Memory

• Introduction
• What is memory?
• What causes memory problems?
• Memory difficulties in people with epilepsy
• Memory problems can affect people in different ways
• Neuropsychological memory assessment
• Memory enhancement strategies
• Specific memory problems
• Summary
• Download our memory booklet

Introduction

This page, originally a booklet written by Professor Gus Baker and colleagues at the UK’s University of Liverpool, is a clear self-help guide to memory problems in people with epilepsy. It explains the difficulties that can be faced and provides simple strategies that may help the individual to overcome them.

Thanks to Professor Gus A Baker, Amy J Hothersall, Jenna E. Mallows, University of Liverpool.

What is memory?

Memory is the ability to recall past experience and knowledge. It is divided into short-term memory (STM) and long-term memory (LTM). Short-term memory deals with information that is to be remembered over a period of a few minutes, and long-term memory deals with anything that is to be remembered for longer than this. Recording the memory in the first place is called encoding. The information is then passed from short-term to long-term memory for storage. Long-term memory is divided
into three types.

• Procedural memory
  Activities which are carried out almost without thinking, for example, riding a bike.

• Semantic memory
  Knowledge that has been acquired but we are not sure when, for example, capital cities.

• Episodic memory
  Personal memories of everyday life.

Memory can also be divided into verbal and visual. Verbal memory is the ability to remember information which is perceived aurally, for example, words and sound. Visual memory is the ability to remember information that is provided visually, for example in terms of pictures and faces. When we want to remember something, the information we need is brought back from long-term memory to short term memory. This is called retrieval.

If we have forgotten something it could be due to problems with:

• recording the memory in the first place (encoding);
• the storing of the memory (storage);
• or recovering the memory from LTM (retrieval).

What causes memory problems?

Everybody will experience some minor lapses in memory. These can occur when we are:

• under stress;
• trying to concentrate on a number of things at once;
• feeling unwell;
• feeling tired.

Also, as we get older, lapses in memory can become more common. This variation is perfectly normal and nothing to be concerned about. However, memory problems can be much more pronounced and long-term. They can be caused by a number of things, for example:

• a dementia type illness such as Alzheimer’s disease;
• an infection of the brain, for example encephalitis;
• a shortage of oxygen to the brain, as in cerebral palsy;
• head injury;
• certain types of stroke;
• a brain tumour or brain haemorrhage;
• epilepsy, on its own or with one of the above.

Memory difficulties in people with epilepsy

The presence of memory difficulties in people with epilepsy is well recognised. In fact people with epilepsy seek help for memory problems more often than for any other impairment. Research has shown that a large portion of memory is located in a specific area of the brain known as the temporal lobe.

There are a number of reasons why people with epilepsy may have memory difficulties.

• Epileptic seizures can affect memory functioning because, in order for memory to work properly, the brain needs continuous self-monitoring. This self-monitoring system can be disrupted during a seizure. Memories prior to a seizure can be lost, as they have not been fully incorporated into our memory system.
  
  During a seizure our memory may also be affected, because a loss of consciousness can interfere with normal brain processes, disrupting the encoding and storage of information. The confusion that can occur following a seizure can also prevent our memory from working properly.
  
  Some people with epilepsy can experience unusual electrical activity within the brain between seizures and this can also affect attention and memory functioning.

• An underlying brain tumour or lesion can disrupt the memory process. Therefore if a tumour or lesion is located in the temporal lobe, which is a part of the brain needed for memory, this may also cause memory problems.

• Some anti-epileptic medications may interfere with memory functioning as they can affect the speed at which the brain can process information. On the other hand they also reduce seizure frequency and, as we have discussed, frequent seizures can also cause memory impairment.
  
  If you are worried your medication may be affecting your memory, it is important to speak to your doctor about your concerns. They can investigate this possibility and will discuss possible solutions with you. It is worthwhile noting that the cause of some of our memory problems may be due to another problem, which is resulting in impairment in memory.
  
