The Tbilisi paper and pencil dual-task.

One function of the central executive component of the working memory model is the coordination of two simultaneous tasks (the dual-task method). The concept of a coordination function has proved effective in identifying brain damaged patients with severe behavioural problems and in discriminating the performance of patients with mild Alzheimer's disease from that of healthy elderly. A computerised version of the dual-task method was successfully used in previous laboratory studies but it is not suited to use in a practical, clinical setting. Thus a paper and pencil version of the dual-task method was devised. The present study was aimed at refining the paper and pencil dual-task method; investigating whether or not age per se affects performance; assessing its test-retest reliability and providing norms for the Georgian population. The new paper and pencil version of the dual-task was administered to 64 young and 64 middle-age and elderly participants. A new, modified, simpler version of the paper and pencil dual-task, the "Tbilisi paper and pencil motor task" was developed. This task has high test-retest reliability and correlates with the established computerised version of the task. No age or education effects were detected.

Neuropsychological evidence for separating components of visuo-spatial working memory.

There is increasing evidence to support the idea that visuo-spatial working memory can be segregated into separate cognitive subsystems. However, the nature of these systems remains unclear. In this paper we report data from two brain injured patients suggesting that information about visual appearance is retained in a different subsystem from information about spatial location, and that this differential processing can be observed when the style of presentation (sequential or simultaneous) is controlled.

The bailiwick of visuo-spatial working memory: evidence from unilateral spatial neglect.

An accurate representation of the visual environment is crucial for successful interaction with objects in that environment. The means by which that representation is formed in working memory is a major focus of the issues and research discussed in this paper. The discussion draws on experimental studies of healthy adults and of patients with impairments of visual perceptual processing or of visuo-spatial mental representation. These disorders are most commonly linked with the disorder referred to clinically as unilateral spatial neglect. We discuss the observed dissociation between perceptual neglect and representational neglect, and the phenomenon of implicit processing of information in the neglected hemifield. In so doing we explore the implications of the findings from this literature for the development of theories of visuo-spatial working memory.

Dissociation between recency and span: neuropsychological and experimental evidence.

This article reports dissociations between verbal span and the recency portion of the serial position curve in immediate free recall, in 2 neuropsychological case studies and in 3 experiments with normal participants. Patient A. N. presented with an impaired serial verbal span while showing an intact recency effect. The opposite pattern was observed in patient G. C., who despite a poor recency showed normal span in verbal serial recall tasks. Experiments 1 and 2 showed a recency effect with visually and auditory presented lists and written recall was resistant to the effects of articulatory suppression and of irrelevant speech, but was disrupted by the suffix effect. Experiment 3 showed that in contrast with recency, memory span was affected by articulatory suppression and irrelevant speech during presentation but not by a suffix. These findings are not consistent with the idea that span and recency measure aspects of the same memory system. Moreover, in clinical practice, they should not be used as equivalent alternatives.

Case studies in working memory: a case for single cases?

Patterns of cognitive deficit in single neuropsychological cases are common sources of evidence for theories of normal cognition. In particular, the working memory model has benefited from data obtained from a number of contrasting patients, in some cases resulting in modifications of the working memory model. In this paper, patterns of data from short-term memory patients and anarthric patients are compared with patterns of data from normal subjects. The patterns of patient data that were unlike those patterns typically found for groups of normal subjects, could be incorporated within a modified version of the articulatory loop component of the working memory model. However a small number of individual normal subjects also did not show the pattern that is reported on the basis of average performance of groups of normal subjects. This causes some difficulty in interpreting those data from such 'aberrant normal' patterns, and those data from single patients with functional cognitive deficits. The implications of these findings for the interpretation of neuropsychological data are discussed in the context of the working memory model, but with the intention of making a general point pertaining to the development of functional models of cognition. It is argued that single case studies should continue to provide a useful source of evidence, providing that care is exercised in considering the implications of such data for models of normal cognition.

What the eyes perceive, the brain ignores: a case of pure unilateral representational neglect.

Bisiach and Luzzatti (1978) provided evidence that unilateral spatial neglect is not only a disorder of visual perception, but also can affect mental representations such that patients fail to report the left side of scenes or objects in mental imagery. However in case reports of representational neglect generally it is accompanied by perceptual neglect. We report a rare occurrence of a patient (NL) who presents a persistent unilateral neglect which appears to be limited to visual imagery. The deficit appeared in tasks which require the formation and manipulation of new visuo-spatial representations as well as those which require access to information about familiar scenes. The patient, who had a lesion in the right parietal lobe, showed no evidence of perceptual or personal neglect, although there was some evidence of visual extinction. We argue that the concept of visuo-spatial working memory can provide a framework within which to interpret aspects of the representational form of neglect, whether or not it is accompanied by perceptual neglect.

