the autobiographical memory interview - short form

THE A UTOBIOGRAPHICAL

M EMORY INTERVIEW SHORT FORM

MANUAL FOR ADMINISTRATION AND SCORING

Martin C. McElhiney Bobba J. Moody and Harold A. Sackeim

Department of Biological Psychiatry New York State Psychiatric Institute and Department of Psychiatry College of Physicians & Surgeons Columbia University

VERSION 3, April 20001

AMI SF

Autobiographical Memory Interivew–Short Form

TABLE OF CONTENTS

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THE AUTOBIOGRAPHICAL MEMORY INTERVIEW - SHORT FORM (AMI-SF) ......... 3 MANUAL FOR ADMINISTRATION AND SCORING................................................... 3 ADMINISTERING THE AMI-SF ................................................................................ 4 GENERAL INSTRUCTIONS ................................................................................. 4 PRE-TREATMENT ADMINISTRATION ................................................................. 4 PRE-Treatment Administration - Part I: Family Member.......................................... 5 PRE-Treatment Administration - Part 2: Travel....................................................... 6 PRE-Treatment Administration - Part 3: New Year’s Eve ........................................ 7 PRE-Treatment Administration - Part 4: Birthday.................................................... 8 PRE-Treatment Administration - Part 5: Employment ............................................. 9 PRE-Treatment Administration - Part 6: Physical Illness ......................................... 9 POST-TREATMENT ADMINISTRATION ............................................................. 10 POST-Treatment Administration: Name/Date Questions....................................... 12 POST-Treatment Administration: Date/Number Questions.................................... 13 POST-Treatment Administration: Address Questions ........................................... 13 POST-Treatment Administration: List Questions .................................................. 13 POST-Treatment Administration: Descriptive Questions ....................................... 13 SCORING THE AMI-SF...................................................................................... 14 PRE-TREATMENT SCORING ............................................................................ 14 PRE-Treatment Scoring: Name/Place Questions ................................................. 15 PRE-Treatment Scoring: Date/Number Questions................................................ 15 PRE-Treatment Scoring: Address Questions ....................................................... 15 PRE-Treatment Scoring: List Questions .............................................................. 16 PRE-Treatment Scoring: Descriptive Questions ................................................... 16 Summarizing the PRE-Treatment Scores ............................................................ 16 POST-TREATMENT SCORING .......................................................................... 16 POST-Treatment Scoring: Name/Place Questions ............................................... 16 POST-Treatment Scoring: Date/Number Questions.............................................. 17 POST-Treatment Scoring: Address Questions ..................................................... 17 POST-Treatment Scoring: List Questions ............................................................ 18 POST-Treatment Scoring: Descriptive Questions................................................. 18 Summarizing the POST-Treatment Scores........................................................... 18 REFERENCES...................................................................................................... 20 Question Category Designation .............................................................................. 21 AMI-SF SCORE SHEET ........................................................................................ 22


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THE AUTOBIOGRAPHICAL MEMORY INTERVIEW - SHORT FORM (AMI-SF) MANUAL FOR ADMINISTRATION AND SCORING This manual describes the administration and scoring of the AMI-SF, which is geared towards examining the nature of amnesia following electroconvulsive therapy (ECT). The AMI-SF was developed as a subset of items from the more extensive Autobiographical Memory Interview (AMI), which in turn was based on an instrument originally used by Richard D. Weiner and colleagues at Duke University (Weiner et al., 1986). Papers by McElhiney et al. (1995), Sobin et al. (1995) and Sackeim et al. (1993, 2000) illustrate the use of the AMI in ECT research. Amnesia for autobiographical events may be an especially powerful adverse effect of ECT (Weiner, 1984). In fact, retrograde amnesia for autobiographical memories is the only domain for which there is evidence that ECT produces persistent deficits. Squire and Slater (1983) found that 3 years after treatment patients reported gaps in memory for events that occurred on average 6 months before and 2 months after bilateral ECT. Squire et al. (1981) also documented amnesia for events occurring in close proximity to bilateral ECT when patients were assessed 7 months after completing treatment. In addition, Weiner et al. (1986) found in a 6-month follow-up that patients treated with bilateral ECT showed persistent impairment in the recall of autobiographical information as compared to non-ECT controls and patients treated with right unilateral ECT. The primary goal of the AMI-SF is to quantify the extent of retrograde amnesia following a course of ECT. To accomplish this, the subject is asked a series of detailed autobiographical questions during the week prior to ECT (PRE). The questions inquire about specific details for six sets of events or experiences, most of which occurred during the previous year. The same questions are asked at four post-treatment testing sessions: during the week following the course of ECT (POST), and at two, four, and six months follow-up (2 MOS POST, 4 MOS POST and 6 MOS POST). In OPT-ECT the 4 month time point (16 weeks) is not used), even though it is represented in the sore sheet. In OPT-ECT patients are tested at only 4 time points (PRE, POST alll acute phase ECT, 8 weeks follow-up and 24-week follow-up. The subject’s ability to remember the specific details originally provided during the PRE treatment interview is measured. Thus, the subject’s answers at PRE are used as a template against which his/her subsequent answers are compared at the four posttreatment time points. The comparison of the post-treatment answers with the answers given at PRE yields “amnesia scores” in the form of percentiles. Because individual norms have not been developed for this instrument, the subject’s “amnesia score” should be used for research purposes only and not as a clinical indicator.


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ADMINISTERING THE AMI-SF GENERAL INSTRUCTIONS It is important to establish a rapport with the subject before beginning the interview in order to provide an environment where he/she is comfortable answering a variety of personal questions and performs to the best of his/her ability. The AMI-SF is introduced as an interview which ascertains an individual’s potential to remember specific personal details from his/her life (see page 3 for the specific instruction). The subject is told that similar interviews will occur at various intervals following the course of ECT. The subsequent interviews are not emphasized as some subjects will try to encode their PRE answers so that they will “do better” on the future interviews. The goal of the instrument is to measure the subject’s ability to recall past events and experiences, so it is important to focus his/her memory on the actual events and original experiences rather than the prior test sessions. The amount of time required to administer the AMI-SF will depend on the clinical and cognitive state of the subject, but averages 30 minutes. Some subjects are very talkative and circumstantial, and will give extraneous details if permitted. Therefore, one of the tasks of the interviewer is to focus and redirect the subject when necessary. Subjects can become apprehensive or suspicious when asked some of the more specific questions, such as the name of his/her past work supervisor, and the address and phone number of a relative. When necessary, the interviewer should again explain the purpose of the interview and reassure the subject that these individuals will not be contacted. Some subjects find it reassuring to know that the same questions are asked of all the subjects in a particular research protocol. The AMI-SF is administered in a structured interview format and requires clinical skill as the interview can be difficult for some subjects. The interviewer will need to judge how much time to give the subject to answer each question. A subject should be given enough time to attempt recall, but not so much time that he/she becomes unduly frustrated when not able to do so. Along these lines, it may be necessary to encourage the subject at various points with a comment such as, “You are doing fine.” The interviewer should acknowledge that it is frustrating being unable to remember things and should validate the subject’s efforts.

