Neuropsychological

Assessment
-Memory-

PSY 420-Fall
Week 7

Dr. Banu DEGIRMENCIOGLU

Lecturer
 Memory?
..consists of
“the power, act, process of
recalling to mind
facts previously learned or
past experiences.

“the process of
“being able to recalling to
remember” mind”
 Critical ideas
about memory:
1. The information
being recalled from
memory is one from
the PAST:

we REMEMBER things from PAST

but EXPERIENCE in the PRESENT.
things from past could be a
childhood memory or something
that happened moments ago.
 Critical ideas
about memory:
2. Memory refers to
a process:

a mental act in which stored

information is recovered (retrieval)
for some current use.
it can be conscious or more
automatic (unaware).
 Critical ideas
about memory:

3. A place, a
location:
 where all the events, information and
knowledge of a lifetime are stored.
 so some divisions present: short-
term memory vs. long-term memory.
 Formal definition

..the mental processes of

acquiring and retaining
information
for later retrieval
and
the mental system that
enables these processes.
 Memory model(s)
• The act of turning an experience into a
memory involves a complicated series of
processes, which are dependent on the
integrity of many brain functions.
• While there are several models, common
themes include 3 stages involving:
 encoding: converting information into a
useable form
 storage: holding this information in memory
 retrieval: taking memories out of storage
 Memory..
• ..refers to 3 different kinds of
mental activities:
 initial ACQUISITION of information
(called LEARNING or ENCODING);
 subsequent RETENTION of the
information;
 RETRIEVAL of the information.

(Melton 1963)
 How memory works?

 Encoding: the information

Encoding gets into our brains in a way
that allows it to be stored.

 Storage: the information is

Storage held in a way that allows it to
later be retrieved.

 Retrieval: reactivating and

Retrieval recalling the information,
producing it in a form similar
to what was encoded.
 Learning vs. Memory
• Learning is “the acquisition of
skill or knowledge,” whereas

• Memory is “the expression of

what you’ve acquired”.

(APA.org)
 Learning and memory
linked
• Learning relies on memory: it requires
the storage and retrieval of information.
• Memory relies on learning.
• An individual’s established knowledge
base provides a structure of past
learning.
• Incoming data attaches to that
structure though association.
 Memory stages
• There are 3 basic memory stages:
 sensory storage (sensory memory)
 short-term memory
 long-term memory
 Sensory storage
• ..or sensory registration or sensory
memory.
• ..the first stage of memory.
• “It refers to the point of time that: an
echo or an image, of all the sensations
we take in is initially registered as a
conscious phenomenon.”
• ..very short in duration, lasting
milliseconds to seconds.
• ..decays rapidly if no further attending
to the stimuli is done.
 Sensory storage

must be
attended
to before
being
transferred
to
short-term
memory.
 Short-term memory
• ..frequently referred to as working memory.
• ..very sensitive to interruption or
interference.
• ..the average capacity of in humans is
typically 7 items ±2.
• ..integrates information from long-term
memory with new information coming in
from sensory memory.
• ..can easily be expanded through
superimposing organization such as
chunking (meaningful units of information
in memory).
 Chunking

the letters in the 4 × 4 array below can be recalled much

more easily if organized thus turning 16 individual items into 6
items.
chunking facilitate semantic clustering thus the number of
items to be recalled is reduced to 7.
 Short-term memory
Short-term memory loss
Short-term memory

without
imposing
some
process like
organizing or
rehearsal,
information in
short-term
memory is
quickly
forgotten.
 Long-term memory
• ..refers to information which is relatively
permanent and can be retrieved
volitionally.
• Several processes facilitate the
consolidation of information into long-term
memory:
 the simple act of rehearsal
 the emotional strength of the material: when
associated with emotional experiences
(positive or negative), it is more easily encoded
and facilitates retrieval.
 elaborating the material.
 saliency of the material to be recalled.
Remembering involves three steps:
1. Incoming information is first held for a second or two by sensory
memory.
2. Information selected by attention is then transferred to temporary
storage in short-term memory. If new information is not rapidly encoded, or
rehearsed, it is forgotten.
3. If it is transferred to long-term memory, it becomes relatively
permanent.
 Comparison of
memory stages
Sensory Short Term Long Term
1.large capacity 1.limited capacity 1.unlimited
2.contains 2.acoustically capacity
sensory encoded
information 2.semantically
3.brief storage
encoded
3.very brief (up to 30
retention seconds w/o 3.storage
(1/2 sec for rehearsal) presumed
visual; 2 secs 4.conscious permanent
for auditory) processing of 4.information
information highly organized
 TYPES OF MEMORY