Recency, primacy, and memory: reappraising and standardising the serial position curve.

In this paper we consider the serial position curve in immediate verbal free recall. A large literature has argued that two components of the serial position curve, recency and primacy, reflect the functioning respectively of short-term and of long-term memory. However, there are a number of difficulties in interpreting the recency effect as a phenomenon uniquely associated with short-term memory. Moreover, the serial position curve has been used widely for clinical investigations in patients with memory deficits. This is despite the lack of norms for the measures derived from the curve. We present a set of standardised norms based on 321 Italian normal subjects. These norms are shown to be applicable both to an English speaking population, and to three groups of brain damaged-patients, namely Alzheimer's, amnesics, and frontals. The standardised norms offer a clinical and experimental tool which, coupled with a multiple single case approach, allows us to show dissociations and double dissociations among the performance patterns obtained from all three pathological groups. The paper concludes with a discussion of a possible interpretation of the recency effect as a emergent property of all types of memory system, including verbal short-term memory. Taking into account previous literature as well as our own data, the recency effect in immediate verbal free recall is here interpreted in terms of a two-component view of verbal short-term memory.

Interference with visual short-term memory.

Working memory (Baddeley and Hitch 1974) incorporates the notion of a visuo-spatial sketch pad; a mechanism thought to be specialized for short-term storage of visuo-spatial material. However, the nature and characteristics of this hypothesized mechanism are as yet unclear. Two experiments are reported which examined selective interference in short-term visual memory. Experiment 1 contrasted recognition memory span for visual matrix patterns with that for visually presented letter sequences. These two span tasks were combined with concurrent arithmetic or a concurrent task which involved manipulation of visuo-spatial material. Results suggested that although there was a small, significant disruption by concurrent arithmetic of span for the matrix patterns, there was a substantially larger disruption of the letter span task. The converse was true for the secondary visuo-spatial task. Experiment 2 combined the span tasks with two established tasks developed by Brooks (1967). Span for matrix patterns was disrupted by a visuo-spatial task but not by a secondary verbal task. The converse was true for letter span. These results suggest that the impairment in short-term visual memory resulting from secondary arithmetic reflects a small general processing load, but that the selective interference due to mode of processing is by far the stronger effect. Results are interpreted as being entirely consistent with the notion of a specialized visuo-spatial mechanism in working memory.

Visuospatial working memory, movement control and executive demands.

Developments in the concept of a specialist visuospatial resource in working memory owe much to a pair of tasks originally developed by Brooks (1967), involving respectively the generation and retention of a mental image of a matrix pattern and the retention of a verbal sequence. Previous literature has demonstrated that the matrix task calls on cognitive resources which are involved in both the processing of visual input and the generation of movement sequences. Using dual task methodology, the study reported here demonstrates that the matrix and verbal versions of the task do indeed rely on separate, specialized cognitive resources, one of which is also involved in generation of action. However, when the secondary task (random generation of numbers) was very demanding of general purpose cognitive resources both the matrix and verbal tasks were performed poorly, suggesting that each of these tasks draw heavily on a common, general purpose resource as well as on their respective specialist resources. It is argued that random generation offers a means to assess general purpose cognitive resources and that the cognitive processes involved in the Brooks tasks may be more complex than has been previously assumed.

Dual task effects of walking when talking in Alzheimer's disease.

Previous studies with Alzheimer Disease (AD) patients have suggested that speed and accuracy in walking can be dramatically affected by a simultaneous secondary cognitive task, such as holding a conversation. Two experiments examined the impact on AD patients and age matched elderly controls of cognitive demands while walking. In Experiment 1 walking for AD patients was more affected than it was for the normal elderly by a concurrent cognitive demand. Experiment 2 demonstrated that both groups were equally impaired under dual task conditions when the demands of the cognitive tasks were adjusted for individual levels of ability. We conclude that walking may draw on general executive resources, that walking relies more heavily on these executive resources in the elderly, and on a damaged executive system for AD patients.

Design issues for socially intelligent user interfaces. A discourse analysis of a data-to-text system for summarizing clinical data.

