How Memory and Learning Can Improve Quality of Life
By: Carbon Radio
Tags: Neuroscience, Life, Future, Science, Learning

Nancy D. Chiaravalloti, PhD is Director of the Center for Neuropsychology and Neuroscience Research and the Center for Traumatic Brain Injury Research at Kessler Foundation and Research Professor of Physical Medicine and Rehabilitation at Rutgers University, New Jersey Medical School. Dr. Chiaravalloti conducts research in cognitive rehabilitation, particularly in new learning, memory and processing speed. She has led numerous externally funded randomized clinical trials to evaluate the efficacy of cognitive rehabilitation protocols in clinical populations, examining post-treatment changes from multiple vantage points such as objective behavior (neuropsychological tests), everyday life (questionnaires, tests of daily life functioning) and at the level of the brain (functional neuroimaging).

In this interview, Nancy Chiaravalloti discusses her research on memory and learning and its potential impact. She also gives us a glimpse into the future of neuroscience and how technology is enabling new advances in research.

What is the focus of your research?

My research seeks to identify treatments for improving new learning and memory. New learning and memory refers to the acquisition of knowledge or skills by experience, study or being taught [learning; https://www.lexico.com/en/definition/learning] and the means by which this information is stored [memory; https://www.lexico.com/en/definition/memory] for later use. Several neurological illnesses and injuries are associated with deficits in new learning and memory, such as Multiple Sclerosis, Dementia, and Traumatic Brain Injury. These deficits have a significant impact on an individual’s everyday life and overall quality of life.

Why is this work important?

Research has shown that difficulties with new learning and memory have a significant impact on everyday life and overall quality of life for several reasons. First, our memories are essential to who we are as individuals and as members of the communities in which we engage. For example, a characteristic that a person might use to describe himself could be “easy to get to know”. The presence of this characteristic however relies on your memory in several respects. You have to remember your previous experiences with other people and be comfortable getting to know new people. You have to be aware that you do not know this new person and engage openly in conversation about yourself. Finally, you have to be able to quickly recall information about yourself that could come up in casual conversation and may be highly variable depending on the person you are meeting. Memory deficits could negatively impact your access to any or all of this information and result in you being a more difficult persons to get to know. Another example is evident in all employment settings. Specifically, we all build skills within our professions. The accumulation of such knowledge is the result of numerous learning experiences and the memory of information acquired over years. To function successfully in our work environments, we rely on this accumulated knowledge and memory problems would thus inhibit successful work functioning.

Our memories additionally guide our behavior, whether recent or distant. Therefore, if a person is not remembering accurately, behavior may seem bizarre or out of place. For example, an individual may fail to remember a colleague that he or she met at a business conference several times. When he meets this colleague at the next conference and does not remember him/her, he may introduce himself as if they had never met before. The colleague would perceive this as odd, yet the behavior is the result of memory failure.

A third factor to consider is that our everyday actions and routines are largely based on memory. The routine of dropping your child off at school, then going to work is based on your memory of that routine. Any disruption in that routine, such as stopping at the bank prior to going to your office, is reliant on a recent memory that there is a need to stop at the bank. Everyday life is substantially less efficient in the presence of memory dysfunction.

The examples provided thus far are significant memory lapses. However, even seemingly simple tasks rely on memory. Cooking a favorite recipe, even when written down, relies on memories of what to include a little more of, which pan is best to use, or if it is better to cook the dish just a little longer. The act of doing laundry relies on the memories of how to use your specific washing machine, which red clothes do not run when washed, or whether or not to use bleach with a particular load of laundry. These seemingly insignificant tasks rely on memory for effective execution and when memory falters, such tasks suffer. The impact on the individual can be devastating.

What are some of the challenges associated with this research?

Memory is a very challenging construct to research because it is heavily intermingled with so many other aspects of the individual. Most notably, emotional functioning has a substantial impact on memory. A large literature base indicates that depressed individuals have poorer memory abilities. Further, research has shown that when memory improves, depression improves as well. It is thus important to distinguish between these constructs, yet this is difficult as they are intertwined.

Variability in other aspects of cognition similarly creates challenges in evaluating memory abilities and treating memory deficits. Many cognitive capacities, such as attention, working memory and processing speed, form the foundation on which new learning and memory functions operate. For example, a child with Attention-Deficit Disorder (ADD) may have poor grades in school. This however, is not because the child is having learning and memory problems that impair the acquisition of new information presented in school. It is rather because the child cannot pay attention sufficiently to allow the information to reach the encoding stage of the memory process. Thus, the child cannot learn and remember the new material due to attention deficits — NOT due to learning and memory deficits.

In addition to the consistent influences of other constructs on learning and memory, it also must be appreciated that all of these constructs change over time — even in healthy persons. That is, we all have days when we are sad and days when we are happier. Many of us contest that we are “morning people” and thus function better in the mornings — with our attentional control and learning and memory systems presumably functioning better in the mornings as well. Such individual differences add variability to the assessment of learning and memory, not only between individuals but also within the same individual.

When working with individuals with neurological diseases, it is important to note that diseases often fluctuate over time. In MS, for example, individuals often experience exacerbations — times during which their symptoms are more severe and have a greater impact on their daily functioning. During an exacerbation, cognitive functioning would be expected to be more impaired, improving after the exacerbation. Yet the boundaries of that exacerbation are not always clear — and sometimes it is not even clear that a given patient might be experiencing an exacerbation at all. Some diseases are additionally known to progress, such as Parkinson’s Disease. With the disease itself changing at the level of the brain, the memory difficulties experienced would be expected to change as well — yet another source of variability.

