Eustache F, Desgranges B, Lalevée C
INSERM U320, Service de Neurologie, CHU Côte de Nacre, Université de Caen.
Rev Neurol (Paris). 1998;154 Suppl 2:S18-32.
An assessment of memory is relevant in many clinical contexts, but its objectives differ from one situation to another. An initial investigation should make it possible to define these objectives and to formulate hypotheses following the interview with the patient and/or his family and with the help of the overall anamnestic data. The tests proposed would aim at answering the questions according to the particular case of the patient: the supposed disorders, a suggested diagnosis, but also demographic data such as age and educational level. Consequently there is no across-the-board examination of memory and this assessment must be situated in a specific theoretical context. Memory is no longer considered as a single but as a compound function made up of different, relatively independent systems. The examination not only seeks to show the deficits which have a certain significance according to the clinical context, but also aims at bringing out preserved abilities which may contribute to the establishing of the diagnosis and on which rehabilitation and cognitive management may be based. In this article we present several methods of memory assessment with reference to the ideas of Tulving and Schacter, who propose five different memory systems: episodic memory, working memory, semantic memory, perceptive representation system and procedural memory. These assessments are made using standardized tools (tests, questionnaires) and experimental paradigms which have recently emerged in clinical neuropsychology (study of priming effects, of acquisition of skills). One of the present issues is the problem of reconciling the use of standard tools with that of the more sophisticated paradigms drawn up in the light of the most recent theoretical models. Another objective is to relate the findings of these tests to the difficulties the patients have in their everyday lives and so to achieve an ecological understanding of memory disorders.
在许多临床情境中,对记忆的评估都具有相关性,但不同情境下其目标各异。初步调查应能在与患者及其家属面谈并借助整体病史数据的基础上,明确这些目标并提出假设。所建议的测试旨在根据患者的具体情况回答相关问题:推测的障碍、建议的诊断,以及诸如年龄和教育水平等人口统计学数据。因此,不存在全面的记忆检查,这种评估必须置于特定的理论背景中。记忆不再被视为单一功能,而是由不同的、相对独立的系统组成的复合功能。检查不仅旨在揭示根据临床背景具有一定意义的缺陷,还旨在发现可能有助于诊断确立且可作为康复和认知管理基础的保留能力。在本文中,我们参照图尔文和沙克特提出的五种不同记忆系统(情景记忆、工作记忆、语义记忆、感知表征系统和程序记忆)的观点,介绍几种记忆评估方法。这些评估采用标准化工具(测试、问卷)以及临床神经心理学中最近出现的实验范式(启动效应研究、技能习得研究)进行。当前的一个问题是如何协调标准工具的使用与根据最新理论模型制定的更复杂范式的使用。另一个目标是将这些测试结果与患者在日常生活中遇到的困难联系起来,从而实现对记忆障碍的生态学理解。