Friday, June 29, 2012

Memories, Like the Corners of My Mind

Misty Fjords - Alaska
Misty Fjords - Alaska (Photo credit: blmiers2)
Like the corners of my mind
Misty water-colored memories
Of the way we were
Scattered pictures,
Of the smiles we left behind
Smiles we gave to one another
For the way we were
Can it be that it was all so simple then?
Or has time re-written every line?
If we had the chance to do it all again
Tell me, would we? could we?
Memories, may be beautiful and yet
What's too painful to remember
We simply choose to forget
So it's the laughter
We will remember
Whenever we remember...
The way we were...

The way we were...
  -- Barbara Streisand

Lately, memory issues are coming to the forefront.  As my Gentle Readers know, I have done an awful lot of remediation on vision, hearing, balance, and motor skill issues.  A number of higher order problems with some higher order problems seem to have cleared themselves up naturally as basic problems with my eyes, ears, and body have been resolved.  I feel that I am thinking much clearer and can get more stuff done since I am not tripping over myself, but memory problems seem to be coming to the forefront.

 I had started doing some work on higher order function including memory with Captain's Log but I am taking a hiatus from Captain's Log as I have been doing waaaayyyy too much and need a break.  Also, I will be winding down vision therapy and not driving out to Lancaster for the months of July and August.   I will also be winding down my body work with Maria for a bit as well.   I have to finish up RevitalVision and get that out of the way.  Customer Support has called me and told me that I am not done yet!  So, I will comply and finish their program.  I still have to finish LACE for auditory discrimination.  But I do want a break from everything and want a period of just living life as a person and not as a patient!

However, I do want a roadmap of what to pick up again.  So I am doing some assessments.  I have an appointment with Dr. Seiderman on July 2 to see where I am with vision.  I will go see a doctor who specializes in smell this summer.   I will also talk with A Total Approach about other higher order deficits than memory.  I'd like to get a plan together as to how to tackle things as I will be starting to return to the real world and will be looking for a part-time job or consulting work soon.  More on that in another post.

But, Back to Memory.   Why is it coming up an issue? When you look at my initial scores in my assessment with Columbia Presbyterian back in 2009,  I don't show any problems, or do I have them, in spite of this test by a prestigious institution?   My working memory was tested as being high average to superior.  Verbal memory, immediate and delayed recall of narrative material was in the average and high average range.  Nonverbal memory scores are mixed:  Serial learning of abstract design was in the high average, the delayed recall was superior, immediate recognition of faces was in the low average range and delayed recognition of faces was in the average range.

The raw data for my scores on my neuropsych assessment is: 

WAIS III Working Memory:

Overall:  77%

Digit Span SS:              Raw Score  16      Percentile   36             Average
   Longest Forward:      Raw Score    7      Percentile   37             Average
   Longest Backward:    Raw Score   4      Percentile   61             Average
   Forward Backward:   Raw Score   3      Percentile   26             WNL

Letter Number:             Raw Score   13    Percentile   84            Average
Arithmetic:                   Raw Score   19    Percentile   14            High Average
Spatial Span:                Raw Score   16    Percentile   63            High Average


WAIS III Information:    Raw Score    26      Percentile    95      Superior
WAIS III Logical Memory:  
    Logical Memory I:      Raw Score   42      Percentile    63      Average
    Logical Memory II:     Raw Score   28      Percentile    75      High Average
    Logical Memory % Retention:   Raw Score   90       Percentile  84    High Average
    LM Recognition:  25/30


  Faces I:                             Raw Score   34       Percentile   25         Low Average
  Faces II:                            Raw Score   35       Percentile   37        Average
  Faces Percent Retention:  Raw Score  100      Percentile   75        High Average