PRE-TREATMENT ADMINISTRATION The AMI-SF form has five columns for recording subject responses at the five time points and one column for notes. The form is organized chronologically with PRE responses in the center column, followed by POST on the right. The columns for 2 MOS POST, 4 MOS POST, and 6 MOS POST are on the next page. The interviewer should write his/her name and the date for each testing session before beginning the interview. The cover page also has a blank for the date the subject entered the hospital or the program. It is important to establish the program entry date with the subject prior to


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beginning each interview because several questions use this date as a point of reference. For example, Question 1, Part 1 asks the age of the subject’s relative “at the time you entered this program.” Six months or more will pass between program entry and the 6 MOS POST testing session, and the age of the relative is likely to change during this time. Both the interviewer and the interviewee will need to be mindful of the date of admission and adjust the answer to the time prior to program entry. This will allow for easier comparison of answers across all time points. Scoring the AMI-SF depends on the answers obtained at PRE. It is crucial, therefore, that these responses be as specific and complete as possible, and that they be recorded clearly. The more detailed and accurate the recorded responses are at PRE, the more sensitive the measure will be to detect amnesia at the subsequent testing sessions. All answers should be recorded, including responses such as “I can’t say” or “I don’t know.” The recording of such responses will be more instructive than an empty response blank during future interviews and when scoring the interviews. After spending some time establishing a rapport with the subject, the examiner should introduce the PRE AMI-SF by stating: “During this interview, I will be asking you to remember different events and experiences that you have had in the past. I will be asking you to recount some very specific details of these events. The interview will help us to assess your ability to remember details from your life, and similar interviews will be given at specific time points after your treatment course.”

PRE-Treatment Administration - Part I: Family Member This section of the interview begins with an introductory question that asks the subject to provide the name of a relative who is the most important to the subject, but who does not live with him/her. A second question asks the subject to state the relation of the individual named. These questions will not be scored, but are used to establish an important person in the subject’s life about whom five fairly detailed questions will then be asked. Some subjects may have difficulty picking just one relative or they may object to identifying one relative as being “the most important”. In either case, the subject should be instructed to name the relative with whom they have the most contact and/or about whom they will be able to answer several detailed questions. Some subjects may not have any contact with their relatives, while others may not have any living relatives. In these instances, the subject should pick their closest friend. Any variation in answering this question should be recorded in the space for notes. The five questions that follow will be directed to elicit information about the person named. Question 1 asks for the Month and Day of the designated person's birthday. The answer given by the subject should be recorded even if it is incomplete (e.g., just the month). If the subject states that he/she does not know, encourage an estimate or a guess. If they are unwilling to offer a guess, record “I don’t know” or “DK” and move on to the next question.


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Question 2 asks for the relative’s age at the time the subject entered the program. This question is often answered with an estimate or a guess, such as “in her 60’s.” Encourage the subject to give a more specific answer by prompting: “Can you please be more specific?,” and record his/her answer. Questions 3 and 4 ask for the complete address and phone number of the individual mentioned. Again, the subject should be encouraged to provide the most complete and accurate information possible. For example, if the subject does not spontaneously offer the apartment number or zip code, prompt him/her for this information and record the response. Many subjects will not have such information memorized, but will offer to look it up in their address book or some such place. The subject should be reminded that the interview is a test of memory and that whatever they can remember will be useful, even if it is incomplete. Question 5 asks for the full names of any person or persons living with the relative at the time the subject entered the hospital or program. If the subject reports that the person is living alone, record this answer as it will be scored as a memory and subsequent interviews will seek to match this answer. If the person named lives in a group situation such as a dormitory or convalescent home, ask the subject if he/she can remember the names of any of the co-residents and record the response.

PRE-Treatment Administration - Part 2: Travel This section of the interview begins with a question that asks the subject to remember his/her last major overnight trip of 100 miles or more away from home, prior to entering the program. If the subject has not traveled farther than 100 miles, ask regarding the most recent overnight trip away from home. If the subject has not taken an overnight trip in the past five years, ask regarding the most recent day trip and ignore Question 2 (which asks where the subject stayed overnight). Some subjects will remember many overnight trips, and should be guided to name the most recent. Encourage the subject to give the most precise answer possible and be sure to record the complete answer. For example, an answer of “Florida” recorded at PRE is less specific and, therefore, less meaningful than the answer, “Miami, Florida.” At subsequent testing sessions, the interviewer will be trying to direct the subject to remember the same trip that was discussed at PRE. A specific and clearly written response will facilitate this process. In the example above, the subject may have made many recent trips to Florida, but only one to Miami. The second introductory question asks the subject to remember the date of the most recent trip. This information will be used during the subsequent testing sessions to help the interviewer establish the exact trip about which the PRE questions were asked. Question 1 asks the subject to remember the number of days, including travel days, that he/she was away. This question is likely to elicit vague guesses such as “a week or so.” The interviewer should encourage a more precise response with a prompt such as, “Can you be more specific?” The interviewer will need to avoid the temptation of suggesting an answer as a means of clarifying the subject’s response. Instead, the subject’s most precise response should be recorded.


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Question 2 asks the subject to provide the full name of the hotel where (or person with whom) he/she spent the majority of this trip. The subject may need encouragement to provide the full name of the hotel (e.g., “Hilton Pink Flamingo” versus “the Hilton”) or the person (e.g., “Martha Stewart’s” versus “Martha’s”). If the subject reports staying in a different location each night of the trip, record the name of the lodging for the first night. Indicate on the answer form that the subject’s response refers to the first night of the trip so that the future interviewers can direct the subject to remember the name of the lodging for that specific night. Question 3 asks the subject to list the full names of the person or persons who went with him/her on this trip. The subject should be encouraged to offer a name even if they only had a travel companion for a portion of the trip. If the subject indicates that he/she traveled entirely alone, this should be recorded and will be counted as a memory. Question 4 asks the subject to remember the main reason for taking the trip. The subject should be gently encouraged to give a specific reason, if one exists. Answers with multiple reasons should be recorded verbatim (e.g., “My niece Diana’s wedding and for vacation”). Question 5 asks what the subject enjoyed most about the trip. This question can elicit vague or general responses and the subject should be directed to consider if there was anything specific that he/she enjoyed. If the subject insists that nothing was enjoyed, record this answer and move on to the next section.

PRE-Treatment Administration - Part 3: New Year’s Eve The introductory question to this section asks the subject to remember the last New Year’s Eve prior to his/her entry into the program. As is noted on the form, the date recorded should be the year it was on December 31st and not the new year. Subsequent testing sessions will depend upon an accurate record of the year. Question 1 asks the subject to list the full names of the person or persons with whom he/she had contact that evening. The answer is fairly straightforward if he/she had a companion or companions during the evening. If the subject attended a party alone, he/she should provide the names of the persons with whom he/she spent time during the party. If the subject remembers having spent most of the evening alone, but visited briefly with a neighbor or spoke on the phone with someone, this should be recorded. Question 2 asks the subject to remember where he/she had dinner that evening. For some subjects the answer will be simply “at home,” while other subjects may have eaten at a restaurant or a dinner party. The subject should be encouraged to recall the name of the restaurant or the name of the host/hostess at whose house he/she dined. Question 3 asks the subject to recall where he/she went that night. The name of the club, bar, restaurant, or as above, the name of the host/hostess of the party should be recorded. The answer might be the same as to Question 2 and should be recorded again if so.


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Question 4 asks subjects to remember what he/she did at the above location. It is likely that a prompt for a more specific response will be required. For example, the subject might recall, “It was a party, we socialized.” The interviewer might then prompt, “Did you do anything in particular or memorable?” The goal is for the subject to give a more specific answer such as, “We drank a lot and danced the Rumba.” Subjects who stayed at home should also be prompted for a specific response. Question 5 asks the subject to remember what he/she did at midnight. Again, prompting may be required to obtain a more specific answer.