Short-term Long-term
Sensory
(Working) Memory
Memory
Memory
 Types of long- term
memory
• Two predominant types of (long-
term) memory, each having unique
associated anatomical and
phenomenological characteristics,
have remained robust:
declarative (or explicit) memory;
non-declarative (or implicit) memory.
 Explicit vs. implicit
memory
Explicit (declarative) Implicit
 conscious recall (nondeclarative)
 effortful  unconscious recall
 intentional  automatic
recollection of  nonintentional
previous experiences
 things you know that
you can TELL others  things you know that
you an SHOW by doing
 Declarative (explicit)
memory
• ..things which we recall including people,
names, faces, events, facts and places, etc.
It is divided into:
 episodic memory: is an autobiographical
memory and recalls the personal events and
facts which are bound in time and place. e.g.;
what you did yesterday, your first car.
 semantic memory: is composed of facts and
knowledge and it is not time dependent. e.g.;
which city is the capital of the USA, the
multiplication tables.
 Episodic vs. semantic
memory
Episodic Semantic
 personal  general knowledge
 events you have  facts
EXPERIENCED
 dated recollections  stored undated
 active recall of the  does not require one
learning event to recall
autobiographical
event when the
material was learned
Non-declarative (implicit)

memory
• ..refers to memory for skills and
procedures which are learned and
recalled.
• ..includes a number of acquired motor
skills, but also includes a great
number of very complex behaviors
such as playing a musical instrument
or driving a car.
• This memory system is often
preserved in injury and disease states.
 you can
SHOW
others

you can
TELL
others
 The neural
basis of
explicit
memory

Temporal lobe and closely related to parts,

such as the amygdala, the hippocampus
and the prefrontal cortex.
 The neural
basis of
implicit
memory

Cerebellum, basal ganglia, premotor cortex, and other

sites related to motor behavior.
Especially, cerebellum and motor cortex occupies an
important position in the brain circuits taking part in
motor learning.
 The neural basis of
elephant memory

Elephants’ memory
 Terms of
memory impairment
• AMNESIA: describes the loss of memory.
 other neuropsychological functions remain
intact.
 individual exhibits a profound inability to
learn new material, in which declarative
memory functions are largely lost.
 non-declarative (implicit) memory is often
preserved.
 two types:
1. anterograde amnesia and/or
2. retrograde amnesia.
 Anterograde
amnesia
• ..the inability to encode new
material since the event onset or
injury.
• ..individual is able to recall
previous events, up to very close
to the time of the event leading to
anterograde amnesia.
 Anterograde
amnesia

50 First Dates
 Retrograde
amnesia
• ..loss of memory for events that occurred
prior to the event leading to an amnesia
syndrome.
• ..inability to recall immediate previous
information from before the event.
• ..memories immediately before the event
leading to amnesia are markedly poor
while memories farther removed from the
event (moving increasingly early in recent
experience) may be better recalled.
 Figure is the
possible consequences of
brain injury on
old and new memories.
Note that retrograde amnesia
may be incomplete,
with older memories
being more preserved than
newer memories.
 The case of H.M.
• H.M. suffered from epilepsy, with epileptic
foci in both temporal lobes. It did not
respond to drugs available at the time and
was life-threatening.

• Therefore, it was decided to remove the

tissue in which the epileptiform activity
originated.

• H.M.’s surgery removed the amygdala, the

hippocampus, and some of temporal lobe
cortex.
 The case of H.M.
• Following surgery, H.M.’s memory of events prior
to the surgery was intact (no retrograde amnesia).