BVTM-R (Brief Visuospatial Memory Test- Revised)
Trial 1                                  Raw Score      7       Percentile   69        Average
Trial 2                                  Raw Score     11      Percentile   90         High Average
Trial 3                                  Raw Score     12      Percentile   92         Superior
Total Recall                         Raw Score     30      Percentile   86          High Average
Learning                              Raw Score      5       Percentile   76          High Average
Delayed Recall                    Raw Score    12       Percentile   93         Superior
Percent Retained                 Raw Score    100     Percentile  >16         Within Normal Limits
Recognition Hits                 Raw Score       6      Percentile  >16         Within Normal Limits
Recognition False Alarms  Raw Score       0      Percentile  >16         Within Normal Limits
Recognition Discrimination Index   Raw Score   6         Percentile  >16         Within Normal Limits
Recognition Response Bias              Raw Score    0.5     Percentile  >16         Within Normal Limits

However,  I had my visual memory tested by Dr. Herzberg later in 2009 with a  whopping score of being in the bottom 9%.  After a year of vision therapy, it had improved to the 85%!  I thought, Woo Hoo!  I've licked that one!  I do think that getting my eyes to work better has helped me not stress and strain over visual material and that a certain amount of problems remembering visual material were really eye teaming, and scanning problems, etc. and not a global memory problem per se.  I remember how much easier visual exercises got when I put on anti-suppression glasses.  However, the story is not so simple.

If my Gentle Readers recall my odyssey through the cortex, they will recall that I finished a program of Balametrics/Tomatis and Interactive Metronome.  These programs left me feeling a lot more mentally on the ball.   I feel that I began to think clearer and not be quite so forgetful.  Before my odyssey down the cortex, I often felt like the absent minded professor.  Now, not so much.

As my Readers remember, I did Posit Science's Brain Fitness.  This program worked on auditory functions, processing speed, auditory discrimination, and auditory memory.  Unfortunately, Brain Fitness does not give you really good statistics, just general measures of improvement; so you don't know if you are at the bottom and made some improvements or just average and made some improvements.  However, I did note that I was having problems passing the test where you are listening to disjoint syllables and remembering the order.  I could get four syllables in order but was having troubles with five syllables.  Also, I was having problems following more than four instructions.  Try as I might, I could not sustain five syllables.   My audiologist thought that I was not having auditory problems per se and that I was having more global memory problems and that maybe I should try Cogmed.

I also have tinnitus and that impacts working memory as well.

When I went to see a neuropsychologist regarding social skills training, I did do a test on emotional  recognition where I performed below average enough to be of concern; but not so far below average as folks with Aspergers syndrome.  I have put off social skills training for a couple of reasons:  my therapists don't think that it is a pressing issue for me and I would simply like to hear better and see better before I tackle that one.  Another thing is that emotional processing is gated by spatial processing.  Facial recognition is also located near the part of the brain that does spatial orientation.  Folks with facial agnosia often have problems with orienting themselves to the world.  I may be dead wrong on this one, but I am wondering if some of these problems will just clear up as I get 3D vision. I do wonder how much memory impacts this as well.

While we are on the subject of outliers, (in medical profession, otherwise known as chasing zebras), I don't have much of a sense of smell.  I got diagnosed with severe anosmia, lack of sense of smell.  I do have some smell sense and it can be activated by a lidocaine mixture.  It has not improved much as I have not been diligent in taking the 600 mg dosage of alpha lipoic acid (ALA) recommended.  However, people don't have a high degree of confidence in ALA.  Why do I bring up smell?  Smell and memory are known to be highly interconnected along with the limbic system.  I wonder if I improve my sense of smell (if at all possible), whether memory will improve as well. 

Meanwhile, I have been flogging away at different memory exercises in vision therapy with Dr. Seiderman.  While I have been wearing the different prisms or using flippers, I have been doing various visual exercises.   I'll have to double check but I don't recall having problems with visual memory with those exercises.   I will ask the vision therapists to get me harder exercises.  They are already having problems finding me challenging visual exercises!

