Question
How is memory assessed in patients with cognitive-linguistic difficulties?
Answer
Memory is one of the key skills assessed in patients with cognitive-linguistic difficulties. There are many types and facets of memory. Typically, for individuals with cognitive-linguistic difficulties, we assess: immediate, working, short-term, prospective and long-term memory. These can be defined as:
- Immediate memory is our ability to hold onto information long enough to write it down. For example, our ability to hear a phone number and then dial it.
- Working memory is our ability to take in information - usually multiple pieces of information - hold onto it, manipulate it, and then get an answer or product. For example, we use working memory when reading a recipe and cross-referencing how much of an ingredient we need with what we already have in order to determine how much more to buy.
- Short-term memory is our ability to recall information from earlier today, yesterday or earlier this week. This pertains to conversations, events, details, etc.
- Prospective memory is our ability to recall things or plans that will happen in the future.
- Long-term memory includes information about where we were raised, our family members, memories from the past.
Patients or family members often say, "Oh, my memory is fine. I can remember everything from when my kids were young." This is where we are called to educate our patients and their families about the different types of memory, and how deficits can exist in one form of memory, but maybe not in others.
The same set of stimuli can be used to assess different types of memory. For example, you can say to the person, "I'm going to give you four words, I want you to repeat them back to me and then remember them for later." It is better to choose words that are unrelated to one another because that is more challenging than providing words that are similar. The patient's ability to restate the words immediately assesses their immediate memory. Their ability to recall the unrelated words after some time has passed assesses short-term memory. A concept called “filled delay” is when the time delay in the task is filled with other stimuli. You would present the words, move on to another task, then go back to the words after some time has passed. The time delay could be a just a minute or two, depending on how the patient did with the immediate memory task. You can even wait longer if you think the patient needs more of a challenge.
If the words are not recalled after this delay, you can scaffold the cues. For example, start with a category cue, such as, "It's a type of flower." If this is not successful, then give binary options, such as, "Was it a rose or a tulip?" Start with the least restrictive cue, increasing as needed for the patient. If you start with the most obvious cue then you won't know if the patient would have been successful with less help.
Short-term memory can be assessed by asking about previous events within the hospitalization, such as what they ate for breakfast or what visitors they had yesterday. Just be sure to know the answers to the questions that you're going to ask.
In order to assess prospective memory, the same set of words can be used from a previous task, but the patient must repeat the words with no prompting. For example, the patient has to repeat the list of words, unprompted, when the clock displays a certain time. Note that prospective memory is an advanced skill, and you may only get to assess this with higher-level patients.
Long-term memory can be assessed by asking the patient about their demographics or their family information. Again, be sure to know the answers to these questions before asking them. If a patient struggles, you want to be able to reinforce the correct information for them.
Please refer to the SpeechPathology.com course, Assessment of Cognitive-Linguistic Skills: The SLP's Role in Acute Care, for more in-depth information on the rationale for completing cognitive-linguistic evaluations with adults in the acute care setting.