• But, he displayed anterograde amnesia, the

inability to form declarative memories after the
surgery.

• H.M.’s memory deficit was confined to verbal

tasks; motor learning (non-declarative memory)
was unaffected.

• However, H.M. displayed anterograde amnesia

for spatial tasks, e.g. navigating new
environments.
 The case of H.M.
H.M.’s brain
 The case of H.M.
“..his limitations in this respect are illustrated by
the manner in which he attempted to guide us to
his house, in June 1966. After leaving the main
highway, we asked him for help in locating his
house. He promptly and courteously indicated to us
several turns, until we arrived at a street that he
said was quite familiar to him. At the same time, he
admitted that we were not at the right address. A
phone call to his mother revealed that we were on
the street where he lived before his operation. With
her directions, we made our way to the residential
area where H.M. now lives.”

(Milner et al., 1968, pp. 216–217)

 Terms of
memory impairment
• DEMENTIA: a syndrome
characterized by failure of recent
memory and other intellectual
functions that is usually insidious in
onset but steadily progresses.
• Alzheimer’s disease is the most
common dementia, accounting for
60–80% of cases in the elderly.
 Alzheimer’s disease
• The earliest sign is typically an
impairment of recent memory
function and attention, followed
by failure of language skills,
abstract thinking and judgment.
• Inevitably, alterations of
personality accompany these
defects.
 Alzheimer’s disease
Neuronal degeneration
in Alzheimer’s disease. (a)
a cell in the prefrontal
cortex of a normal
human;
(b)
cells from the same area
of cortex in Alzheimer’s
disease patients at
various stages of
deterioration.
Note the shrinkage of
the dendritic tree.
Alzheimer’s disease
 Alzheimer’s disease

What happens in brain?

 Terms from
neuropsychological view
• Long-term memory:
memory scores obtained after a delay of
usually 30–40 minutes.
this performance is highly correlated
with memory function after days to
weeks, although some temporal
forgetting or decay does occur.
• Short-term memory:
memory scores obtained usually after a
proceeding recall trial.
 Terms from
neuropsychological view
• Immediate memory:
recall of material immediately after
presentation.
material must exceed attention span.
material may be either verbal or visual
(nonverbal).

• Working memory:
immediately processed information
before it is sent to short-term memory.
 Terms from
neuropsychological view
• List Learning:
 immediate and delayed recall for a rote
memorization of a word list.
 word list may have words that are part of several
semantic clusters (e.g., furniture, animals),
 or the list may have words unrelated to each other.

• Visual Memory (NonVerbal memory):

 memory for nonverbal material developed to avoid
being easily verbally encoded such as faces,
geometric figures.
 typically includes immediate memory and delayed
recall of nonverbal material.
 Terms from
neuropsychological view
• Delayed recall:
recall of a previously exposed material
after some period of delay, typically less
than 1 hour.

• Delayed recognition:
refers to recognition of stimuli
previously presented.
 Neuropsychological
assessment
of short-term memory
• Wechsler Adult Intelligence Scale -
Revised / Digit Span subtest.
an assessment about simple attentional
capacity.
also test of short-term memory (working
memory); string of numbers is
RECALLED forward or backward.
 Digit span

• The numbers from 1 to 9, which were

determined before are given to the
subject in a mixed order and subject is
expected to recall&repeat the numbers
in the same order (e.g.; a 5 digit span: 6-
4-3-9-2).
• There are some premade digit spans in
many test batteries like WAIS (Wechsler
Adult Intelligence Scale) or WMS
(Wechsler Memory Scale).
 Digit span