PRE-Treatment Administration - Part 4: Birthday The introductory questions ask the subject for his/her birth date and the age he/she became on the last birthday prior to entering the program. It is useful here to do some quick math to make sure the subject is assigning the correct age to this last birthday. Subsequent testing sessions will all refer to that birthday, and so it is worth checking that you and the subject are referring accurately to the last birthday. Most subjects will not remember the actual day of his/her birthday, but will recall the most celebratory event from the last birthday. Question 1 asks the subject to list the full names of the person or persons who helped him/her to celebrate on his/her last birthday. If the subject reports that no one acknowledged his/her birthday or helped him/her to celebrate, record this response as a specific memory. Question 2 asks the subject to remember where he/she celebrated that birthday. If the subject gives a response such as, “I don’t celebrate my birthday,” the interviewer should inquire if the subject recalls specifically where he/she was that day independent of any celebration. Question 3 asks the subject to elaborate what he/she did at the above named location(s). The subject may need encouragement to produce specific responses. Questions 4 asks the subject to list the names of the person(s) from whom he/she received gifts. If one or no gifts were received, the subject should also be asked to list the names of any persons from whom he/she received cards. A notation should be made after the name of each person indicating if they gave a gift or a card. This will help the future interviewers prompt for the list of names at the future testing sessions. The subject will need to list the names of each person, for example “I received cards from all of my children” is not specific enough. The subject should be asked to name his/her children. Question 5 asks the subject to remember what gifts he/she received. If no gifts were received, this question should be skipped. Subjects will sometimes respond with speculative answers such as “I usually get a sweater from my niece each year, so that’s what I probably got.” The subject should be asked if he/she can specifically remember the gift by asking, “Can you describe the sweater you received this year?” The gifts should be recorded in as much detail as possible to provide unique identification (e.g., a


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blue tie, a green sweater). If the subject received money, he/she should be prompted to recall the amount.

PRE-Treatment Administration - Part 5: Employment This section begins by asking the subject to remember the name of the company or organization for which he/she last worked before entering the program. If the subject is self-employed, ask him/her to recall the last job held before becoming self-employed. If the subject has never worked outside of the house or last worked more than 20 years ago, ask regarding any volunteer work, club, or organization with which he/she was most recently affiliated. If these also seem like unfruitful possibilities, ask regarding his/her spouse’s most recent place of employment. Be sure to record on the answer form any variation in obtaining an answer. The second introductory question asks the subject to remember the month and year that he/she last worked for this employer. The answer to this question will not be scored, but will be used at the post-treatment sessions to remind the subject of his/her original answer. Question 1 asks the subject to remember his/her job title when last working for the above named employer. The subject should be prompted for the most specific “official” title he/she recalls (e.g. Research Assistant vs. “over-worked gopher”). Question 2 asks the subject to remember the name of his/her supervisor at this last place of employment. If the subject had no supervisor, ask the name of his/her immediate subordinate and record the answer with a note of this alteration on the form in the space provided. The future interviewers will need to know to prompt for a subordinate versus a supervisor to elicit the correct response. Questions 3 and 4 ask the subject to remember the complete address and phone number of the building where he/she worked. The subject may need prompting to include the zip code and area code. If the subject did not have his/her own phone line, ask him/her to recall the company’s general number. Question 5 asks the subject to remember the month and year that he/she first started working for this employer. Encourage the most specific answer as possible, and record the response even if it is just the year.

PRE-Treatment Administration - Part 6: Physical Illness The first introductory question asks the subject to remember the last time he/she consulted a physician for a physical complaint or illness prior to entering the program. The subject is asked why he/she went to see a doctor by naming the complaint. If the subject’s last visit was for a check up, ask him/her to recall the last time he/she went to the doctor for a physical complaint and note this in the space provided. Subjects will frequently respond by including visits to see their psychiatrist, since this is the doctor they see the most frequently and some psychiatric disorders include somatic symptoms. The question should be restated emphasizing that the visit be for a physical complaint or illness. The second introductory question asks the subject to remember the month


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and year of the visit. Like all previous introductory questions, this will not be scored but may be useful as a reminder in the event that the subject has difficulty remembering the specific visit at subsequent testing sessions. Question 1 asks the subject to remember the first and last name of the doctor he/she saw at that time. If the subject initially gives only the last name, prompt for the first name. Question 2 asks for the address of the building or hospital where the doctor was seen during that last visit. The subject may not be able to give the complete address, but record what he/she does remember. Question 3 asks the subject to recall the floor number of the building or hospital where the appointment occurred. This might be redundant if the subject included the floor in answering the above question. Nevertheless, the floor number should be entered in the space available on the answer form. Question 4 asks the subject to remember what treatments or medications were prescribed during this visit. All prescriptions should be noted, even refills. Doses and frequency of the medications are not necessary. Suggestions by the physician such as “bed rest” should be recorded and scored. Question 5 asks the subject to remember the month and year that he/she first noticed these symptoms. In some instances, the onset of the condition may have been many years ago or even at birth. The subject should be encouraged to recall the most specific answer as possible.

POST-TREATMENT ADMINISTRATION The initial POST treatment interview is generally given 24-72 hours following the course of ECT (end of all acute ECT). If possible, the scheduling of this initial POST interview for all subjects should not be on the first day following treatment. For example, it would be best if all the subjects were tested on either the seond or third day following their last treatment. It is recommended that the person who administered the PRE interview with a particular subject, also administer the subsequent post-treatment interviews. The interview will proceed more smoothly with an interviewer who is familiar with the subject and the answers he/she gave at PRE. When this is not possible, the new interviewer should spend a few minutes reviewing the answers given at PRE and note any variations in the PRE administration (e.g. the subject is self-employed and all the employment questions were asked regarding a job prior to her becoming selfemployed). The instructions for all the post-treatment sessions (POST, 2 MOS POST, and 6 MOS POST) are essentially the same. For the sake of simplicity, the following instructions will be described using the term “POST,” but apply to all post-treatment sessions. At each administration, the examiner should record the date and write his or her name on the interview form. The examiner should introduce the task with the following statement:


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“During this interview, I will be asking you to remember different events and experiences that you have had in the past. I will be asking you to recount some very specific details of these events. The interview will help us to assess your ability to remember details from your life. Similar interviews will be given during follow-up testing at future time points.” The subject may or may not remember the previous testing session. Some subjects will try to remember what his/her answers were during the earlier interviews and focus on how well he/she is doing in comparison. These subjects should be encouraged to attend to the present questions and to try and recall the original experiences. Sometimes a few words of encouragement will go a long way to help the subject to relax and attend to the immediate task. Some subjects who do not immediately remember previous interviews will become agitated as he/she begins to realize that he/she has been asked the questions at an earlier occasion. The subject should be told that they have been asked similar questions and that it is not unusual for some forgetting to take place. After the task has been introduced, proceed to administer the interview omitting all the questions that were not asked at PRE or that were scored 0 points at PRE. Again, the interview seeks to measure what memories have been lost and not what has been gained compared to PRE. If a question at PRE was answered with an incomplete response, such as the month of the relative’s birthday without the day, the examiner will ask the question as at PRE, but there will be no need to press the subject for an answer that is more specific than that offered at PRE. If the subject spontaneously responds with a more complete answer than at PRE, the whole answer should be recorded even though the extra information will not affect the score. In administering the introductory questions that precede each section, the examiner will try to establish with the subject if he/she is recalling the same person or event recalled at PRE. For example, when asked about the most important relative in Part 1, the subject may give a different name than the name given at PRE, such as “Robert” rather than “Joe.” This new name should be written in the space provided and the interviewer should then remind the subject that he/she also talked about “Joe” when they met previously, and establish if he/she remembers “Joe.” If the subject recalls this person, the interviewer should write "Recalls Joe" in the space provided, tell the subject that he/she will be asking some questions about Joe, and proceed with the section. It is unlikely that the subject will not remember the relative when reminded. If the subject absolutely does not remember the original person, the interviewer should skip that section, scoring each item 0 points, and move on to the next. It may become apparent during a post-treatment interview that a subject misremembered an event or experience at PRE. For example, the subject might say that the trip he mentioned at PRE was not his most recent trip prior to entering the program. In this event, the post-treatment interviewer should still inquire about the trip mentioned at PRE, and make a note of the subject’s change of recollection. The note should warn all subsequent interviewers that the trip reported at PRE might not be the