I also have worked on Captain's Log and was having some problems with certain exercises.  I described these problems to Maude and she, too, started to think about memory problems.  However, she was not sure that Cogmed would be the right program to start with as there was not too many auditory memory exercises compared to visual exercises and she did not want visual memory skills to get too far ahead of auditory ones. 

So,  she managed to get ahold of a trial copy of AWMA, Automated Working Memory Assessment, from Pearson.  the same company that does Cogmed.  I am a good guinea pig  and will sit through another round of mindless testing!  I don't know who else would sit through this stuff!  Well, all for a good cause.   The interesting thing about AWMA is that it looks at both Verbal and Visual Working Memory and Short Term Memory.

TEST                                                 STANDARD SCORE    PERCENTILES

Digit recall                                                       111.0                     77.0
Word recall                                                        93.0                     32.0
Nonword recall                                                113.0                     86.0
Composite score                                              107                        70

Listening recall                                                119.0                      91.0
Listening recall processing                                99.0                      50.0
Counting recall                                                  96.0                      44.0
Counting recall processing                                94.0                      44.0
Backwards digit recall                                     119.0                       90.0
Composite score                                               114                          83

Dot matrix                                                          88.0                       24.0
Mazes memory                                                   70.0                        3.0
Block recall                                                        77.0                         5.0
Composite score                                                 73                            4

Odd-one-out                                                       82.0                        17.0
Odd-one-out processing                                     80.0                       16.0
Mister X                                                            118.0                      92.0
Mister X processing                                          113.0                       88.0
Spatial recall                                                       86.0                       20.0
Spatial recall processing                                     86.0                       22.0
Composite score                                                  94                         38

So the net result, for those who aren't up for reading statistics is that, for my age group:
  • Verbal working memory is within the average
  • Verbal short term memory is within the superior/high average
  • Visuo-Spatial Short Term Memory is below average
  • Visuo-Spatial Working Memory is average
So, what does this all mean?  I don't know quite yet and will wait for my chat with Maude to figure this stuff out.

Another interesting thing that is popping up is that I am also doing some intense bodywork and getting a lot of knots worked out of my body with Maria.  There is a lot of intense emotional memories that have tied up my poor body in knots.  These emotional memories are very suppressed and often times, I don't know what they are other than a general feeling of sadness.  But they are going away as she untangles my body.  Sometimes, this is a very intense experience as she manipulates my body and I am just yowling as she hits a tender spot-- you know, it's that fine line between pleasure and pain.   So, as my body gets worked out, I wonder what that will mean for memory as well.

At the end of the day, what does this mean in real life?  I feel that my memory has improved from all my therapies but I am still having some problems.  Some of these problems relate to some ADHD symptoms I have.  My occupational therapist, Wilma,  has noted that I can tend to get excited about something and start blurting it out before certain social signals have passed indicating that she is ready to have this conversation.  She blames it on memory--I have something I really want to say but I am like a kid who has to go to the bathroom (a kind of OOOOHHH, OOOOHHH, I can't hold it in any longer!).

I also find I act like Poindexter in Felix the Cat TV show.  Just absent mindedly starting one task and then going on to another.    So some of this whole memory could relate to some attentional problems I have.  Columbia Presbyterian didn't think I have ADHD but did note some problems with impulsivity and attention via the Conners Test.  I did the TOVA and it reaffirmed some problems with response time and response time variability.  So maybe some of my problems are indeed attentional.

Wilma also noted that I have a choice:  I can continue to work on memory issues with other providers or I can learn some compensations from her.  I told her I wanted to do both!  I think I can improve memory but that at middle age, I am potentially just pushing back the tide and that I better learn compensations that I can draw upon later on in life even if memory is improved for now.   I think I will make an assault on memory and see where that takes me and then reach for compensations as I need them.  I think every five years I will get evaluated and check around to see if there is anything new on the market.  I think that given the large number of aging Baby Boomers that there will be lots of research done on memory so there may be other things to try.  

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