Introduction to Memory and Cognition

Memory and Cognition complaints are some of the most common symptoms in psychiatric and neurologic practice.

• Retrograde amnesia: inability to remember things that occured prior to a central nervous system injury
• Anterograde amnesia: Inability to remember things that occur after a central nervous system injury (i.e. - cannot form new memories)

On history and mental status:

• Difficulty remembering recent events (conversations, meals)
• Increased reliance on lists/calendars
• Repetition
• Requires frequent reminders
• Autobiographical and implicit memory relatively preserved until severe stages

On cognitive testing:

• Difficulty with repeating words and/or digits
• Difficulty with delayed recall
• Rey Auditory Verbal Learning Test

On history and mental status:

• Expressive
  • Word-finding difficulty
  • Decreased spontaneity of speech
  • May not recall names of friends or family
  • Paraphasic errors, substitution of specific terms with general
    • “that thing” or “you know what I mean”
• Comprehension

On cognitive testing:

• Expressive - Naming, verbal fluency (letter and category), “Boston Naming”
• Comprehension – verbal commands

On history and mental status:

• Increased reliance on others or maps for directions
• Getting lost
• Difficulties with previously familiar tasks (carpentry, sewing, driving)
• Gnosis – inability to recognize familiar objects

On cognitive testing:

• Drawing a clock
• Figure copying - cube/intersecting pentagons
• Demonstrating learned movements, i.e. - testing for apraxia (wave goodbye, show me how you would comb your hair)

On history and mental status:

• Change in personality
• ↓ Empathy
• ↓ Recognition of emotions
• Apathy
• Inappropriate social behavior

On cognitive testing:

• Identification of emotions in images of faces
• Theory of Mind story cards – elicit information about characters

On history and mental status:

• Difficulty with multitasking
• Decision making
• Problems with IADLs

On cognitive testing:

• Trail making test
• Clock drawing (+visual-spatial tasks)
• Working memory: repeating letters/numbers backwards
• Insults to circuits from dorsolateral prefrontal cortex (frontal) going all the way basal ganglia/thalamus (deep brain structures) can be be responsible for bedside “frontal” findings

On history and mental status:

• Routine tasks take longer or more errors
• ↑ Difficulty in environments with multiple stimuli (TV, radio, conversation)
• ↑ Difficulty holding new information in mind (e.g. - phone numbers, addresses)

On cognitive testing:

• Digit span forward
• Vigilance A test (tapping)
• Spelling backwards