Historical events additionally influence cognition. On the news today we often hear about COVID fatigue — a sense of mental tiredness related to the Coronavirus pandemic. However, fatigue is also typically associated with depression, as well as memory difficulties. COVID may also bring with it post-traumatic stress disorder (PTSD) — which similarly entwines with depression and memory deficits. This is similar to what might have been observed in the NY region after the 911 attacks.

What advances in neuroscience and public health are you most excited about and why?

The neuroscience field is rapidly changing, largely due to advances in technology. The field of Neuroimaging is constantly changing with new technologies and new approaches to imaging data analysis every day. These new methodologies provide researchers with a window to the brain — not only in terms of structure, but also in terms of function. The advances help us understand memory functioning at more intricate levels, furthering our understanding of more minute structures in the brain. We have been increasingly utilizing neuroimaging to evaluate cognitive rehabilitation techniques and understand how they work.

Advances in Virtual Reality (VR) similarly impact our understanding of cognition and ability to evaluate cognitive rehabilitation. VR technology is increasingly becoming more refined and programmable to accurately reflect everyday life. VR programming allows us to evaluate cognition in an everyday life setting while maintaining consistency in the environment and objectivity in the evaluation. It additionally affords us an opportunity to place cognitive rehabilitation protocols within a daily life setting to increase the generalizability of treatment to daily life — which is a major need in the treatment of cognitive impairments.

Tele-rehabilitation has understandably grown significantly during the past 9 months. This technology has allowed clinicians and researchers to continue to evaluate and treat cognition remotely — maintaining the required social distancing and minimizing risk of infection. These advances however, are beneficial well beyond the boundaries of the current pandemic. Transportation to clinical appointments has long been a struggle for the disability community and some of my proposed work has addressed the need for remote treatment. Tele-rehabilitation is an exciting advancement that allows us to circumvent the physical disabilities, transportation challenges and infectious control issues that plague the disability community.

What is the future of this research?

This research is primed to have a significant impact on our ability to maintain new learning and memory abilities in many populations of people currently living with impairments in these domains. This includes individuals with neurological diseases such as MS, individuals who have had a trauma to the brain such as traumatic brain injury or stroke, individuals aging and experiencing normal declines in learning and memory, as well as individuals living with dementia. We are making progress in regard to improving learning and memory in these populations but this research is unfortunately slow due to the need for human participation. As we continue to move forward, we will be able to maximize our techniques to increase the benefit to individuals and help more people enjoy greater memory abilities for a longer period of time. Technology only helps us work toward our goal. Through the application of neuroimaging, virtual reality and tele-rehabilitation, we will be able to maximize the efficacy of individual techniques and increase the number of people we can treat with effective techniques.

What opportunities do you see on the horizon for this and related research?

Given the rapidly developing technology, as described above, as well as the dire need to improve learning and memory coupled with the limited capacity to do so to date, the opportunities for growth in this research is substantial. It is important to recognize that memory fails all the time — even in healthy individuals. There is so much room to improve memory — we just have to identify the best way to do that. Our failures to date highlight the opportunities for future work.

What would enable further advances in this research?

In addition to the continued technological advances that will continue to advance this field, greater participation of healthy individuals, as well as individuals with neurological diseases, would be a tremendous asset in our ability to answer the questions we pose. Human research is difficult as individuals must consent to the research and commit to spending the time in the ongoing clinical trials. We encourage people to volunteer for our research and greatly appreciate it when they do.

How does technology influence this work?

Neuroimaging developments in particular have had a significant impact on our ability to identify and understand changes in cognition in the face of neurological illness and injury. Our previous work has identified neurofunctional changes that underlie cognitive deficits in both MS and TBI. In addition, we have shown that treatment with a memory rehabilitation treatment developed at Kessler Foundation, the modified Story Memory Technique (KF-mSMT™) results in increased activity in brain regions known to underlie memory functioning on functional neuroimaging. This technology has thus advanced our knowledge of not only the memory impairment itself, but also the changes in brain function that result from our treatment. Our ongoing work utilizes functional neuroimaging to examine the KF-mSMT™ in other neurological populations (e.g. dementia) and examines neurological changes associated with memory rehabilitation protocols that we have developed more recently.

What future research will be enabled by advances in technology?

Advances in technology will enable us to understand the source of the efficacy of memory treatments and maximize benefit from such treatments. In addition, advances in technologies such as Virtual Reality will allow the development of more advanced cognitive rehabilitation treatments by recreating everyday life in a structured, safe, observable environment. The combination of neuroimaging and virtual reality in one research study would allow us to understand efficient and inefficient daily life functioning at a neurofunctional level. This knowledge can help direct treatment efforts to the symptoms or deficits that have the greatest impact on daily life.

What about this work inspires you?

This is a very exciting line of work. The extent of that which we do not know is inspiring. There are so many questions to ask and research studies to design to answer those questions. We have so much room to improve and grow. The most motivating aspect of this work however is that there are so many people who can be helped. We all would like to improve our memory abilities, but there are people who truly suffer from significantly impaired memory. It is so rewarding when a research participant sends a note of thanks because they were helped by your treatment. There is nothing more inspiring than knowing that the work you do truly improved someone’s life.