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most recent, and that they should direct the subject to try to remember the trip originally reported. It is important during the post treatment testing sessions that the interviewer prompt the subject to ascertain if he/she is able to reproduce all the material originally given at PRE. Answers should be recorded clearly and in complete detail so that they can be compared to the PRE answers. As in the PRE interview, answers such as “I don’t know” or “none” should be recorded, as they are more meaningful than a blank space when scoring the interview. Prompting for a response is somewhat different for the POST interview sessions as compared to PRE. The subject may need more guidance in order for the interviewer to establish whether or not he/she can remember the material produced at PRE. For example, if a subject says she traveled with “Mary” and stops there, the interviewer should probe for the person's last name if it was given at PRE. If the subject omits a person with whom she traveled, she should be asked if there was anyone else present. The subject should be given enough time and encouragement to produce the complete list of fellow travelers until it is clear that the subject's memory is exhausted for this event. For the purposes of describing the administration and scoring of the AMI-SF, the items that comprise the interview have been organized into five question categories: Name/Place, Date/Number, Address, List, and Descriptive. Instead of proceeding item by item, the issues regarding the administration of the interview at the post-treatment time points will be addressed by item category. Appendix 1 is a table listing the question by number and their category designation.

POST-Treatment Administration: Name/Date Questions The seven Name/Place questions ask the subject to recall the names of people such as his/her doctor and work supervisor, and the names of places such as where the subject celebrated his/her birthday and New Year's Eve, and where the subject stayed during his/her last trip. The examiner should note the response that was given at PRE, and, with gentle prompting, ascertain if the subject is able to recall the name or place with the same level of detail as at PRE. For example, if the subject names his/her physician by first and last name at PRE, and only by last name at POST, he/she should be prompted for the complete memory. A suitable prompt might be, "Can you recall your doctor's first name?" The examiner should not say, "Last time you said both first and last names, what is her first name?" Whether or not the subject recalls the full PRE answer after prompting, a notation should be made on the form such as "Can't recall first name” or "His first name is Marcus." If the subject produces a different name or location than recalled at PRE, the subject should be prompted to determine if there might be another answer to the question. For example, the subject might have recalled at PRE that the supervisor at his last job was "Larry Tate." If at POST he says, "Mr. Drisdale," the examiner might ask the subject if he had any other supervisors on that job, and if so, what were their names. The examiner might also want to confirm that they are talking about the same job using the dates given at PRE.


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POST-Treatment Administration: Date/Number Questions The eight Date/Number questions require the subject to provide dates such as the month and day of his/her relative's birthday, and the month and year of his/her last doctor's visit; numbers such as the age of his/her relative, the number of days away on his/her last vacation, and phone numbers. Again, the goal is to determine if the subject is able to retrieve the same memory he/she produced at PRE and if it is at the same level of specificity. The subject may need encouragement or focusing to achieve this goal. For example, if the subject recalls a telephone number without the area code, the examiner will need to inquire if the subject can also recall this information. If the subject produces an answer that is more general or more vague than that given at PRE, he/she will need to be directed to attempt a more specific answer. For example, if the subject recalls his/her relative's age to be "In his early 60's" where the answer at PRE is "He's 63," the subject should be prompted, "Can you be more specific?" If at first the subject cannot recall an answer that he/she was able to produce at PRE, the examiner should encourage the subject to take a moment to see if the answer comes back to them. If it appears that the subject is not going to recall that memory, the examiner should move on to the next question with a prompt such as: "That's O.K., if the answer comes back to you, let me know. Here's the next question..."

POST-Treatment Administration: Address Questions The three questions on the AMI-SF that ask the subject to recall the address of his/her relative, last place of employment, and doctor's office. The subject will need to be directed to recall all the elements of an address that he/she produced at PRE. The subject's score on one of these questions will depend on the number of elements produced at a post treatment interview compared to the number of elements produced at PRE. Even details such as an apartment number will be counted as an element of an answer. It is important, therefore, that the subject have the encouragement and a chance to produce all of the elements he/she gave at PRE. An appropriate prompt might be, "Is there an apartment number?" or "Do you recall the zip code?" It will not be necessary to push for the details that were not given at PRE.

POST-Treatment Administration: List Questions The six list questions ask the subject to provide a list such as the persons with whom the subject celebrated his/her birthday and New Year's eve, with whom he/she traveled, and from whom he/she received gifts. As with the other types of questions, administer a list question at a post treatment time point requires the examiner to look at the answer given at PRE and to prompt the subject to attempt similar recall. Even if the subject's answer at PRE was not a list, such as "I spent the evening alone," the question should be asked at POST as it was at PRE to see if the subject can recall the same memory.

POST-Treatment Administration: Descriptive Questions The six descriptive questions ask the subject to recall and describe an event or activity such as the reason for his/her last trip, what he/she enjoyed about that trip, or what he/she did at midnight to celebrate the new year. The interviewer will need to use


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his/her judgment to ascertain if the subject has exhausted his/her memory of an event and produced as detailed a response as possible. These questions pull for answers that are less factual and are more subjective than the other types of questions. Consequently, the subject's answer might change over time and still be correct. For example, the subject might respond at PRE that she "toasted with her friends and danced" at midnight on the last New Year's Eve. When asked at POST her response might be, "My husband and I kissed." While the POST answer might also be an accurate memory of that event, the interviewer's job is to determine if the subject can also recall the PRE response. The interviewer might prompt for the original answer by asking, "What else do you recall doing around midnight?" The interviewer should continue to prompt until he/she determines that the subject has either recalled the original response or has exhausted the subject's memory of the event.

SCORING THE AMI-SF The AMI-SF is scored by comparing the answers obtained at the post-treatment administrations with the answers given at baseline (PRE). Scoring the PRE AMI-SF, like administering the PRE interview, is different than at the post-treatment time points as there are no standard answers for comparison at PRE. The instructions for scoring the PRE treatment interviews will be given first, followed by an outline for scoring the post-treatment administrations.

PRE-TREATMENT SCORING The purpose of scoring the interview at PRE is to establish which baseline answers are sufficiently specific to warrant comparison with the POST interviews that follow. Also, the PRE score provides an actual number by which all POST scores will be divided in order to obtain the final amnesia score. It is suggested that the person who conducts the interview also be responsible for scoring the responses, and that he/she do so immediately while the interaction is fresh in his/her mind. The following general rules apply to scoring the PRE treatment interviews. Any answer that is complete, can be recognized later, and appears to be a memory, gets 2 points. Any answer that is a clear memory failure, such as “I don’t know” or “I can’t recall,” receives 0 points. An answer at PRE is given either 2 points or 0 points, with no intermediate scores (1 point) allotted. This is different from scoring the post-treatment interviews which will include an intermediate score of 1 point for partially correct answers. Scoring the answers at PRE is somewhat lenient and inclusive. Some incomplete answers, as will be outlined below, will be scored 2 points, so long as they offer specific information. Again, the purpose of the PRE interview is to gather as rich and inclusive a baseline as possible to be used as a comparison for the post-treatment interviews. As described above, the items that comprise the AMI-SF have been organized into five categories: Name/Place, Date/Number, Address, List, and Descriptive. Each of the five


Page 15

item types have slightly different scoring rules and will be addressed separately. Appendix X is a table listing the questions by number and their category designation.