  For example:
  • an attention problem – if we do not pay attention to the information we are presented with then this information is not recorded by our memory;
    
    
  • a language problem – sometimes in conversation we find it hard to find the word that we are looking for. This can be misinterpreted as forgetting words;
    
    
  • a visual/spatial problem – people can have difficulty working out where they are in relation to other places or objects and therefore can experience difficulty in working out how to get somewhere;
    
    
  • anxiety and depression – people with an altered emotional state often experience memory difficulties; those who experience anxiety can find their mind is too occupied with worrying thoughts to concentrate on things around them. Those who are low in mood can also feel lethargic and low in motivation, therefore lacking the attention needed to record a memory;
    
    
  • sleep disturbances – if we are not getting enough sleep then we can experience difficulty concentrating which again disrupts our attention to information. How are people with memory problems affected?

Memory problems can affect people in different ways

It may be that a person’s memory problems are very general, and will therefore affect most areas of memory functioning. However they can also be very specific and might only affect one aspect of memory functioning, such as remembering what people tell you. Memory problems can cause a range of difficulties, making it difficult to cope with everyday living and relationships. These difficulties can cause a great deal of distress for the person affected. However, while memory problems cannot be cured, it is possible to adapt to having a memory impairment, making it easier to cope and live a relatively normal life.

Neuropsychological memory assessment

In order to get an accurate assessment of your memory function, the doctor may suggest carrying out a neuropsychological assessment. Neuropsychological simply means looking at the processes that the brain carries out, one of which is memory. This assessment aims to get an accurate idea of how well your memory is currently functioning and will be carried out by a psychologist. It will look at all areas of your memory ability. More specifically it will be looking at your ability to remember pictures, stories and numbers. Through looking at these areas, the psychologist will be able to discover where your memory difficulties lie and if there is any difference between your:

• visual memory (your ability to remember pictures) and;
• verbal memory (your ability to remember information presented orally).

This information then provides some focus on which memory enhancement strategies are going to be the most helpful to you.

Memory enhancement strategies

It is possible to find ways of adapting to living with memory problems. Various methods can be used to help people with memory problems store and recall memories more effectively.

Possible ways of doing this are:

• following a set routine;
• adapting your surroundings;
• using external memory aids;
• using ‘mnemonics’;
• improving general well-being.

Strategies can be combined to help you adapt to living with memory problems. The following section will outline these strategies in more detail. It is likely to take some time to get used to using the various strategies which can help to enhance your memory.

There may be some ‘trial and error’, and it will require effort on your part. However, experience has shown that, once incorporated into your lifestyle, these strategies can be extremely effective and beneficial. It is worth noting here that the key to making these strategies work effectively is organisation and establishing a routine, as this reduces the demands placed on your memory.

Following a set routine

It cannot be stressed enough how important following a routine is to improving your memory. Having a routine means you can get used to what to expect, which helps reduce the demands placed on your memory. A lot of people find it useful to make a note of their regular activities in their diary or on the calendar. Also, always doing things at certain times of the day, for example always taking medication with breakfast can help some people.

Adapting your surroundings

By adapting your surroundings you will have less need to use your memory, and therefore this reduces the difficulties you can experience. This can be achieved in a number of ways:

• by keeping a note pad by the phone to take messages;
• using a notice board for important information;
• having a particular place to keep things, such as keys and glasses, and always putting them in the same place;
• abelling cupboards to remind you what goes in them.

People around you can help with this by altering how they do things, or how they respond to you as a person with a memory impairment.

Using external memory aids

There is a wide range of external memory aids and the most important thing is to choose something that you feel comfortable with. What suits one person may not necessarily suit another. For example, pictures or diagrams may be more useful for people who find reading difficult.

Possible memory aids are:

• a diary;
  
• a notebook;
  
• making lists, for example shopping lists;
  
• an alarm clock or a timer;
  
• a mobile phone with an alarm;
  
• a calendar;
  
• a wall chart or wipe clean memo board;
  
• a tape recorder or Dictaphone;
  
• an electronic organiser;
  
• an electronic pager;
  
• a pill reminder box for medication;
  
• Post-It notes;
  
• a photo album or memory book.

Getting used to a new memory aid can be quite demanding and it may take you a little while. However, the more you use a memory aid the easier it will become to incorporate into your everyday life. Eventually it will seem like second nature. It can be easier to use memory aids that you are more familiar with, for example, if you like using modern technology then you may find personal organisers and computer diaries work for you. However, if you are not keen on computers, pen and paper methods such as diaries and calendars may be easier to use.

