The Assessment, Meaning and Amelioration of Everyday Memory Difficulties in People with Epilepsy Rhiannon Corcoran Doctor of Philosophy Institute of Neurology ProQuest Number: U062546 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest U062546 Published by ProQuest LLC(2017). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106- 1346 THE ABSTRACT The project was inspired by a frequent, if rather paradoxical, clinical observation. While patients with epilepsy frequently reported disruptive memory difficulties, neuropsychological testing often failed to confirm the serious nature of the patients' complaints. It had previously been assumed that patients were overstating their difficulties. However, the same anomalous pattern has been noted elsewhere, notably in elderly and head-injured samples. This investigation was therefore undertaken to assess further the nature and degree of everyday memory difficulties in people with epilepsy. The first study assessed subjects' beliefs about the incidence of memory failures using self-report techniques. Seven hundred and sixty patients with epilepsy and one hundred and forty-six subjects without epilepsy participated in the study. The level of patients' complaints was explored with respect to epilepsy, treatment and psychological factors. Findings demonstrated significantly more perceived memory failures in the subjects with epilepsy. Factors which were related to this increased vulnerability to failures included later onset of the condition, elevated levels of negative moods and, to a lesser extent, perhaps a less efficient use of preventative memory strategies. In study two the relationship between subjects' beliefs and the prospective recording of memory failures was examined. Results indicated that subjects with epilepsy are underestimating the level of memory failures on the retrospective questionnaire. Study three examined the relationship between memory complaints and actual test performance in a subsample of patients with epilepsy, thirty of whom were classified as complainers and thirty non-complainers. Relationships between performance measures and beliefs were weak. Only ‘two memory tests were predictive of self-report indices. Contrary to expectation, tests of planning and organisation were not found to be sensitive to prospective memory performance. Finally, two small scale interventions aimed at ameliorating memory difficulties in this population were conducted. Results were promising though variable with motivational factors contributing greatly. Table of Contents Page No. Title Page 1 Abstract 2-3 Table of Contents 4«r6 List of Tables 7-13 List of Figures 13-14 Part A : The Literature Review. Chapter One. Epilepsy: The Condition and Seizure Classification. 15-26 Chapter Two. The Meanings of Memory. 27-40 Chapter Three. Memory and Epilepsy. 41-56 Chapter Four. Memory, Seizure Types and Epilepsy Classification. 57-68 Chapter Five. Temporal Lobe Epilepsy and the Lateralisation of Memory Functions. 69-84 Chapter Six. The High Risk Triad: The Roles of Seizure Frequency, Age of Onset and Duration of Epilepsy. 85-96 Chapter Seven. The Role of Subclinical Discharges and Transient Cognitive Impairment. 97-102 Chapter Eight. The Effects of Anticonvulsant Drugs on Memory Functions. 103-125 Page No. Chapter Nine. The Study of Everyday Memory in Cognitive and Neuropsychology. 126- 148 Chapter Ten. Epilepsy, Mood and Memory: A Neglected Relationship? 149- 163 Chapter Eleven. The Use of Memory Aids and Mnemonics: Examining and Altering Memory Behaviour. 164- 169 Part B : The Studies. Study A . The Questionnaire Survey. 170- 248 Study B. The Memory Checklist Study. 249- 279 Study C . Neuropsychological Tests and Everyday Memory. 280- 311 Study D (i). Memory Training Techniques. The Outpatient Method. 312- 338 Study D (ii) . Memory Training Techniques. The Memory Group. 339- 361 Discussion I. Interpreting the Findings. 362- 389 II. Suggestions for future work. 390- 399 III. Conclusion. 400- 402 Acknowledgements. 40 3 References. 404-461 Page No. List of Appendices: 462-463 Appendix I 464 Appendix II 465 Appendix III 466 Appendix IV 467 Appendix V 468-469 Appendix VI 470 Appendix VII 471-472 Appendix VIII 473-474 Appendix IX 475 Appendix X 476 Appendix XI 477-478 Appendix XII 479-489 Appendix XIII 490-494 Appendix XIV 495-499 Appendix XV 500-503 Appendix XVI 504-506 Appendix XVII 507 Appendix XVIII 508-509 Appendix XIX 510 List of Tables Page No. Table One, Anticonvulsants of Choice According to Seizure Type. 24-25 Table Two. The Metamemory Questionnaires. 133 Table Three. The eight most frequently used external memory aids. 177 Table Four. The eight most frequently used internal mnemonic strategies. 178 Table Al. Demographic Details and Epilepsy Patient Categories of the Samples (Frequencies and approximate percentages). 