• The important point is: to read these

spans with a speed of 1 number/1
second. If it is read more slowly or
more fastly, the subject can promote
some other strategies beside
attention skill.
• Do not ‘‘chunk’’ the numbers into
small groups!!
 Digit span
• For Digit Span Forward (DSf), the examinee
is read a sequence of numbers and recalls
the numbers in the same order.
• For Digit Span Backward (DSb), the
examinee is read a sequence of numbers
and recalls the numbers in reverse order.
• DSf is measuring a different aspect of
memory from that of DSb.
• DSb task requires more mental
manipulation and visualization of numbers,
whereas the DSf task can be done with
simple rote recall.
 Digit span
• Instructions:
İleriye doğru sıralama:
“Size bazı sayılar söyleyeceğim,
dikkatle dinleyin ve ben bitirdiğimde
hemen arkamdan tekrar edin.”
(Her 1 sayıyı 1 saniye hızında
söylemelisiniz.)
 Digit span
Forward +/- Score Backward +/- Score

582 24
694 58
6439 283
7286 415
42731 3279
75836 4968
619473 15286
392487 61843
5917423 539418
4179386 724856
58192647 8129365
38295174 4739128
275862584 94376258
713942568 72819653
 Digit span
• Instructions:
Geriye doğru sıralama:
“Size bazı sayılar söyleyeceğim, bu sefer ben
bitirdiğimde bu sayıları sondan başa doğre
saymanızı istiyorum. Örneğin, eğer ben size 7-1-9
dersem, siz nasıl sıralayacaksınız?”
(Eğer kişi doğru yanıtlarsa (9-1-7) “Doğru” deyin
ve teste başlayın.)
Eğer kişi örneği yapamazsa şöyle deyin:
“9-1-7 demeliydiniz, ben size 7-1-9 dedim. O
nedenle sizin sondan başa doğru saymanız ve 9-1-
7 demeniz gerekiyordu. Şimdi şu sayıları deneyin,
sondan başa doğru saymanız gerektiğini
hatırlayın, 3-4-8.”
(Her 1 sayıyı 1 saniye hızında söylemelisiniz.)
 Digit span
Forward +/- Score Backward +/- Score

582 24
694 58
6439 283
7286 415
42731 3279
75836 4968
619473 15286
392487 61843
5917423 539418
4179386 724856
58192647 8129365
38295174 4739128
275862584 94376258
713942568 72819653
 DSf Score + DSb Score =
7+6= 13 Digit span
Forward +/- Score Backward +/- Score

582 + 1 24 + 1
1 694 + 1 58 + 1 discontinu
6439 + 1 283 + 1 e when
2 the
7286 + 1 415 + 1
subject
42731 + 1 3279 + 1
3 scores of 0
75836 + 1 4968 + 1 on both
619473 + 1 15286 - 0 trials of an
4 item!
392487 - 0 61843 - 0
5917423 - 0 539418
5
4179386 - 0 724856
58192647 8129365
6 38295174 4739128
275862584 94376258
7
713942568 72819653
 Digit span
• Digit span forward:
Range: 0 - 14
• Digit span backward:
Range: 0 – 14
• Digit span:
Range: 0-28 High score = good
 Digit span
• In normal adults;
DSf may differ between 5 to 7 numbers
span.
DSb may differ between 4 to 5 numbers
span.
typically adults and adolescents produce
DSf that are 1 to 2 digits longer than
DSb.
longer DSb than DSf occur relatively
rarely within the normal population of
adults.
 WAIS Digit Span Test
Normative Data for
Turkish People
Age Range 17-64 Low Education = 0-5 years

Forward Backward Total

 WAIS Digit Span Test
Normative Data for
Turkish People
Age Range 17-64 Mid/High Level of Education >5 years

Forward Backward Total

 WAIS Digit Span Test
Normative Data for
Turkish People
Age Range 65-82 Low Level of Education = 0-5 years

