobe) – Picture Card event Semantic (neo-cortex, non frontal)- General knowledge

of objects on Picture Card Memory Processes:

Encoding – visual, intentional Retrieval – free recall, (cued recall)

CMT- Psychometrics (1)

Descriptive - screen for memory recall impairments Evaluative - monitors change in status and can be

used to plan a rehab program Clinical Utility

Quick (5-10 mins) & easy to administer Multidisciplinary Lengthy and confusing scoring

Standardized - manual and normative data

CMT- Psychometrics (2)

Reliability Recall scores compared morning and restaurant versions (.73-.81),

with higher reliability for context versions Predictive scores were found to be highly reliable (.90) Strategy scores had high correlation between the two versions (.75) Test-retest correlations for immediate and delayed recall .85-.94.

(Mackler, MMY) Test-retest correlations for person’s with BI .85-.95 (Josman et al.,

2000) Validity

Concurrent (correlated with RBMT) - upper .70s to mid .80s (Raphael, MMY)

Concurrent (correlated with RBMT) is .80-.84 (Josman et al., 2000)

CMT- Strengths

Asks about strategies – aids in planning intervention

Option of contextual prompt Adaptations made for language barriers & clients

with dysphasia Alternative description names allowed Flexible in testing procedures – recall vs.

recognition Uses pictures of everyday objects Easy to transport

CMT- Weaknesses

Must be used as compliment to other memory assessments

Ceiling effect - may not identify clients with subtle memory deficits

Normative data focused on Caucasian, highly educated, young population

More research required on psychometric testing Language barriers – may not recognize objects Manual is confusing & lengthy

                                                                                                                                  

Rivermead Behavioural Memory Test (RBMT)

Purpose/Focus – developed to detect impairment of everyday memory functioning & monitor change throughout treatment

Population - adults 16 - 69 years, tested on a wide variety of diagnoses

Approach – structured assessment Unique Feature – attempts to simulate demands

placed on memory by normal, everyday life Versions – 2nd edition, elderly, extended, children

RBMT - Process

1. First & Second Name2. Hidden Belonging3. Appointment4. Story - immediate & delayed5. Pictures - delayed6. Route - immediate & delayed7. Message - immediate & delayed8. Faces - delayed9. Orientation & Date

RBMT - Scoring

Each subtest has its own section & instructions on score sheet

2 scores produced Screening score (separate per subtest) Standardized profile score (whole test)

Easy to score Clear instructions Interpretation of scores provided Norms provided

RBMT – Analysis of Test

Information Processing: Short term - Immediate recall (eg, story) Long term - Delayed recall & recognition (eg, route)

Types of Memory: Episodic (med. temporal lobe) - each subtest except orientation/date Semantic (neo-cortex, non frontal) – orientation/date, faces, pictures Prospective (prefrontal cortex) – appointment, belonging, first &

second name, message Memory Processes:

Encoding - visual, visual-spatial, verbal Storage – short & long delays Retrieval - free recall, recognition, prospective recall (cued recall)

RBMT – Psychometrics (1)

Descriptive - screens for impairment of everyday memory functioning

Evaluative - monitors change following treatment Clinical Utility

Easy to learn & administer Takes 30-40 mins Multidisciplinary 2 options for scoring, practical

Standardized - manual and normative data

Reliability Inter-rater: 100% agreement for screening & profile scores (Wilson,

1989; Paolo, MMY) Test-retest: .78-.85 for screening & profile scores (Wilson et al.,

1989; Paolo, MMY) Correlations between 4 forms generally satisfactory (Baddeley et al,

1995; Paolo, MMY) Validity

Good ecological validity (Westergren, MMY) Discriminiation between subjects with BI & controls is good

(Baddeley et al., 1995) Correlations with client’s & relative’s ratings of memory loss

reported (Baddeley et al., 1995)

RBMT – Psychometrics (2)

RBMT - Strengths

Extensive research conducted Tests everyday memory functioning - practical Used in a variety of settings (avoid use in busy

wards due to distractions) Some adaptations for language barriers, visual-

perceptual deficits, visual or auditory problems Multiple versions for various populations Study reported usefulness to evaluate long-term

effectiveness of rehab (Baddeley et al., 1995) Results not influenced by self-reported anxiety or

depression

RBMT - Weaknesses

Ceiling effect - poor detection of early or mild memory problems

Not sensitive to specific diagnoses Interpret norms for 70+ years with caution

(ageing effects) Not able to calculate profile score if subtests

are omitted due to visual or other problems No information obtained on awareness of

memory issues or strategies used

                                                                                                                      