Mnemonics

A mnemonic is a verbal or visual aid which helps us to remember information, usually in the form of sayings, rhymes or pictures. For example to remember the colours of the rainbow some people use the rhyme: Richard Of York Gave Battle In Vain
Red Orange Yellow Green Blue Indigo Violet.

Some people find visually pairing items can be useful; one such method is known as the peg method. ‘Pegs’ are used to help you to remember a list of items. Each number is given a rhyming visual cue – ‘one - bun, two - shoe, three - tree, four - door etc. Using this method you would visualise the first thing you want to remember and associate it with a bun. Other people try to remember information in the form of a story they have made up. These are only suggestions of methods you could use. Often the best thing is to be imaginative and make up ones that are personally relevant and work for you.

Combining a variety of strategies to enhance memory

People with memory difficulties can often find it helpful to use several aids or strategies, so that if one method fails there will be another one as a back-up. Writing on the calendar and using an alarm to remind you of an appointment is one example. It can take time to establish a memory system but, once it has been set up and is used frequently, it can be very effective.

Improving well-being

Living with memory problems, you may often feel vulnerable and unsure of yourself. Given the practical difficulties of memory problems you may experience some anxiety. Anxiety management and the use of relaxation techniques can therefore be beneficial.

Your GP will be able to give you advice on where you can get information on this. Factors causing a reduction in well-being can include a loss of structure to your daily routine (for example losing your job) or a general loss of independence, status or role. This can be exaggerated if it is accompanied by other factors, such as an inability to drive and a dependence on others.

Improvements in well-being can be achieved in a number of ways, for example through developing new activities or hobbies. It can also be helpful to talk to others experiencing similar problems and to find out if there are any organisations or support groups in the area that may be useful.

Specific memory problems

Some of the most common difficulties people with memory impairments can experience are:

• remembering to do something;
  
• remembering people’s names;
  
• remembering where you put something;
  
• remembering what people tell you;
  
• remembering what you are reading;
  
• remembering how to get somewhere.

The following section will outline how these problems can be made easier to cope with and which strategies will work well for particular problems. These are only suggestions to give you an idea and you may think of others that you find more useful.

Remembering to do something

• Leave things in your front hall before you go out, for example, letters you need to post.
• Watches or organisers can be programmed to sound an alarm at certain times to remind you to do something.
• If possible, do things immediately rather than later on.
• Keep a pen and paper handy at all times.
• Use diaries, wall charts and calendars

People often forget if they have done a particular task (such as locking the door). A way to improve this type of memory is to say out loud what you are doing at the time you are doing it.

Remembering people’s names

Recording the information

Recalling the name

Remembering where you have put something

Remembering what people tell you

Remembering what you are reading

Preview
Skim through the information to get a general idea about what is being said.

Question
Decide upon questions you want to be able to answer once you have read the information and write them down.

Review
Re-read the information.

State
Sum up the most important points.

Test
Test yourself by seeing if you can answer the questions that you set for yourself earlier.

Remembering how to get somewhere

Summary

Be organised

√ Keep a fixed routine, with set things at set times of the day.

√Be well organised – have a place for everything and have everything in its proper place. Use labels if necessary.

General advice

√Get a good night’s sleep and do difficult jobs when you’re feeling fresh and there are not too many distractions.

√Try not to do too many things at once. Do major activities one bit at a time.

√Try to stay calm and avoid stressful situations. If you forget to do something, don’t get too upset about it. Try to keep things in perspective.

Better ways of remembering

√ If you have to remember something, go over it in your mind at regular intervals.

√ Try to find meaning in things you have to remember – use mnemonics and make associations.

√If you cannot remember something, try thinking about associations that might jog your memory.

Hints for Helpers

This page has been written primarily for someone who has epilepsy and memory problems. If you are close to someone who has epilepsy and memory problems, it may help to improve your understanding of the difficulties they face and how they might handle them. You can help, whether you are a close relative, friend or work colleague, by following these simple guidelines:

Do

√Try to understand what their difficulties are.

√Be a bit more patient than usual.

√Support them by accepting the ways that they try to cope with their memory difficulties.

√Adapt your way of relating to them.

Don’t

x Patronise or do everything for them.

x Make too many demands or have high expectations that require a great deal of memory recall.

x Tidy up or put things away if that disrupts their way of coping.

x Interrupt them when they are talking or concentrating on something.

• Download our memory booklet