Introduction

A young man with head injuries described his memory functioning in the following words: 'My memory is like a tape on a tape recorder with large chunks erased or of poor quality'. Like this young man, people often talk about memory as though it were one particular skill or single function. We might hear someone say, 'He has a photographic memory' or 'My memory is dreadful'. In fact, memory comprises a number of subskills, subsystems, or subfunctions working together. The number of these subdivisions, and their roles, depend on the model or classification system used to interpret or explain memory functioning. One influential model proposed by Baddeley and Hitch(1..) subdivides memory into three main categories depending on the length of time information is stored. We can also divide memory into a number of systems for remembering different types of information that can be labelled as semantic, episodic, or procedural. Yet another way to conceptualize memory is by considering the different stages involved in remembering: namely encoding, storing, and retrieving. Other ways of regarding memory include subdividing the kinds of remembering required into recall or recognition; or by demonstrating that something has been remembered in terms of whether it is explicit or implicit; or, in the case of lost memories, whether they date from before or after a neuropsychological insult, that is whether there is retrograde or anterograde amnesia. We shall consider all these subsystems and categories in more detail in this chapter.

Although dementia is probably the biggest cause of organic memory impairment, memory problems are common after many other neurological insults including traumatic head injury, encephalitis, vascular disorders, chronic alcohol abuse, temporal lobe epilepsy, cerebral tumour, and anoxia. Whatever the cause, memory-impaired people tend to share certain characteristics in that they do not lose personal identity, their immediate memory functioning is normal or nearly normal, they have problems remembering after a delay or distraction, they have difficulty learning new information, they usually recall things that happened some time before the insult better than things that happened a short time before, and they typically do not forget how to do things they learned well before the insult such as reading, swimming, or riding a bicycle. Of course, there are exceptions to this general pattern particularly with certain syndromes such as semantic dementia. We shall discuss typical amnesic patients together with some of the less common memory disorders as this chapter progresses.

Although few people working in memory rehabilitation would claim to be able to restore memory functioning in someone whose problems result from an organic cause, there is nevertheless a considerable amount that can be done to help memory-impaired people and their families or carers. We can organize the environment to make it easier for people to cope without adequate memory functioning; we can help memory-impaired people to learn more efficiently; we can teach them to compensate for their impairments; and we can reduce the anxiety or other emotional sequelae resulting from impaired cognition. Again, these rehabilitative approaches will be discussed more fully later in this chapter.

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