PRE-Treatment Scoring: Name/Place Questions The seven Name/Place questions which require the subject to recall the names of people and the names of places are usually brief and a proper name. Any answer that represents a clear memory such as "We celebrated at Aunt Agatha's house" or "They took me to dinner at the 21 Club" or "My physicians name is Dr. Whelby" are all scored 2 points. Even answers that are incomplete such as "Dr. Whelby" or "the Hilton" versus "Dr. Marcus Whelby" or "the Hilton Pink Flamingo" are scored 2 points, as long as the answer represents a clear memory. At minimum, either a first or last name must be provided where a person's full name is requested in order for that answer to be scored 2 points. Similarly, at least half of the name of a restaurant or hotel must be provided to receive 2 points. Answers that are not a specific recollection, such as "we stayed in a hotel, I forget the name" or "we must have eaten out" are scored 0 points, as are pure memory failures such as "I don't remember."

PRE-Treatment Scoring: Date/Number Questions The Date/Number questions require the subject to provide dates such as the month and day of his/her relative's birthday, and numbers such as the number of days away on his/her last vacation and phone numbers. Any answer that is complete and specific such as "we were away for 2 weeks" or "he's 62 years old", receives 2 points. An answer that is specific but only half complete such as "His birthday is in August, but I don't know the date" is also scored 2 points. At minimum, the subject will need to recall at least the month where a month and day are requested, a year where a month and year are requested, and a phone number where a phone number and area code are requested for the answer to receive 2 points. Similarly, the three questions that request a specific number (age of relative, floor of Dr.'s appointment, days away on vacation), will require at least a specific range of numbers for the answer to be scored 2 points. Answers such as, "The appointment was on the third or fourth floor" and "He is either 62 or 63 years old" are reasonable 2 point answers. However, it would have been preferable for the interviewer to have pressed the subject to give a more specific answer. Any answer that is too broad such as "He's over 60" or "His birthday is in the Summer" is scored 0 points.

PRE-Treatment Scoring: Address Questions While many subjects will not know all the elements of an address, such as the apartment number or Zip Code, an answer is scored 2 points if it has at least the name of the street, city and state. An answer with any less information than this is scored 0 points.


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PRE-Treatment Scoring: List Questions If the subject provides names or items for the list, even if it is just one name or item, the answer is scored 2 points. If the subject clearly states that no names or items belong on the list, for example, if he/she received no gifts or cards, or traveled alone, then the answer is also be scored 2 points. If the subject states that he/she simply cannot recall, the answer is scored 0 points.

PRE-Treatment Scoring: Descriptive Questions Scoring the six Descriptive questions requires the examiner to determine if the subject is recalling a specific memory. Any answer to one of these questions that suggests a clear memory of an event such as "We went to Florida to attend my niece's wedding" or "We kissed at midnight" is scored 2 points. If the subject has not been very active or social, the answers to some of these questions might be limited. For example, the subject may have gone to bed early on New Year's Eve. If he/she specifically recalls going to sleep early that night, the answer is scored 2 points. All memory failures such as "I don't remember" are scored 0 points.

Summarizing the PRE-Treatment Scores After scoring the interview, each item in the PRE column should have a score of 0 or 2 entered in the score box. The score for all items in the PRE column are summed, and the total score is entered in the ‘PRE total score’ box at the bottom of the PRE column. The PRE total scores for the six Parts are then transcribed from the bottom of the PRE columns to the Summary Score page (page 13). The six PRE total scores are summed to obtain the PRE Grand Total. This number will be used in the calculation of the amnesia score for each of the post-treatment interviews.

POST-TREATMENT SCORING The goal of scoring the interview at any of the post-treatment sessions is to compare the answers with those given at PRE. If the answer at POST is identical with the answer at PRE, it is scored 2 points. Again, memory failures such as "I Don't remember" are scored 0 points. If an answer at POST is partially correct, that is, it is the same as PRE but missing one element, it will be scored 1 point. The specifics for determining if an answer should receive partial credit will be outlined below for each of the five question types.

POST-Treatment Scoring: Name/Place Questions Any name of a person or place given at POST that is essentially the same as the PRE answer is scored 2 points. The subject’s answer at POST might be a scrambled version of the PRE answer. For example, “Hilton, Pink Flamingo” versus “The Pink Flamingo


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Hilton.” These answers convey the same amount of information and the POST answer is scored 2 points. Answers to the Name/Place questions will usually have more than one element, such as a first and last name. Any answer at POST that is missing just one non-essential element or where one non-essential element is incorrect, is scored 1 point. A nonessential element is defined as part of the name of a place or person, without which the person or place is still identifiable. For example, the word “Club” in the name of the restaurant “Twenty One Club” is not necessary and if left off of an answer given at POST is scored 1 point. Similarly, an answer at POST such as “Dr. Whelby,” where the PRE answer was “Dr. Marcus Whelby,” receives partial credit and is scored 1 point. The exception to this rule is where the answer at PRE is already comprised of only one element, and the answer at POST omits that one element or gets that one element wrong. To use the above example, if the subject says “Dr. Whelby” at PRE and “Dr. Wheatly” at POST, the POST answer is scored 0 points. As with scoring a PRE interview, any memory failure at POST is also scored 0 points.

POST-Treatment Scoring: Date/Number Questions If the answer given at POST has all the elements and they are the same as the PRE answer, the item is scored 2 points. Answers that are the same in content but different in wording are also scored 2 points. For example, the answer “Two weeks” at PRE, and “We were away for 14 days” at POST, suggest that the subject is recalling the same information and is scored 2 points. Most of the answers in this category have only one element and will rarely receive a partial score of 1 point. The three questions in this category that ask for a simple number: age of relative, days away on the last trip, and floor of doctor’s appointment, are given partial credit if the answer is one unit away from the PRE answer. For example, if the answer at PRE for days away on the last trip was “14 days” and the answer at POST is “15 days.” For the two questions requiring a phone number, the subject can get one digit wrong or forget the area code and still get partial credit (1 point). The question asking the subject to recall his/her relative’s birthday can be off by one day to receive partial credit. The two questions asking for the month and year of an event can be off by one month to receive partial credit. For example if a subject reports at PRE that she left her last job in March of 1996, and at POST she recalls leaving that job in April of 1996, the POST answer is scored 1 point. Responses at POST that lose a crucial aspect of the answer such as the day of the month for the birthday question, or the phone number is significantly wrong, are scored 0 points as are obvious memory failures.

POST-Treatment Scoring: Address Questions The three address questions are comprised of multiple elements. The answer at POST needs to include all the elements given at PRE and they must be equivalent to be scored 2 points. If any element is missing or different, a partial score should be


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considered. Any new elements offered at POST compared to PRE should be ignored when scoring. If one element is missing or is wrong, a partial score of 1 point is given. If more than one element is missing and/or wrong, the item is scored 0 points.