         

Delayed Recall

Do you remember the route

Occupational PerformanceGrocery Shopping

Memory CMT RBMT

Short-term Immediate recall – to prepare grocery list you look in fridge and write down

Immediate recall – spouse says “we’re out of milk” and you write it on list right away

Cognition Strategy use – to prepare grocery list you use chunking (eg. dairy, produce, meat)

NA

Metamemory Awareness – detail of grocery list (eg, veggies vs. carrots, onions, celery, etc.)

NA

Long-term Delayed recall – know route to grocery store from last grocery shop

Delayed recall – know your preferred store is Loblaws

Prospective NA Cued recall – remember to get gas on the way home from shopping

Semantic Immediate & delayed recall – knowing how to recognize a carrot

Immediate & delayed recall – knowing that you need to pay

Episodic Immediate & delayed recall – knowing the deli meat is to left of entrance

Immediate & delayed recall – knowing where to pick up cart

Occupational PerformanceSubway Ride

Memory CMT RBMT

Short-term Immediate recall – hear the stop announced and then get off the train

Immediate recall – ask direction of destination and go to proper platform

Cognition Strategy use – counting stops until you get to destination

NA

Metamemory Awareness – checking signs at every stop NA

Long-term Delayed recall – Remember to get off at your destination

Delayed recall – knowing price of tokens

Prospective NA Cued recall – remember to get tokens when you get off of train

Semantic Immediate & delayed recall –knowing that a seat is for sitting

Immediate & delayed recall – knowing that you have to pay to get on the train

Episodic Immediate & delayed recall – remember where to stand on the platform so that you can get off at the stairs at your destination

Immediate & delayed recall – remember that you have to get off at Queen’s Park to go to MSB

                                                                                                                                  

Questions

References

Baddeley, A., Wilson, B., & Watts, F. (1995). Handbook of Memory Disorders. Chichester, West Sussex: John Wiley & Sons Ltd.

Clare, L., Wilson, B., Emslie, H., Tate, R., & Watson, P. (2000). Adapting the Rivermead Behavioural Memory Test Extended version (RBMT-E) for people with restricted mobility. British Journal of Clinical Psychology, 39, 363-369.

Guaiana, G., Tyson, P., & Mortimer, M. (2004). The Rivermead Behavioural Memory Test can predict social functioning in schizophrenic patients treated with clozapine.International Journal of Psychiatry in Clinical Practice, 8, 245-249.

Josman, N., Berney, T., & Jarus, T. (2000). Performance of children with and without traumatic brain injury on the Contextual Memory Test (CMT). Physical and Occupational Therapy in Pediatrics, 19(3/4), 39-51.

Mental Measurements Yearbook. (Retrieved on January 25, 2005). The Rivermead Behavioural Memory Test, Second Edition, http://web5.silverplatter.com/webspirs/start.ws?customer=c3334&databases=(YB)

Mental Measurements Yearbook. (Retrieved on January 25, 2005). Contextual Memory Test, http://web5.silverplatter.com/webspirs/start.ws?customer=c3334&databases=(YB)

Moradi, A., Neshat Doost, H., Taghavi, M., Yule, W., & Dalgleish, T. (1999). Everyday memory deficits in children and adolescents with PTSD: Performance on the Rivermead Behavioural Memory Test. Journal of Children Psychology and Psychiatry, 40(3), 357-361.

Sohlberg, M., & Mateer, C. (2001). Cognitive rehabilitation: An integrative neuropsychological approach. New York, NY: The Guildford Press.

Toglia, J.P. (1993). Contextual memory test. Tucson, AZ: Therapy Skill Builders. Wills, P., Clare, L., Shiel, A., & Wilson, B. (2000). Assessing subtle memory impairments in the everyday

memory performance of brain injured people: Exploring the potential of the Extended Rivermead Behavioural Memory Test. Brain Injury, 14(8), 693-704.

Wilson, B., Cockburn, J., & Baddeley, A., (1985). Rivermead Behavioural Memory Test. Bury, St Edmunds: Thames Valley Test Company.