Learning/Memory/Timing

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Physicians Guide to the Management of Huntington's Disease
The Cognitive Disorder (CHAPTER 4)

Learning & Memory/Timing

Learning & Memory

The type of memory impairments found in HD consist mostly of difficulties in learning new information, and in retrieving acquired information, but not in storage of information. Problems occur in getting information in and out, due to the slowed speed of processing and the poor organization of information.

Several studies have found that HD patients can demonstrate normal memory for information if offered in a recognition format. If, rather than asking "can you tell me what time your doctor's appointment is today?," one inquires "is your doctor's appointment at 10:00 or 11:00 today?," persons with HD can often answer correctly.

Similarly, if patients with HD are given a long list of words to learn and are required to say the words back freely they perform poorly. But if they are given a list of words and asked to recognize which ones were on the earlier list they demonstrate good memory.

It has been observed that persons with severe amnesia such as that associated with Korsakoff's syndrome, herpes encephalitis, or Alzheimer's disease can experience defective explicit memory, such as for names and dates, and intact implicit, or unconscious memory, such as the ability to tie one's shoes.

In contrast, persons with HD typically have impairments in skills that depend on implicit memory. Driving, playing a musical instrument, or riding a bike are all motor memories that can be considered implicit, or unconscious.

HD impairs this motor memory system, making HD sufferers reliant on more effortful conscious memory systems to drive a car. Consequently, driving will take much more concentration and effort, resulting in increased fatigue and irritability.

Timing

Some recent findings have suggested that persons with HD have difficulty with the estimation of time. For instance, persons with HD may be less able to judge how much time has elapsed. Spouses often complain that their once-punctual spouse becomes frequently late and mis-estimates how long activities will take.

Frequent reminders may be needed to keep on schedule. It is helpful to allow extra time and avoid time pressure when possible.

TABLE 10: COPING STRATEGIES FOR MEMORY

Keep day to day activities as routine as possible.

Use schedules.

Use "to do" lists and reminders.

Offer a list of choices to assist with recall.

Provide cues to help with the retrieval of information.