This paper was originally prepared by Prof. Alan Parkin, University of Sussex and
revised in 2002 by Prof Barbara Wilson, Clinical Director,Oliver Zangwill Centre,
Ely
Encephalitis is a broad ranging term but, in adults at least, the most common form
results from the herpes simplex virus. However, encephalitis can also be caused
by other viruses such as the chickenpox virus, herpes zoster. If we look at the
brain of someone who has suffered a herpes simplex infection it is almost inevitable
that we will see some damage to the temporal lobes of the brain. The location of
the damage explains why memory loss is the most frequent and often most disabling
effect of encephalitic illness. It is well established that the temporal lobes are
actively concerned with forming new memories (a process known as consolidation)
and that this brain region is also responsible for storing memories. For this reason
a person who has suffered from encephalitis will have problems remembering new information
(e.g. the name of their doctor) and also have difficulties recalling events before
their illness (e.g. family holidays).
Confronted with someone who has memory problems following encephalitis it is very
important to remember that not every aspect of memory is affected. Thus although
most people will have marked difficulties in remembering what has happened and what
is going to happen , they will usually remember people and facts they learned
some time before they became ill. Skills, such as typing and swimming are usually
unaffected and language also survives fairly well - however some deficits, particularly
word finding problems, may sometimes be encountered.
There are several straightforward practical steps that you can take to help someone
with a memory problem. These apply particularly to life in the home.
- Use labels to indicate where things go (e.g. which cupboards are for crockery, food
etc.).
- Place signs in places where the memory impaired person might forget to take something
(e.g. a sign by the door reminding him/her to remember the key). Placing things
on the floor by the door e.g. keys, library books etc. helps people to remember.
- Use a prominent wall chart to indicate the date and any events that are taking place
that day. Effective use of this can reduce the amount of repetitive questioning
that sometimes occurs when people have a memory impairment and also increase self
reliance.
- Encourage the person to use a diary and write notes. This will also reduce repetitive
questioning and increases self reliance.
- If the person has problems finding certain places then try to make them distinctive.
The toilet, for example, can be made easier to find by painting the door a different
colour to the rest. Alternatively the path to it can be marked with distinctive
masking tape.
- If there are certain items that the person habitually misplaces (e.g. glasses) put
a flow chart on the wall giving instructions about which places to look for them.
- Try to stick to a regular routine. There is plenty of evidence that memory-impaired
people can pick up routines and that they can become quite unsettled if these routines
are interrupted and they are not told - don't take it for granted that they "know"
what's going on.
- Organise the environment so it is structured and uncluttered - keep things
in the same places as much as possible. This will enhance the possibility of the
person learning where things are.
- Keep a notepad by each telephone so that the person can take messages. Try to ensure
that the caller's number is always recorded. A specially designed memo pad
is useful here - with standard spaces for time of call, name of caller, telephone
number and message.
- Using the memory function on the telephone for more commonly dialled numbers can
help greatly, avoiding the need to recall a number. Telephone diallers are
also becoming more common and consist of-a pocket sized device which stores names
and telephone numbers enabling a number to be found easily, and will activate automatic
dialling if used with a multi-frequency telephone exchange.
-
Display photographs of family and friends prominently and label them with their
names.
The above are all things you can do without any specialised help but more is possible
if you seek the professional help of a psychologist who is trained in neuropsychological
rehabilitation techniques.
With the benefits of modern technology there are now a large number of electronic
memory aids on the market and these offer great scope for memory-impaired
people. Personal organisers hold the greatest potential because these can store
lots of information and prompt the person at specific time points up to a year ahead.
However, learning to operate these requires a degree of memory ability and you may
well need the help of a psychologist to achieve this. While some people have successfully
made use of personal organisers others have found them too difficult to use. Nonetheless
there are simpler approaches that may still be effective. One approach is to use
a watch that beeps every hour and train the person to consult a daily schedule (e.g.
at 11 am put the oven on for lunch) whenever the watch beeps. There are watches
that will display a limited amount of information at a particular time point. Casio,
for example, make a watch that can be programmed to display short messages at particular
times and this costs around £30. There are also "pill reminding"
devices that be obtained for about £15. Post it notes can be invaluable. A
pager called NeuroPage has been studied extensively in Cambridgeshire and has been
shown to reduce the everyday problems of many memory impaired people . NeuroPage
is now available as a service from The Oliver Zangwill Centre,Princess of Wales
Hospital,Ely,Cambs,CB6 1DN.
There is a large market in electronic reminding devices and you should be
able to get something useful at a reasonable cost. However, make sure you get advice
first.
In the last 20 or so years there has been great interest in developing various means
of helping people cope with memory difficulties. One idea was that a damaged memory
was rather like a damaged muscle which, with appropriate exercise, could be made
strong again. To test this out psychologists got memory-impaired people to practice
using their memory by carrying out drills (e.g. trying to remember lots of lists
of words). This rather boring therapy was made somewhat more enjoyable by the use
of computers but the results were disappointing - a damaged memory does not recover
with practice. Memory loss arises because brain cells have been irreparably damaged
and there is no way of restoring their function.