OBJECTIVES: This study aims to demonstrate the usability of discourse analyses as a means of evaluating medical informatics systems by examining one particular computer-based data-to-text system for delivering neonatal health care information. METHODS: Six textual summaries of clinical information, three produced by human clinicians and three by the data-to-text system, were subjected to fine-grain discourse analysis. Analysis was performed 'blind' on all six textual summaries. Analysis focused on the identification of lexical items and on the potential effects of these items on users of these clinical information summaries. RESULTS: Results showed that there were clear differences between human- and system-generated clinical summaries, with human clinicians providing better narrative flow and textual detail. The data-to-text system successfully produced textual summaries although it fell short of human abilities. CONCLUSIONS: These results indicate potential future improvements to the system. Discourse analysis as used here may offer significant advantages in evaluating and developing similar medical informatics systems.

Dissociating mental transformations and visuo-spatial storage in working memory: evidence from representational neglect.

A study is reported of visuo-spatial working memory in two individuals suffering from a cognitive deficit known as unilateral spatial neglect, and seven healthy control participants. Both patients have difficulties reporting details on the left side of imaged representations, and one has an additional difficulty with perceptual input to the left of his body midline. All participants were asked to report the location and identity of objects presented in novel 2 x 2 arrays that were either present throughout or were described orally by the experimenter, with no visual input. On half of the trials, the report was to be made from the opposite perspective, requiring 180 degree mental rotation of the mentally represented array. The patients show an impaired ability to report details from the presented or the imagined left, but had no difficulty with mental rotation. Results point to a clear separation between the processes of perception and those of visuo-spatial working memory. Results also suggest that the patients might be suffering from damage to the system used for holding visuo-spatial representations rather than a difficulty with attending to elements of that representation.

Processing and storage in working memory span.

Two experiments are reported that address theoretical assumptions as to the nature of working memory involved in working memory span tasks (Daneman & Carpenter, 1980). Experiment 1 used a version of the sentence span task, and Experiment 2 combined arithmetic verification with recall of presented words. In each experiment, working memory processing span was assessed independently of temporary storage span prior to their combination. Combined task performance under high demand for each component resulted in substantial residual performance for both task elements, particularly in Experiment 2. The results do not challenge the utility of the sentence span task as a measure of on-line cognition, but they raise concerns as to how resource might be allocated to processing and storage elements of the task within a single flexible resource pool, or between different resources of a multiple component working memory system. Although both models lack predictive power regarding resource allocation in these tasks, the multiple resource model appears to offer the better account.

Storage and processing in visuo-spatial working memory.

Visuo-spatial working memory has been used to account for performance in a wide range of visuo-spatial tasks, including perceptuo-motor tracking and immediate recall of visually presented patterns. However a developing body of evidence points to a fractionation of the concept into visuo-spatial processing that calls on general purpose executive resources, and a visual 'cache' memory for temporary storage in on-line cognition. Two related experiments are described which address whether processing and temporary memory draw on overlapping or on distinct resources in working memory. Experiment 1 demonstrates that participants can accurately respond to a series of targets appearing in random locations whether or not they have the additional load of retaining and subsequently recalling the appearance of each target. Memory for target appearance likewise is largely unaffected by the additional load of requiring a response to each target. Experiment 2 demonstrates similar findings when verbal labeling of the patterns is inhibited through the use of articulatory suppression. Results are interpreted as consistent with a multiple component working memory system.

Counting on working memory in arithmetic problem solving.

Mental calculation is an important everyday skill involving access to well-learned procedures, problem solving, and working memory. Although there is an active literature on acquiring concepts and procedures for mental arithmetic, relatively little is known about the role of working memory in this task. This paper reports two experiments in which dual-task methodology is used to study the role of components of working memory in mental addition. In Experiment 1, mental addition of auditorily presented two-digit numbers was significantly disrupted by concurrent random letter generation and, to a lesser extent, by concurrent articulatory suppression, but was unimpaired by concurrent hand movement or by presentation of irrelevant pictures. Although the number of errors increased with two of the dual tasks, the incorrect responses tended to be quite close to the correct answer. In Experiment 2, the numbers for addition were presented visually. Here again, random generation produced the largest disruption of mental arithmetic performance, while a smaller amount of disruption was observed for articulatory suppression, hand movement, and unattended auditorily presented two-digit numbers. The overall levels of performance were better and the absolute size of the disruptive effects shown with visual presentation was very small compared with those found for auditory presentation. This pattern of results is consistent with a role for a central executive component of working memory in performing the calculations required for mental addition and in producing approximately correct answers. Visuospatial resources in working memory may also be involved in approximations. The data support the view that the subvocal rehearsal component of working memory provides a means of maintaining accuracy in mental arithmetic, and this matches a similar conclusion derived from previous work on counting. The general implications for the role of working memory in arithmetic problem solving will be discussed.