POST-Treatment Scoring: List Questions The six List questions have the potential of having many elements to each answer. A POST answer that has the same list items as PRE is scored 2 points. If the PRE answer was not a list (“I traveled alone”) and the response at POST is the same, then 2 points are given. If any list item is missing or is incomplete, a partial score should be considered. Any items included on a list at POST that are not on the list at PRE should be ignored. If one list item is missing from a POST answer as compared to PRE, the question is scored 1 point. If one list item at POST is incomplete, for example, a last name is forgotten, the question is scored 1 point. A list at POST that has more than one missing or incomplete item is scored 0 points. In other words, if the answer at POST is significantly different than the PRE answer, it is scored 0 points. For example, an answer at POST listing three travel companions when the answer at PRE stated that the subject traveled alone, is scored 0 points.

POST-Treatment Scoring: Descriptive Questions The six Descriptive questions have the potential to contain multiple elements and are scored in a similar fashion to the Address and List questions. An answer at POST that contains the same number of elements having similar content to PRE is scored 2 points. For example, the subject’s PRE answer, “We went to Florida for my niece’s wedding and to have a vacation” is considered to have two elements that will need to appear in the POST answer for a score of 2 points. An answer with one element at PRE will need to have an answer at POST that conveys the same content to receive a score of 2 points. Any additional elements at POST are ignored. An answer at POST with multiple elements but that is missing one element compared to PRE is scored 1 point. Using the above example, an answer at POST of “We went to Florida for my niece’s wedding” is scored 1 point, since it missed the “vacation” aspect of the PRE answer but still had a matching element. An answer at POST that contains no matching elements to the PRE answer is scored 0 points, as are pure memory failures.

Summarizing the POST-Treatment Scores After an interview is scored, each item in that column should have a numeric value (0, 1, or 2) in the score box, even items that were not administered. The scores of all the items in that column are summed and the total score entered in the box provided at the


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bottom of the page. The total score for the six Parts are then transcribed to the appropriate column in the Summary Score pages of the interview form (pages 13 or 14). These six figures are summed to obtain the Grand Total, which is entered in the box at the bottom of the column. The Grand Total for that administration is then divided by the PRE Grand Total and multiplied by 100. The resulting percentage is the Amnesia Score for that administration and represents a ratio of the amount of information recalled during that administration relative to the amount originally recalled at PRE.


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REFERENCES McElhiney, M.C., Moody, B.J., Steif, B.L., Prudic, J., Devanand, D.P., Nobler, M.S., Sackeim, H.A. (1995). Autobiographical memory and mood: Effects of electroconvulsive therapy. Neuropsychology, Vol. 9, 4, 501-517. Sackeim, H.A., Prudic, J., Devanand, D.P., Kiersky, J.E., Fitzsimmons, L., Moody, B.J., McElhiney, M.C., Coleman, E.A., & Settembrino, J.M. (1993). Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive thereapy. New England Journal of Medicine, Vol. 328, 839-846. Sackeim, H.A., Luber, B., Moeller, J.R., Prudic, J., Devanand, D.P., and Nobler, M.S.: Electrophysiological correlates of the adverse cognitive effects of electroconvulsive therapy. Journal of ECT, 2000, 16:110-120. Sackeim, H.A., Prudic, J., Devanand, D.P., Nobler, M.S., Lisanby, S.H., Peyser, S., Fitzsimons, L., Moody, B.J., and Clark, J.: A prospective, randomized, double-blind comparison of bilateral and right unilateral ECT at different stimulus intensities. Archives of General Psychiatry, 2000, 57:425-437. Squire, L.R., & Slater, P.C. (1983). Electroconvulsive therapy and complaints of memory dysfunction: A prospective three-year follow-up study. British Journal of Psychiatry, 142, l-8. Squire, L.R., Slater, P.C., & Miller, P.L. (1981). Retrograde amnesia and bilateral electroconvulsive therapy. Long-term follow-up. Archives of General Psychiatry, 38, 39-95. Sobin, C., Sackeim, H.A., Prudic, J., Devanand, D.P., Moody, B.J., McElhiney, M.C. (1995). Predictors of retrograde amnesia following ECT. American Journal of Psychiatry, Vol. 152, 7, 995-1001. Weiner, R.D. (1984). Does ECT cause brain damage? Behavioral and Brain Sciences, 7, 1-53. Weiner, R.D., Rogers, H.J., Davidson, J.R., & Squire, L.R. (1986). Effects of stimulus parameters on cognitive side effects. Annals of the New York Academy of Sciences, Vol. 462, 315-325.


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Question Category Designation QUESTION NUMBER Part 1: Family Member Question 1 Question 2 Question 3 Question 4 Question 5 Part 2: Travel Question 1 Question 2 Question 3 Question 4 Question 5 Part 3: New Year’s Eve Question 1 Question 2 Question 3 Question 4 Question 5 Part 4: Birthday Question 1 Question 2 Question 3 Question 4 Question 5 Part 5: Employment Question 1 Question 2 Question 3 Question 4 Question 5 Part 6: Physical Illness Question 1 Question 2 Question 3 Question 4 Question 5

QUESTION CATEGORY

QUESTION CONTENT

Date/Number Date/Number Address Date/Number List

relative’s birthday (mo/day) relative’s age relative’s address phone number house mates

Date/Number Name/Place List Descriptive Descriptive

days away name of lodging travel companions reason for trip enjoyed about trip

List Name/Place Name/Place Descriptive Descriptive

companions dinner location evening location activity activity at midnight

List Name/Place Descriptive List List

companions celebration location activity received gifts from gifts received

Name/Place Name/Place Address Date/Number Date/Number

job title supervisor’s name work address work phone number date job began (mo/yr)

Name/Place Address Date/Number Descriptive Date/Number

doctor’s name doctor’s address floor of office treatment prescribed symptoms began (mo/yr)


AMI-SF SCORE SHEET

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1

PART 1: FAMILY MEMBER

Interviewer: You will begin this section by asking the subject to name a relative about whom five questions will be asked. If several relatives are mentioned, ask regarding the relative with whom the subject has the most frequent contact. If the subject has no relative, ask regarding his/her closest friend.

I AM GOING TO ASK YOU SOME QUESTIONS ABOUT A FAMILY MEMBER: WHAT IS THE FIRST AND LAST NAME OF THE RELATIVE WHO IS THE MOST IMPORTANT TO YOU BUT WHO DOES NOT LIVE WITH YOU? PRE: name provided POST: name provided NOTES:

NOTES:

WHAT IS HIS/HER RELATION TO YOU? PRE: relationship NOTES: Interviewer: At POST, if the name recalled is different than the name given at PRE, remind the subject of the original name and relation, and proceed with questions 1-5.

QUESTION 1: NOTES:

QUESTION 2: NOTES:

QUESTION 3: NOTES:

WHAT IS THE MONTH AND DAY OF HIS/HER BIRTHDAY? score PRE: month & day POST: month & day

score

WHAT WAS HIS/HER AGE AT THE TIME YOU ENTERED THIS PROGRAM? score PRE: age POST: age

score

WHAT WAS HIS/HER COMPLETE ADDRESS AT THE TIME YOU ENTERED THIS PROGRAM? score score PRE: address POST: address number, street, & apt.

city:

number, street, & apt.

state:

zip code:

QUESTION 4: NOTES:

QUESTION 5: NOTES:

state:

zip code:

WHAT WAS HIS/HER PHONE NUMBER WITH AREA CODE AT THE TIME YOU ENTERED THIS PROGRAM? score score PRE: phone number POST: phone number

LIST THE FULL NAMES OF THE PERSON OR PERSONS LIVING WITH YOUR RELATIVE AT THE TIME YOU ENTERED THIS PROGRAM? score score PRE: house mates POST: house mates

PRE: total score

PAGE 1

city:

POST: total score


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2

PART 1: FAMILY MEMBER

Interviewer: You will begin this section by asking the subject to name a relative about whom five questions will be asked. If several relatives are mentioned, ask regarding the relative with whom the subject has the most frequent contact. If the subject has no relative, ask regarding his/her closest friend.

