Prospective memory in clinical populations [post-print]

Objective: Prospective memory (PM) has emerged as a form of episodic memory that is frequently impaired in a variety of clinical populations. Neuropsychologists who routinely evaluate these populations are often unaware of the possibility of PM deficits or the impact these deficits may have on everyday functioning. The objective of this special issue is to provide an overview of the nature of prospective deficits in a range of clinical populations, to discuss neuropsychological assessment techniques, and to critically evaluate management strategies. Method: We solicited papers from established researchers and issued a general call for papers for the special issue on PM in clinical populations. Results: We received submissions from the nine authors that we solicited. These submissions range from developmental disorders, including autism, attention deficit hyperactivity disorder, and dyslexia; to disorders of adulthood, such as schizophrenia, HIV, brain injury, and multiple sclerosis; and finally disorders that tend to occur at older ages, such as Parkinson’s disease and mild cognitive impairment. In addition, we have included four original research articles that provide novel data on other populations. These are children and adolescents with 22q11.2 deletion syndrome, first-degree relatives of people with schizophrenia, individuals with mild brain injury, and individuals with idiopathic REM sleep behavioral disorder. Conclusions: The issue highlights the need for clinical neuropsychologists to be aware of the possible existence of deficits in PM in a variety of clinical populations and the importance of both assessment and management strategies to reduce the impact on daily life

False Oaths: The Silent Alliance between Church and Heretics in England, c.1400-c.1530

This dissertation re-examines trials for heresy in England from 1382, which saw the first major action directed at the Wycliffite heresy in Oxford, and the early Reformation period, with an emphasis on abjurations, the oaths renouncing heretical beliefs that suspects were required to swear after their interrogations were concluded. It draws a direct link between the customs that developed around the ceremony of abjuration and the exceptionally low rate of execution for “relapsed” and “obstinate” heretics in England, compared to other major European anti-heresy campaigns of the period. Several cases are analyzed in which heretics who should have been executed, according to the letter and intention of canon law on the subject, were permitted to abjure, sometimes repeatedly. Cases that ended in execution despite intense efforts by the presiding bishop to obtain a similarly law-bending abjuration are also discussed. These cases are situated within explorations of the constitutions governing heresy trials, contrasting their use of apparently standard legal terminologies with more aggressive continental inquisitors, as well as the theology and cultural standing of oaths within both Wycliffism and the broader Late Medieval and Early Modern world. This dissertation will trace how Lollard heretics gradually accepted the necessity of false abjuration as one of a number of measures to preserve their lives and their movement, and how early adopters using coded writing carefully persuaded their co-religionists of this necessity. Furthermore, it will argue that the bishops who conducted the trial system deliberately constructed it to encourage this type of perjury, even suppressing attempts to alter heretics’ actual convictions, for the sake of social order and stability

A review of prospective memory in individuals with acquired brain injury [pre-print]

OBJECTIVE: Prospective memory (PM) deficits have emerged as an important predictor of difficulty in daily life for individuals with acquired brain injury (BI). This review examines the variables that have been found to influence PM performance in this population. In addition, current methods of assessment are reviewed with a focus on clinical measures. Finally, cognitive rehabilitation therapies are reviewed, including compensatory, restorative and metacognitive approaches. METHOD: Preferred reporting items for systematic reviews and meta-analyses guidelines were used to identify studies. Studies were added that were identified from the reference lists of these. RESULTS: Research has begun to elucidate the contributing variables to PM deficits after BI, such as attention, executive function and retrospective memory components. Imaging studies have identified prefrontal deficits, especially in the region of BA10 as contributing to these deficits. There are now several clinical measures available with good psychometric properties. Rehabilitation techniques have mostly focused on compensatory strategies, but, in addition, some restorative and metacognitive approaches have shown preliminary promise. CONCLUSIONS: PM deficits are a common and important deficit after BI. Clinical evaluation is recommended and further understanding of rehabilitation techniques is needed

Effect of Type of Cue, Type of Response, Time Delay and Two Different Ongoing Tasks on Prospective Memory Functioning after Acquired Brain Injury [post-print]

Failures of prospective memory (PM) are one of the most frequent, and least studied, sequelae of brain injury. PM, also referred to as memory for intentions, is the ability to remember to carry out a future task. Successful completion of a PM task requires the ability to monitor time, keep the action to be performed periodically in awareness, remember the task to be performed, and initiate the action. Although PM has been shown to be a common difficulty after brain injury, it remains unknown which aspects of performance are impaired. In this study, the performance of 25 individuals with brain injury and that of 25 healthy participants were measured separately on the following variables: time until completion of the task, difficulty of the ongoing task being performed while waiting, whether the task to be performed is an action or is verbal, and whether the cue to perform the task is the passing of a particular amount of time (e.g., 10 minutes) or is an external cue (e.g., an alarm sounding). Individuals with brain injury demonstrated impairment compared to healthy adults on virtually all variables. PM performance was also compared to a battery of standard neuropsychological measures of attention, memory, and executive functions, and to self-report measures of PM functioning, in order to determine the underlying cognitive deficits responsible for poor PM performance, if any. PM performance was correlated with measures of executive functioning but not to self-report measures of PM functioning. Implications are discussed in terms of cognitive rehabilitation recommendations

Measurement of prospective memory in Spanish speakers

Introduction: This study aimed to provide preliminary evidence on the psychometric properties of a measure of prospective memory in Spanish speakers, the Memory for Intentions Test (MIST) Spanish translation. Methods: In addition, this study investigated whether acculturation influenced performance on the MIST. Finally, we measured other cognitive factors that might be impacting the relationship between culture and prospective memory performance. These factors were working memory, autobiographical memory, and episodic future thought. Results: Overall, the psychometric properties of the Spanish MIST appear to be similar to the English language MIST, but our sample size was too small to allow for the creation of a normative database. The MIST recognition item was significantly related to years of education and years of speaking either Spanish or English. Discussion: This suggests a need to investigate ways to improve the test to eliminate these effects. In addition, acculturation was related to the measure of episodic future thought

