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A Qualitative Analysis of Figural Memory Performance in Persons

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A Qualitative Analysis of Figural Memory Performance in Persons Louisiana State University LSU Digital Commons LSU Doctoral Dissertations Graduate School 2002 A qualitative analysis of figural memory performance in persons with epilepsy Deborah Schrager Hoffnung Louisiana State University and Agricultural and Mechanical College, [email protected] Follow this and additional works at: https://digitalcommons.lsu.edu/gradschool_dissertations Part of the Psychology Commons Recommended Citation Hoffnung, Deborah Schrager, "A qualitative analysis of figural memory performance in persons with epilepsy" (2002). LSU Doctoral Dissertations. 1034. https://digitalcommons.lsu.edu/gradschool_dissertations/1034 This Dissertation is brought to you for free and open access by the Graduate School at LSU Digital Commons. It has been accepted for inclusion in LSU Doctoral Dissertations by an authorized graduate school editor of LSU Digital Commons. For more information, please [email protected]. A QUALITATIVE ANALYSIS OF FIGURAL MEMORY PERFORMANCE IN PERSONS WITH EPILEPSY A Dissertation Submitted to the Graduate Faculty of the Louisiana State University and Agricultural and Mechanical College in partial fulfillment of the requirements for the degree of Doctor of Philosophy in The Department of Psychology by Deborah Schrager Hoffnung B.A., Washington University, 1996 M.A., Louisiana State University, 1998 August 2002 ACKNOWLEDGMENTS The author wishes to thank Dr. Drew Gouvier, for sticking with me all these years in good humor, Dr. Ken Perrine, for reading over each and every “last draft”, Dr. Faith Gunning-Dixon, for picking up the slack, Rosanne and Lynda for working so hard and being so kind, Ari Hoffnung, for putting up with a floor full of dissertation materials, and Mocha, for staying (or sleeping) by my side through it all. ii TABLE OF CONTENTS Acknowledgments …………………………………………………………………………….…. ii Abstract ……………………………………………………………………………….……......... v Introduction ……………………………………………………………………………………… 1 Review of Epilepsy ………………………………………………………………………………. 4 Classification of Seizures ………………………………..………………………………. 4 Defining Epilepsy ………………………………………………………………………... 5 Diagnosis ………………………………………………………………………………… 6 Treatment ………………………………………………………………………………... 7 Assessment of Nonverbal Memory ……………………………………………………………… 9 Development of the Rey-Osterrieth Complex Figure Test …………………………..…. 10 Other Measures of Figural Memory ……………………………………………………. 11 Other Measures of Nonverbal Memory ………………………………………………… 12 Research with the ROCF …………………………………………………………………….…. 14 Development of Modern Scoring Methods for the ROCF ……………………………………... 16 Quantitative Scoring Systems ………………………………………………………..… 16 Qualitative Scoring Systems ……………………………………………………………. 18 The Boston Qualitative Scoring System (BQSS) ……………………………………………..... 19 Psychometric Properties of the BQSS …………………………………………………. 20 Research with the BQSS ……………………………………………………………….. 22 Goals of the Current Investigation ……………………………………………………………... 25 Methodology …………………………………………………………………………………… 27 Participants …………………………………………………………………...………… 27 Instruments …………………………………………………………………...………… 29 Procedures ……………………………………………………………...……....……… 31 Results ………………………………………………………………………………………….. 33 Characterization of Neuropsychological Data ……………………………………..…… 33 Interrater Reliability ……………………………………………………………………. 33 Equivalence of PENCIL and VIDEO Administration Methods …………………..…… 35 Group Differences on Visual Memory and Visuoperceptual Tests …………………….. 38 Group Differences on Taylor-Osterrieth Quantitative Scoring System ………………… 39 Comparison of the BQSS Summary Scores with the Taylor-Osterrieth Quantitative Scoring System ……..………………………………………………………….. 40 Group Differences on BQSS Scores …………………………………………………… 41 iii Comparison of BQSS Scores with Other Neuropsychological Tests ………….……….. 43 Calculation of Effect Sizes ………………………………………………………...…… 47 Discussion ………………………………………………………………………...……………. 49 Power of the Administered Tests …………………………………………………...….. 51 Epilepsy Effect ………………………………………………………………………..... 53 The ROCF as a Measure of Visuoperception ………………………………………….. 55 Conclusions …………………………………………………………………………………….. 62 References ……………………………………………………………………………………… 66 Appendix A: Gross Anatomy of the Temporal Lobes ………………………………………….. 77 Appendix B: Rey Osterrieth Complex Figure ………………………………………………….. 78 Appendix C: Scoring Units for the ROCF …………………...………………………………… 79 Appendix D: BQSS Configural Elements, Clusters, and Details ………………..……………... 80 Appendix E: Brief Description of the BQSS Qualitative Scores ……….………………………. 81 Appendix F: Taylor-Osterrieth Criteria for the ROCF ………………………………...……….. 82 Appendix G: Distribution of ROCF Delay Scores for Taylor-Osterrieth Criteria ……………… 84 Vita ………………………………………………………………………………...