187 Table A2. Summary statistics of MQ total, RMQ total and frequency of nuisance ratings for epilepsy and non-epilepsy groups. 191 Table A3. Kendall's Tau correlations between self and observer scores and subjective nuisance ratings for epilepsy and non-epilepsy groups. 192 Table A4. Demographic details of epilepsy and non-epilepsy educational attainment subgroups. 194 Table A5. The top five problems of epilepsy and non-epilepsy groups. 196 Table A6. The neuroepileptic and treatment characteristics of the epilepsy subgroups and whole sample. 198-200 Page No. Table A 7 . Median MQtots and nuisance ratings for the two age of onset groups. 201 Table A 8 . Median MQtots and nuisance ratings of the two duration groups. 202 Table A 9 . Median and ranges of MQtot ‘ according to presence/absence of the six [ i seizure types. 204 i Table A10. Nuisance ratings of subjects with and without primary generalised, secondarily generalised and complex partial sei zures. 205 Table All. Median and range,MQtot according to seizure frequency within seizure type. 207 Table A12. Median and range MQtot and nuisance ratings for subjects with one, two or three seizure types. 210 Table A13. Median and range MQtot and nuisance ratings of subjects with no focus, temporal, frontal or focal onset elsewhere. 211 Table A14. Median and range MQtot and nuisance ratings of subjects with left, right or bilateral temporal lobe epilepsy. 212 Table A15. Median and range MQtot and nuisance ratings of subjects taking phenytoin, carbamazepine or sodium valproate monotherapy. 213 Page N o . Table A16. Median and range MQtot and nuisance ratings of subjects taking 0-4 anticonvulsant drugs. 215 Table A17. Percentage use of external and internal memory aids by both groups. 217 TableAl8. Pattern of diary use in epilepsy and non-epilepsy groups. 218 Table A19. Means and s.ds. of external, internal and grand total aid use in both groups. 218 Table A20. Kendall's Tau correlations between use of memory aids and MQtot in the two groups. 219 Table A21. Percentage use of diaries, mental retracing of events and rhymes in epilepsy and non-epilepsy groups divided according to nuisance ratings. 222 Table A22. Median mood scores and percentages of subjects scoring at or above the cut-offs for the scales. 226 Table A23. Subjects classified according to mood on the HAD scale. 227 Table A24. Kendall's Tau correlations between MQtot and mood scale scores. 228 Table A25. Median and range MQtot for the groups divided according to presence or absence of negative moods. 229 Page No. Table A26. Median and range BDI and HAD scale scores for subjects divided according to memory nuisance rating. 230-231 Table A27. Median and range MQtot for subjects with epilepsy classified by mood on the HAD scale. 232 Table Bl. The demographic and medical characteristics of the checklist subjects. 253-254 Table B 2 . Median and range scores of the memory scales for those with and without epilepsy divided according to sex. 258 Table B3 . Medians and ranges of CLtot and RCLtot» Kendall's Tau correlations between CLtot and RCLtot. 259 Table B4. Kendall's Tau correlations between questionnaire scales of memory beliefs and prospectively recorded failures. 261 Table B5 . Summary statistics of the adapted three month CLs and MQs. 262-263 Table B 6 . Median and range CLtot scores according to nuisance ratings. 264 Table B7. Comparing the modal MQ responses to the median CL responses. 265 Table B8. The top five daily failures reported on the CL and MQ by the epilepsy and non-epilepsy groups. 266-267 Table B9. Kendall's Tau correlation between CLtot and age of onset. Median and range CLtot for the two onset groups. Table BIO. Median and range CLtots in those with complex partial seizures of varying frequencies. Table Bll. Kendall's Tau correlations between use of external and internal memory strategies and CLtot. The use of aids by groups split at the median CLtot score. Table B12. Kendall's Tau correlations between mood and CLtot.. The median and range CLtots for groups divided according to mood scale cut-offs. Table Cl. Demographic, epilepsy and treatment characteristics of the two test subject groups. Table C 2 . The MQ and RMQ data for the two groups of test subjects. Table C3. Descriptive statistics of the memory test scores of complainers and non-complainers. Table C4. Kendall's Tau correlations between MQtot and the memory tests. Table C5. Details of daily word finding difficulties and Boston Naming Test scores in complaining and non-complaining groups. Table C6. The frequency of daily prospective memory failures with corresponding performance on the belonging test. Table C7. The frequency of daily prospective memory failures in the two test groups and corresponding performance on the WCST and Maze test.