I AM GOING TO ASK YOU SOME QUESTIONS ABOUT A FAMILY MEMBER: WHAT IS THE FIRST AND LAST NAME OF THE RELATIVE WHO IS THE MOST IMPORTANT TO YOU BUT WHO DOES NOT LIVE WITH YOU? 2 MOS POST: name provided 4 MOS POST: name provided 6 MOS POST: name provided

NOTES:

NOTES:

NOTES:

Interviewer: At all POST testing sessions, if the name recalled is different than the name given at PRE, remind the subject of the original name and relation provided, and proceed with questions 1-5.

QUESTION 1: WHAT IS THE MONTH AND DAY OF HIS/HER BIRTHDAY? score score 2 MOS POST: month & day 4 MOS POST: month & day 6 MOS POST: month & day

score

QUESTION 2: WHAT WAS HIS/HER AGE AT THE TIME YOU ENTERED THIS PROGRAM? score score 2 MOS POST: age 4 MOS POST: age 6 MOS POST: age

score

QUESTION 3: WHAT WAS HIS/HER COMPLETE ADDRESS AT THE TIME YOU ENTERED THIS PROGRAM? score score score 2 MOS POST: address 4 MOS POST: address 6 MOS POST: address number, street, & apt. #:

city:

number, street, & apt. #:

state:

zip code:

city:

number, street, & apt. #:

state:

zip code:

city:

state:

zip code:

QUESTION 4:

WHAT WAS HIS/HER PHONE NUMBER WITH AREA CODE AT THE TIME YOU ENTERED THIS PROGRAM? score score score 2 MOS POST: phone number 4 MOS POST: phone number 6 MOS POST: phone number

QUESTION 5:

LIST THE FULL NAMES OF THE PERSON OR PERSONS LIVING WITH YOUR RELATIVE AT THE TIME YOU ENTERED THIS PROGRAM? score score score 2 MOS POST: house mates 4 MOS POST: house mates 6 MOS POST: house mates

2 MOS POST: total score

PAGE 2




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PART 2: TRAVEL

3

Interviewer: You will begin this section by asking the subject to recall the LAST major trip that he/she took before entering the program. If the subject has never traveled farther than 100 miles, ask regarding the most recent overnight trip away from home.

I AM GOING TO ASK YOU SOME QUESTIONS ABOUT THE LAST MAJOR TRIP YOU TOOK BEFORE YOU ENTERED THIS PROGRAM: WHERE DID YOU GO ON YOUR LAST OVERNIGHT TRIP OF 100 MILES OR MORE AWAY FROM HOME? PRE: trip destination POST: trip destination NOTES:

NOTES:

IN WHAT MONTH AND YEAR DID YOU TAKE THIS TRIP? PRE: month & year of trip

NOTES:

QUESTION 1: NOTES:

Interviewer: At POST, if the trip recalled is different than the trip given at PRE, remind the subject of the original trip and date, and proceed with questions 1-5.

COUNTING THE DAYS YOU SPENT TRAVELING, HOW MANY DAYS WERE YOU AWAY? score score PRE: days away POST: days away

QUESTION 2: WHAT IS THE FULL NAME OF THE HOTEL AT WHICH (OR PERSON WITH WHOM) YOU STAYED DURING THE MAJORITY OF THIS TRIP? score score PRE: name of lodging POST: name of lodging

NOTES:

QUESTION 3: NOTES:

QUESTION 4: NOTES:

QUESTION 5: NOTES:

LIST THE FULL NAMES OF THE PERSON OR PERSONS WHO WENT WITH YOU ON THIS TRIP: score score PRE: travel companion(s) POST: travel companion

WHAT WAS THE MAIN REASON FOR TAKING THIS TRIP? score PRE: reason for trip POST: reason for trip

score

WHAT DID YOU ENJOY MOST ABOUT THIS TRIP? score PRE: enjoyed about trip

score

PRE: total score

Page 3

POST: enjoyed about trip

POST: total score


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PART 2: TRAVEL

4

Interviewer: You will begin this section by asking the subject to recall the LAST major trip that he/she took before entering the program. If the subject has never traveled farther than 100 miles, ask regarding the most recent overnight trip away from home.

I AM GOING TO ASK YOU SOME QUESTIONS ABOUT THE LAST MAJOR TRIP YOU TOOK BEFORE YOU ENTERED THIS PROGRAM: WHERE DID YOU GO ON YOUR LAST OVERNIGHT TRIP OF 100 MILES OR MORE AWAY FROM HOME? 2 MOS POST: trip destination 4 MOS POST: trip destination 6 MOS POST: trip destination

NOTES:

NOTES:

NOTES:

Interviewer: At all POST testing sessions, if the trip recalled is different than the trip given at PRE, remind the subject of the original trip and date provided, and proceed with questions 1-5.

QUESTION 1: COUNTING THE DAYS YOU SPENT TRAVELING, HOW MANY DAYS WERE YOU AWAY? score score score 2 MOS POST: days away 4 MOS POST: days away 6 MOS POST: days away

QUESTION 2: WHAT IS THE FULL NAME OF THE HOTEL AT WHICH (OR PERSON WITH WHOM) YOU STAYED DURING THE MAJORITY OF THIS TRIP? 2 MOS POST: name of lodging score 4 MOS POST: name of lodging score 6 MOS POST: name of lodging score

QUESTION 3: LIST THE FULL NAMES OF THE PERSON OR PERSONS WHO WENT WITH YOU ON THIS TRIP: 2 MO POST: travel companion(s) score 4 MO POST: travel companion(s) score 6 MO POST: travel companion score

QUESTION 4: WHAT WAS THE MAIN REASON FOR TAKING THIS TRIP? score score 2 MOS POST: reason for trip 4 MOS POST: reason for trip 6 MOS POST: reason for trip

score

QUESTION 5: WHAT DID YOU ENJOY MOST ABOUT THIS TRIP? 2 MO POST: enjoyed about trip score 4 MO POST: enjoyed about trip score

score


Page 4


6 MO POST: enjoyed about trip



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5

PART 3: NEW YEAR'S EVE

I AM GOING TO ASK YOU SOME QUESTIONS ABOUT LAST NEW YEAR'S EVE: WHAT WAS THE YEAR OF THE LAST NEW YEAR'S EVE BEFORE YOU ENTERED THIS PROGRAM (I.E., THE YEAR IT WAS ON DECEMBER 31ST) ? NOTES: PRE: year POST: year

Interviewer: At POST, if the year recalled is different than the year given at PRE, remind the subject of the original year, and proceed with questions 1-5. Emphasize that you are asking about the last New Year's Eve BEFORE he/she entered the program.

QUESTION 1: NOTES:

QUESTION 2: NOTES:

QUESTION 3: NOTES:

QUESTION 4: NOTES:

QUESTION 5: NOTES:

LIST THE FULL NAMES OF THE PERSON OR PERSONS YOU WERE WITH THAT EVENING: score score PRE: companion(s) POST: companion(s)

WHERE DID YOU EAT DINNER THAT EVENING? score PRE: dinner location

POST: dinner location

score

WHERE DID YOU GO THAT NIGHT? PRE: location

score

POST: location

score

WHAT DID YOU DO THERE? PRE: activity

score

POST: activity

score

WHAT DID YOU DO AT MIDNIGHT? PRE: midnight

score

POST: midnight

score

PRE: total score

Page 5

POST: total score


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6 PART 3: NEW YEAR'S E V E I AM GOING TO ASK YOU SOME QUESTIONS ABOUT LAST NEW YEAR'S EVE: WHAT WAS THE YEAR OF

THE LAST NEW YEAR'S EVE BEFORE YOU ENTERED THIS PROGRAM (I.E., THE YEAR IT WAS ON DECEMBER 31ST) ? 2 MOS POST: year 4 MOS POST: year 6 MOS POST: year

NOTES:

NOTES:

NOTES:

Interviewer: At all POST testing sessions, if the year recalled is different than the year given at PRE, remind the subject of the original year, and proceed with questions 1-5. Emphasize that you are asking about the last New Year's Eve BEFORE he/she entered the program, and not necessarily the most recent New Year's Eve.