Forward Backward Total

 WAIS Digit Span Test
Normative Data for
Turkish People
Age Range 65-82 Mid/High Level of Education > 5
years
Forward Backward Total
 Neuropsychological
assessment
of (long-term) memory
• Evaluation of memory processes
must include assessment of:
1) learning,
2) immediate memory,
3) delayed memory,
4) recognition formats.
 Neuropsychological
assessment
of long-term
memory
• Wechsler Memory Scale - Revised /
Visual Reproduction Test:
the subject must reproduce
figures both immediately after
presentation (immediate) and
following a delay (delayed).
Visual Reproduction Test
• Instructions:
“Size her seferinde bir çizim
göstereceğim ve onları bu kağıda
kopya etmenizi isteyeceğim. Her
çizime bakmak için sadece 10
saniyeniz olacak. 10 saniyenin
sonunda çizimi alacağım ve
hafızanızdan çizmenizi isteyeceğim.
Ben başlamanızı söyleyene dek
çizmeye başlamayın. Hazır mısınız?”
Visual Reproduction Test
• This test assesses memory for
nonverbal visual stimuli.
• A series of five designs is shown, one
at a time, for 10 seconds each.

• After each design is presented, the

examinee is asked to draw the design
from memory.
 Visual
Reproduction
Test
Card A
Visual Reproduction Test
• After instructions:
İlk çizimi (10 saniye) gösterin ve
kopya edilecek kağıttaki boşluğu
göstererek şöyle deyin:
“Şimdi bu boşluğa çizin. Başlayın.”
Visual Reproduction Test
• Eğer kişi çizme konusunda tereddüt
ederse:
“Sanatsal yeteneklerinizle ilgili
endişelenmeyin, yapabildiğiniz
kadarıyla çizin.”
• Eğer kişi hatırlamadığını söylerse:
“Tamam, tahmininize göre çizin.”
 Visual
Reproduction
Test
Card B
 Visual
Reproduction
Test
Card C
Visual Reproduction Test
• D kartını vermeden önce:
“Bu kart biraz zor, çünkü üzerinde 2 çizim
var. Her ikisine de dikkatle bakmanızı
istiyorum. Yine karta bakmak için 10
saniyeniz var. Sonra kartı geri çekeceğim
ve her iki çizimi de hafızanızdan
yapacaksınız. Kartın sol yanındaki çizimleri
kağıdın sol tarafına, sağ yanındaki çizimleri
ise kağıdın sağ yanına çizin (kopya
kağıdının sol ve sağ taraflarını göstererek).
Hazır mısınız?”
Visual Reproduction
Test
Card D
Visual Reproduction Test
• Delayed recall (approximately 30 min. later):
“Bir süre önce bazı çizimler göstermiştim,
her kartta birer çizim bulunmaktaydı. Her bir
karta bakmış ve böyle bir kağıda çizmiştiniz
(kopya edilecek kağıdı gösterin). Hatrıladınız
mı? Onları bu kağıda çizmenizi istiyorum, bu
sefer hafızanızdan. Daha önceki gibi sırayla
çizmek zorunda değilsiniz. Şimdi o
çizimlerden birini bu boşluğa yapın.”
• Eğer kişi hatırlayamazsa, genel olarak
cesaretlendirin.
Visual Reproduction Test
• The delayed condition
assesses long-term visual-
spatial memory with free
recall.
• Designs are drawn from
memory in any order.
Visual Reproduction Test
• For scoring, there is a detailed
manual: VISUAL REPRODUCTION
SCORING CRITERIA.
For Card A : 0-7
For Card B : 0-9
For Card C : 0-7
For Card D : 0-18
TOTAL : 0-41
 Neuropsychological
assessment
of long-term memory
• Rey Auditory Verbal Learning Test:
 involves LEARNING, the repeated exposure to the
material to be recalled.
 it is more sensitive in detecting memory impairment
than tests that are presented only once.
 consists in reading a 15-word list to the examinee at a
slow pace five times in a row.
 after each turn, the examinee has to recall the words,
without having to follow the same order of presentation.
 recall of the word list is also tested after presentation of
a new list and after a delay.
 finally, the subject is shown a list of 50 words and must
identify the list I words.
 Rey Auditory Verbal
Learning Test
• ..starts with a list of 15 words, which an examiner
reads aloud at the rate of one per second.
• ..task is to repeat all the words he or she can
remember, in any order.
• this procedure is carried out a total of five times.
• then the examiner presents a second list of 15
words, allowing the patient only one attempt at
recall.
• immediately following this, the patient is asked to
remember as many words as possible from the
first list.
 Rey Auditory Verbal
Learning Test
• Instructions:
Deneme I: “Size bir kelime listesi
okuyacağım. Dikkatle dinleyin, ben
itirdiğimde hatırlayabildiğiniz kadar
çok kelimeyi bana tekrarlayacaksınız.
Onları hangi sırada söylediğinizin bir
önemi yok. Sadece olabildiğince çok
kelimeyi hatırlamaya çalışın.”
 READ
LIST