Working memory and strategies in syllogistic-reasoning tasks.

It has often been asserted that working-memory limitations are a major factor contributing to problem difficulty; for example, Johnson-Laird's (1983) mental-models theory appeals to working-memory limitations to explain the difficulty of syllogistic reasoning. However, few studies have directly explored working memory in problem solving in general or syllogistic reasoning in particular. This paper reports two studies. In the first, working-memory load was varied by presenting syllogistic tasks either verbally or visually (so that the premises were continuously available for inspection). A significant effect of memory load was obtained. In the second study, premises were presented visually for a subject-determined time. Dual-task methods were used to assess the role of working-memory components, as identified in Baddeley's (1986) model. Syllogistic performance was disrupted by concurrent random-number generation but not by concurrent articulatory suppression or by concurrent tapping in a preset pattern. Furthermore, the concurrent syllogism task interfered with random generation and to a lesser extent with articulatory suppression, but not with tapping. We conclude that while the central-executive component of working memory played a major role in the syllogistic-task performance reported here, the articulatory loop had a lesser role, and the visuospatial scratch pad was not involved.

Aberdeen polygons: computer displays of physiological profiles for intensive care.

The clinician in an intensive therapy unit is presented regularly with a range of information about the current physiological state of the patients under care. This information typically comes from a variety of sources and in a variety of formats. A more integrated form of display incorporating several physiological parameters may be helpful therefore. Three experiments are reported that explored the potential use of analogue, polygon diagrams to display physiological data from patients undergoing intensive therapy. Experiment 1 demonstrated that information can be extracted readily from such diagrams comprising 8- or 10-sided polygons, but with an advantage for simpler polygons and for information displayed at the top of the diagram. Experiment 2 showed that colour coding removed these biases for simpler polygons and the top of the diagram, together with speeding the processing time. Experiment 3 used polygons displaying patterns of physiological data that were consistent with typical conditions observed in the intensive care unit. It was found that physicians can readily learn to recognize these patterns and to diagnose both the nature and severity of the patient's physiological state. These polygon diagrams appear to have some considerable potential for use in providing on-line summary information of a patient's physiological state.

Users' perceptions of a computerised information system in intensive care (ABICUS) on introduction and after 2 months use.

The aim of the present study was to assess the perceived utility of a computerised information system in an intensive care unit (ICU). Questionnaires were devised in which ICU staff indicated the ease or difficulty of obtaining and recording information (a) under the previous manual system, (b) soon after the introduction of the computerised system and (c) two months after computerisation. Results indicated the system was well received immediately and this favourable attitude persisted unchanged after two months experience. The questionnaire method also served to pinpoint some particular interface problems which are to be remedied in future versions of the system.

The decline of working memory in Alzheimer's disease. A longitudinal study.

A previous study (Baddeley et al., 1986) explored the hypothesis that patients suffering from dementia of the Alzheimer type (AD) are particularly impaired in the functioning of the central executive component of working memory. It showed that, when patients are required to perform 2 concurrent tasks simultaneously, the AD patients are particularly impaired, even when level of performance on the individual tasks is equated with that of age-matched controls. Although the results were clear, interpretation was still complicated by 2 issues: first, the question of comparability of performance on the separate tests between AD and control patients; secondly, the question of whether our results could be interpreted simply in terms of a limited general processing capacity being more taxed by more difficult dual tasks than by the individual tasks performed alone. The present study followed up the AD and control patients after 6 and 12 mths. We were able to allow for the problem of comparability of performance by using patients as their own control. Under these conditions, there is a very clear tendency for dual task performance to deteriorate while single task performance is maintained. A second experiment varied difficulty within a single task in which patients and controls were required to categorize words as belonging to 1, 2 or 4 semantic categories. There was a clear effect of number of categories on performance and a systematic decline in performance over time. There was, however, no interaction between task difficulty as measured by number of alternatives and rate of deterioration, suggesting that the progressive deterioration in performance shown by AD patients is a function of whether single or dual task performance is required, and is not dependent on simple level of task difficulty. Implications for the analysis of the central executive component of working memory are discussed.