A study of the normative psychometric properties of the ALFIE, a novel measure of accelerated long-term forgetting in temporal lobe epilepsy
Creators: name: Cameron, Emma
Publisher: name: University of Lincoln
Year: 2024
Subjects: C800 - Psychology

description: Background: Patients with Temporal Lobe Epilepsy (TLE) typically complain of memory difficulties, but these are not always evident on objective memory assessments. This discrepancy may result from under- or over-reporting of memory problems as a result of motivation (e.g., to avoid confrontation, functional consequences on employment), impact of psychosocial factors (e.g., mood) or epilepsy patients’ perception of their difficulties (e.g., memory disturbances may cause difficulties with patients’ metamemory, meaning they lack the ability to accurately comment on their cognitive capabilities). Alternatively, this could be explained by a lack of specificity in current memory measures that utilise delay periods of 30-40 minutes. Research suggests that extending published memory tests to assess recall over a longer period (e.g., a two-week delay) allows the memory deficits described by those with TLE to be seen – a phenomenon known as Accelerated Long-term Forgetting (ALF). However, the literature has yet to address difficulties with test ecological validity and clinical practicability.Aim: The aim of this research was to further develop a novel measure of ALF to examine whether it was a clinically viable test measure. This was explored through assessments of validity, reliability, and acceptability/practicability of the implemented test procedure, for this novel measure.Method: 50 healthy participants’ objective memory performance was assessed by asking them to recall and recognise information at three time points: immediately after presentation of stimuli (T1), after 40 minutes (T2), and after two-weeks (T3). Alongside a published story and word list tasks, a novel measure was used – the Accelerated Long-term Forgetting In Epilepsy (ALFIE) test. We believe this to be more ecologically valid and clinically practical than other memory measures, due to the test using multi-modal stimuli drawn from real-life televised news broadcasts (concordant with a verisimilitude approach), with use of telephone follow-up phone-calls to assess two-week recall and recognition. Subjective memory performance was assessed via use of a self-report questionnaire.Results: Convergence of results on the ALFIE and published memory measures was found. Although extension of the published measure to a two-week delay might then seem justifiable, the ALFIE test showed greater correlations with subjective memory scores than the published story and word lists tasks. This suggests greater ecological validity of the ALFIE measure than the published memory test. Reliability was assessed through inter-rater reliability and analysis of parallel forms. The ALFIE showed high inter-rater reliability and although parallel forms reliability was poor, through standardisation versions may be used as alternate forms. Low attrition rates suggest that use of a two-week delayed assessment via telephone might be a clinically viable solution for specialist Epilepsy services assessing ALF, often over large geographical regions (where it would be costly, impractical and hard to co-ordinate for patients to return for extended delay follow-ups within such a restrictive time limit). Significant differences in performance between genders needs further examination, but may partially be explained through emotional salience of materials.Conclusion: The ALFIE test appears to be a viable test measure for assessing memory that is more ecologically-valid and clinically practicable than current memory measures.