examiner reads
aloud at the rate of
one per second.
 Rey Auditory Verbal
Learning Test
• Instructions:
Deneme II-V: “Şimdi aynı listeyi size tekrar
okuyacağım ve bir kere daha bitirdiğimde
hatırlayabildiğiniz kadar çok kelimeyi, ilk
seferde söylemiş olduklarınız da dahil
olmak üzere hatırlamanızı istiyorum. Hangi
sırada söylediğinizin önemi yok. Daha
önce söylemiş olun ya da olmayın sadece
hatırlayabildiğiniz kadar çok kelimeyi
söyleyin.”
 READ
LIST
BEFORE
EACH
TRIAL
 Rey Auditory Verbal
Learning Test
• Instructions:
Deneme B: “Şimdi size ikinci bir
kelime listesi okuyacağım. Bu kez,
ikinci listeden hatırlayabildiğiniz
kadar çok kelimeyi söylemeniz
gerekiyor. Yine hangi sırada
söylediğinizin önemi yok. Sadece
olabildiğince çok kelimeyi
hatırlamaya çalışın.”
READ
LIST
 Rey Auditory Verbal
Learning Test
• Instructions:
Deneme VI: Şimdi ilk listeden
olabildiğince çok kelimeyi tekrar
hatırlamanız gerekiyor.”
TRIAL VI

DON’T
READ
LIST
 Rey Auditory Verbal
Learning Test
• After 20 min. do the 7th trial. It is
recommended NOT to do another
VERBAL neuropsychological test
between trial VI and VII.
• Instructions:
Deneme VII: Şimdi ilk listeden
olabildiğince çok kelimeyi tekrar
hatırlamanız gerekiyor.”
TRIAL VII

DON’T
READ
LIST
13
0
 Rey Auditory Verbal
Learning Test

7 12
59
11
13
0

Analysis of task performance yields considerable

information, including acquisition, learning rate,
susceptibility to proactive and retroactive interference
and retention/forgetting.
 Rey Auditory Verbal
Learning Test
• Learning: changes in the number of
words recalled across the 5 trials.
• Acquisition: summing the total
number of words recalled across the
first 5 recall trials.
• Learning rate: comparing the number
of words recalled on the 1st trial with
the number of words recalled on the
5th recall trial.
 Rey Auditory Verbal
Learning Test
• Retention: 5th trial is followed by the
distractor list (List B), then followed by
immediate (Trial 6) and delayed recall
(7th trial).
• Forgetting: comparing the number of
words recalled on the 5th recall trial
with the number of words recalled after
the 20-minute delay (7th trial).
 Rey Auditory Verbal
Learning Test
• Recognition trial permits the
identification of individuals with
suspected retrieval problems, who may
score better on this trial than on free
recall.
• In addition, comparison of recognition
of the two lists permits the evaluation
of words that have been studied five
times (List A) versus words that were
studied once only (List B).
 Rey Auditory Verbal
Learning Test

A person with
a generalized memory deficit
will perform poorly on
both free recall
and recognition trials.
 Memory deficits/complaints
A behavioral guide
Encoding Delayed Recognition Common Disease
Recall
Very Poor Very Poor Very Poor Bilateral frontal lobe
damage
Alzheimer’s Disease
Poor Severe Mild Impairment Initial Stages of AD
Impairment Bilateral Mesial Temporal
Lobe Lesions
Normal Poor Good Sub-cortical
Vascular dementias
Variable Variable Good Dementias affecting
frontal lobes
Traumatic brain injuries
Poor Variable Normal Depression
Anxiety
thanks
for your
attentio
n!