A different approach is to try and teach the person strategies for using their remaining
memory abilities more effectively .There are strategies to help people remember
some information more efficiently and psychologists have shown that memory-impaired
people can be taught to use some of these effectively. Thus it has been shown that
people can improve their memory for text by using particular study techniques and
that a range of other memory aids can also be effective. Because it is difficult
for people with memory problems to remember to use these strategies spontaneously,it
is often family members or therapists who devise and work through these strategies
or mnemonics. Their value lies in the fact that people learn things more quickly
when using these strategies than when simply repeating things without a strategy.
We can also provide memory-impaired people with a rule book for them to
consult when attempting to remember something. One Dutch study gave
people the following rules to help them with remembering:
- Use external aids wherever possible
- Pay more attention.
- Spend more time.
- Repeat information you wish to remember.
- Make associations to the things you are trying to remember.
-
Organise what you are trying to remember.
Four months after training it was found that those people given the rules did better
than those subjected to memory drills.
A number of psychologists now run memory "clinics". This is a rather misleading
term because it tends to imply that attendance will somehow make memory better.
In fact these clinics usually operate by assigning the memory-impaired patient to
a "memory group". In these groups people often try out new strategies
for remembering things and generally discuss their problems. While there is always
a tendency for these group discussions to spill over into other aspects of individual's
difficulties, there is evidence that people attending them become less depressed
even though there is no improvement in their memory ability.
The outstanding benefit obtained in the groups that we have been involved in has
been twofold - first it provides an environment where people can discuss problems
with others who understand from first hand experience the specific difficulties
encountered by others. In many cases this has led to relief when participants
discover that their problems are shared by the majority of people - when previously
they had thought themselves to be alone and abnormal (particularly with problems
of anger and frustration). Secondly this led to "self help" discussions,
with participants passing on tips for coping with problems, which were typically
better received coming from other "sufferers" than from carers or
other experts. These aspects which arose unexpectedly from the group are of a social
nature, and could be facilitated on a more casual level in small
self help groups with a sympathetic uninvolved facilitator.
While strategies may be of some help many psychologists believe that memory rehabilitation
can only be effective if it targets specific needs. One area, in particular, is
that of learning to use a computer. Rehabilitation and day-care centres frequently
contain computers but their use will be limited if the clients are unable to learn
how to use them more flexibly. Recently a number of studies have shown that even
severely impaired people can be taught how to use computers and, in some instances,
this training has enabled the person to resume employment. At first it might seem
paradoxical that someone who is unable to remember anyone's name should nevertheless
learn to operate a computer. The explanation is that learning how to use a computer
partly relies on a form of memory that is usually unaffected by brain damage. Thus
although learning is slower, and less comprehensive than that obtained by normal
people, it can proceed to a point where the person has acquired enough knowledge
to work independently. However, training the average memory-impaired person to use
a computer is not easy and will usually require some assistance from a psychologist
specialising in rehabilitation.
Up until recently it was usual practice to encourage a memory-impaired person to
guess if they did not know the answer to question. Recent research does, however,
question this approach because what happens is that the person tends to keep remembering
their incorrect guess rather than the correct answer. This has given rise to a new
form of training which is called "errorless learning". In this training
the person is exposed to the answer a number of times before being asked to remember
it thus greatly reducing the possibility of an error being generated. Studies in
Cambridge and Sussex have shown the method to be effective for teaching
people to remember names, directions, and how to operate a personal organiser. This
approach has great promise but it is still in its infancy. Nonetheless, the basic
message is clear: if you are trying to teach a memory-impaired person something
avoid them making errors at all costs. We can only benefit from our mistakes if
we can remember the mistakes.
Whether you are memory-impaired or a carer we hope this article has given you some
encouragement about coping with memory difficulties. Much of what we have said involves
things you can do for yourself. However, we are acutely aware that some things (e.g.
computer training) require considerable professional help which may not be available
in your area. Nonetheless, we hope that simply knowing it is available will encourage
you to pursue it.
Useful literature
Clare L and Wilson B.A. Coping with Memory Problems: A Practical Guide for
People with Memory Impairments and their Relatives and Friends (1997) Bury St Edmunds,Thames
Valley Test Company
A useful book especially written for families.
Kapur, N. Managing Your Memory. A Self-Help Manual for Improving Everyday
Memory Skills.
Wilson, B.A. Memory Problems after Head Injury. Booklet published by Headway.
Both the above are very useful leaflets aimed at both people affected and carers.
Baddeley, A.D. Your Memory: A User's Guide. 2nd Ed. London: Lifecycle publications.
1993
This is a good introduction for the intelligent lay person
Parkin, A.J. Memory and Amnesia: An Introduction.. Oxford: Blackwells. 2nd
Ed.
This is aimed more at non-psychology professionals who seek a broader understanding
of memory and its dysfunction.
Wilson, B.A & Moffat, N. Clinical Management of Memory Problems. London:
Chapman & Hall. 1992.
Aimed at professionals. Contains a great deal of information about all aspects of
memory rehabilitation.
Last modified: September 2004