…………… 85 iv ABSTRACT This study examined nonverbal memory in patients with intractable temporal lobe epilepsy (TLE) on a figural reproduction task, the Rey-Osterrieth Complex Figure (ROCF). The Boston Qualitative Scoring System (BQSS) was used to examine whether qualitative features of ROCF performance could discriminate between those with right and left TLE. As predicted, seizure groups did not differ on a standard quantitative scoring system for the ROCF. Contrary to prediction, the right TLE group did not perform more poorly on BQSS measures of quality or organization, and they did not have greater difficulty recalling the figure after a delay. There was a trend towards poorer performance by the right TLE group on 2 BQSS scales, those quantifying the presence or absence of elements of the figure. ROCF performance was more strongly correlated with measures of visuoperception than with additional measures of nonverbal memory. Thus, the BQSS does not appear to be assessing nonverbal memory, and the implications of the ROCF as a visuoperceptual task are discussed. v INTRODUCTION Daniel Schacter notes in his treatise on memory: “There may be nothing more important to human beings than our ability to enshrine experience and recall it. While philosophers and poets have elevated memory to an almost mystical level, psychologists have struggled to demystify it” (1996; book jacket). For those suffering with memory loss, the act of remembering becomes more than simply pulling bits of stored data out of our past. Learning and memory are resilient, yet, at the same time quite vulnerable to the effects of neurological and psychological disease and trauma. The current study focuses on the assessment of memory impairment in epilepsy patients, specifically, in individuals with seizures originating in the temporal lobes. Memory researchers identify and discuss many different categories of memory; the current study focused on one such category, nonverbal memory. Whereas verbal memory involves the retention of language or sounds that have been spoken, thought, read, or heard, nonverbal memory involves the preservation of information that has been observed or presented visually. In epilepsy, learning and memory deficits are often material specific; individuals with left temporal lobe involvement tend to perform more poorly on verbal memory tasks, whereas those with primarily right temporal lobe seizures usually perform more poorly on nonverbal/visuospatial learning tasks (Milner, 1966). The current study examined nonverbal memory in patients with intractable temporal lobe epilepsy on a figural reproduction task, the Rey-Osterrieth Complex Figure (ROCF; Osterrieth, 1944; Rey, 1941). The ROCF is used by many neuropsychologists in both clinical and research settings, and is most often employed as a measure of visuoconstructional ability and visual memory. The individual is asked to copy a complex geometric figure, and then, without prior warning, is asked to reproduce the figure he/she has just 1 copied. The individual is again asked to reproduce the figure from memory after a delay (30 minutes). Despite the widespread use of the ROCF and similar figural reproduction tests as measures of nonverbal memory, conflicting findings have been reported among persons with epilepsy. To date, the ROCF has shown only limited value in the identification of nonverbal memory impairment in presurgical patients with right temporal lobe epileptic foci (Barr, 1997a; Barr et al., 1997b). That is, the reproductions of individuals with right temporal lobe seizures, with dysfunction in cortical areas theorized to be vital to nonverbal memory function, have not been reliably discriminated from the reproductions of individuals with left temporal lobe seizures and intact right hemisphere functioning. Critics argue that it is not that the measures themselves are insensitive to lateralizing differences (i.e. intact vs. deficient right temporal lobe function), but rather, that the standardized quantitative scoring systems fail to capture the qualitative aspects of figural reproduction that depend on the integrity of the right temporal lobe. The term quantitative refers to an appraisal of the amount of information the individual has reproduced, and quantitative scoring systems are traditionally based on the presence and accuracy of specific elements (i.e., line segments) of the figure. In contrast, a qualitative analysis seeks to evaluate the respondent’s strategies and organizational approach, in other words, the process by which the individual approaches their reproduction of the figure. Proponents of the qualitative systems contend that superficial evaluation of presence or accuracy does not capture the specific deficits in strategy and organization that may characterize subtle brain dysfunction (Troyer & Wishart, 1997).
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