Visual-Spatial and Set-Shifting Functions in Patients with Parkinson\u27s Disease

Patients with Parkinson\u27s disease (PD) (N=20) were compared to age and education-matched normal control subjects (N=20) on 18 paper-and-pencil neuropsychological measures. These tests were chosen to measure two specific functions. The first set of tests was chosen to measure spatial orientation, and these tests were divided into those that measure personal orientation, extrapersonal orientation, mental rotation, and right/left orientation. The second set of tests was chosen to measure the ability to shift mental set. Hotelling\u27s multivariate T2 tests revealed a significant difference between the PD patients and the normal control subjects on the tests chosen to measure set-shifting ability but no difference between the groups on those tests chosen to measure spatial orientation. These results are related to other studies that have demonstrated deficits in PD patients similar to those observed in patients with damage to the frontal lobes, supporting the hypothesis that a disruption of dopaminergic fibers to the prefrontal cortex may partly account for the cognitive deficits observed in patients with PD

Prospective memory intervention using visual imagery in individuals with brain injury [pre-print]

Prospective memory deficits are common after brain injury and can create impediments to independent living. Most approaches to management of such deficits are compensatory, such as the use of notebooks or electronic devices. While these can be effective, a restorative approach, in theory, could lead to greater generalisation of treatment. In the current study a metacognitive technique, using visual imagery, was employed under conditions of rote repetition and spaced retrieval. Treatment was provided in an AB-BA crossover design with A as the active treatment and B as a no-treatment attention control to 20 individuals with brain injury. A group of 20 healthy participants served to control for effects of re-testing. Individuals with brain injury demonstrated improvement on the main outcome measure of prospective memory, the Memory for Intentions Screening Test, only after the active treatment condition. In addition, some generalisation of treatment was measured in daily life. Moreover, treatment gains were maintained for one year after treatment was completed

Intraosseous Synovial Sarcoma of the Proximal Tibia

Synovial Sarcoma is a malignant mesenchymal tumor that comprises 5–10% of all soft tissue sarcomas. The mean age of onset is thirty years old. Intraosseous presentation is very rare and has only been documented a few times. We report herein a case of a 53-year-old man with synovial sarcoma arising in the left proximal tibia. The patient underwent a wide surgical resection and reconstruction, followed by adjuvant chemotherapy. Three years later, the patient developed a local recurrence that resulted in an above-the-knee amputation. Eight months later, the patient has completed chemotherapy and is without signs of recurrence. The current recommended treatment for synovial sarcoma is wide surgical resection followed by chemotherapy as well as long-term followup. Despite improved surgical techniques, long-term survival rates remain low

Prospective memory in schizophrenia: Relationship to medication management skills, neurocognition and symptoms in individuals with schizophrenia [pre-print]

Objective: Impaired adherence to medication regimens is a serious concern for individuals with schizophrenialinked to relapse and poorer outcomes. One possible reason for poor adherence to medication ispoor ability to remember future intentions, labeled prospective memory skills. It has been demonstratedin several studies that individuals with schizophrenia have impairments in prospective memory that arelinked to everyday life skills. However, there have been no studies, to our knowledge, examining therelationship of a clinical measure of prospective memory to medication management skills, a key elementof successful adherence. Methods: In this Study 41 individuals with schizophrenia and 25 healthy adultswere administered a standardized test battery that included measures of prospective memory, medicationmanagement skills, neurocognition, and symptoms. Results: Individuals with schizophrenia demonstratedimpairments in prospective memory (both time and event-based) relative to healthy controls.Performance on the test of prospective memory was correlated with the standardized measure ofmedication management in individuals with schizophrenia. Moreover, the test of prospective memorypredicted skills in medication adherence even after measures of neurocognition were accounted for.Conclusions: This suggests that prospective memory may play a key role in medication managementskills and thus should be a target of cognitive remediation programs

Application of Lean Principles to Neurosurgical Procedures: The Case of Lumbar Spinal Fusion Surgery, a Literature Review and Pilot Series

BACKGROUND Delivery of higher value healthcare is an ultimate government and public goal. Improving efficiency by standardization of surgical steps can improve patient outcomes, reduce costs, and lead to higher value healthcare. Lean principles and methodology have improved timeliness in perioperative medicine; however, process mapping of surgery itself has not been performed. OBJECTIVE To apply Plan/Do/Study/Act (PDSA) cycles methodology to lumbar posterior instrumented fusion (PIF) using lean principles to create a standard work flow, identify waste, remove intraoperative variability, and examine feasibility among pilot cases. METHODS Process maps for 5 PIF procedures were created by a PDSA cycle from 1 faculty neurosurgeon at 1 institution. Plan, modularize PIF into basic components; Do, map and time components; Study, analyze results; and Act, identify waste. Waste inventories, spaghetti diagrams, and chartings of time spent per step were created. Procedural steps were broadly defined in order to compare steps despite the variability in PIF and were analyzed with box and whisker plots to evaluate variability. RESULTS Temporal variabilities in duration of decompression vs closure and hardware vs closure were significantly different (P = .003). Variability in procedural step duration was smallest for closure and largest for exposure. Wastes including waiting and instrument defects accounted for 15% and 66% of all waste, respectively. CONCLUSION This pilot series demonstrates that lean principles can standardize surgical workflows and identify waste. Though time and labor intensive, lean principles and PDSA methodology can be applied to operative steps, not just the perioperative period