QUESTION 1: LIST THE FULL NAMES OF THE PERSON OR PERSONS YOU WERE WITH THAT EVENING: score score score 2 MOS POST: companion(s) 4 MOS POST: companion(s) 6 MOS POST: companion(s)

QUESTION 2: WHERE DID YOU EAT DINNER THAT EVENING? score 2 MOS POST: dinner location score 4 MOS POST: dinner location

6 MOS POST: dinner location

score

QUESTION 3: WHERE DID YOU GO THAT NIGHT? score 2 MOS POST: location 4 MOS POST: location

score

6 MOS POST: location

score

QUESTION 4: WHAT DID YOU DO THERE? score 2 MOS POST: activity 4 MOS POST: activity

score

6 MOS POST: activity

score

QUESTION 5: WHAT DID YOU DO AT MIDNIGHT? score 2 MOS POST: midnight 4 MOS POST: midnight

score

6 MOS POST: midnight

score


Page 6




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PART 4: BIRTHDAY

7

I AM GOING TO ASK YOU SOME QUESTIONS ABOUT YOUR BIRTHDAY: WHAT IS THE DATE OF YOUR BIRTH(MONTH/DAY/YEAR) ? PRE: birth date (mo/dy/yr) POST: birth date (mo/dy/yr) NOTES:

NOTES:

HOW OLD DID YOU BECOME ON YOUR LAST BIRTHDAY BEFORE YOU ENTERED THIS PROGRAM? Interviewer: At POST, if the age recalled PRE: age NOTES: is different than the age given at PRE, remind the subject of the original age, and proceed with questions 1-5.

QUESTION 1: NOTES:

QUESTION 2: NOTES:

QUESTION 3: NOTES:

QUESTION 4: NOTES:

QUESTION 5: NOTES:

LIST THE FULL NAMES OF THE PERSON OR PERSONS WHO HELPED YOU CELEBRATE ON YOUR LAST BIRTHDAY: score PRE: companion(s) POST: companion(s)

score

WHERE DID YOU CELEBRATE YOUR BIRTHDAY? score PRE: location

POST: location

score

WHAT DID YOU DO THERE? PRE: activity

POST: activity

score

score

FROM WHOM DID YOU RECEIVE GIFTS (IF NO ? GIFTS, ASK REGARDING CARDS) score PRE: received gifts from POST: received gifts from

score

WHAT DID YOU RECEIVE? PRE: gifts received

score

score

PRE: total score

Page 7

POST: gifts received

POST: total score


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PART 4: BIRTHDAY

8

I AM GOING TO ASK YOU SOME QUESTIONS ABOUT YOUR BIRTHDAY: WHAT IS THE DATE OF YOUR BIRTH(MONTH/DAY/YEAR) ? 2 MOS POST: birth date 4 MOS POST: birth date 6 MOS POST: birth date

NOTES:

NOTES:

NOTES:

Interviewer: At all POST testing sessions, if the age recalled is different than the age given at PRE, remind the subject of the original age, and proceed with questions 1-5. Emphasize that you are asking about the subject's last birthday BEFORE he/she entered the program, which may not necessarily be his/her most recent birthday.

QUESTION 1:

LIST THE FULL NAMES OF THE PERSON OR PERSONS WHO HELPED YOU CELEBRATE ON YOUR LAST BIRTHDAY: score score 2 MOS POST: companion(s) 4 MOS POST: companion(s) 6 MOS POST: companion(s)

score

QUESTION 2: WHERE DID YOU CELEBRATE YOUR BIRTHDAY? score score 2 MOS POST: location 4 MOS POST: location

6 MOS POST: location

score

QUESTION 3: WHAT DID YOU DO THERE? score 2 MOS POST: activity 4 MOS POST: activity

6 MOS POST: activity

score

score

QUESTION 4: FROM WHOM DID YOU RECEIVE GIFTS (IF NO ? GIFTS, ASK REGARDING CARDS) 2 MO POST: received gifts from score 4 MO POST: received gifts from score 6 MO POST: received gifts from

score

QUESTION 5: WHAT DID YOU RECEIVE? score 2 MOS POST: gifts received 4 MOS POST: gifts received

score


Page 8

score


6 MOS POST: gifts received



Page 31

PART 5:

9

EMPLOYMENT Interviewer: You will begin this section by asking the subject to recall the LAST job that he/she held before entering the program. If the subject has never been formally employed, ask about volunteer work or the job of his/her spouse. If the subject is self-employed, ask him/her to recall the last job held before becoming self-employed. I AM GOING TO ASK YOU SOME QUESTIONS ABOUT YOUR MOST RECENT EMPLOYMENT BEFORE YOU ENTERED THIS PROGRAM: WHAT WAS THE NAME OF THE COMPANY OR ORGANIZATION WITH WHICH YOU WERE AFFILIATED? PRE: name of company POST: name of company NOTES:

NOTES:

BEFORE YOU ENTERED THIS PROGRAM, IN WHAT MONTH AND YEAR DID YOU LAST WORK FOR THIS EMPLOYER? Interviewer: At POST, if the job recalled is PRE: month & year last worked NOTES: different than the job given at PRE, remind the subject of the original job and date provided, and proceed with questions 1-5.

QUESTION 1: NOTES:

WHAT WAS YOUR TITLE WHEN LAST WORKING AT THIS JOB? score PRE: job title POST: job title

score

QUESTION 2: WHAT WAS THE FIRST AND LAST NAME OF YOUR SUPERVISOR? score PRE: supervisor's name POST: supervisor's name

NOTES:

QUESTION 3: NOTES:

WHAT WAS THE COMPLETE ADDRESS OF THE BUILDING WHERE YOU WORKED? score score PRE: address POST: address number & street:

city:

number & street:

state:

zip code:

QUESTION 4: NOTES:

QUESTION 5: NOTES:

city:

state:

zip code:

WHAT WAS YOUR PHONE NUMBER WITH AREA CODE AT THIS JOB? score PRE: phone number POST: phone number

score

IN WHAT MONTH AND YEAR DID YOU FIRST START WORKING FOR THIS EMPLOYER? score score PRE: mo & yr job began POST: mo & yr job began

PRE: total score

Page 9

score

POST: total score


Page 32

10 PART 5: EMPLOYMENT You will begin this section by asking the subject to recall the LAST job that he/she held before entering

Interviewer: the program. If the subject has never been formally employed, ask about volunteer work or the job of his/her spouse. If the subject is self-employed, ask him/her to recall the last job held before becoming self-employed.

I AM GOING TO ASK YOU SOME QUESTIONS ABOUT YOUR MOST RECENT EMPLOYMENT BEFORE YOU ENTERED THIS PROGRAM: WHAT WAS THE NAME OF THE COMPANY OR ORGANIZATION WITH WHICH YOU WERE AFFILIATED? 2 MOS POST: name of company 4 MOS POST: name of company 6 MOS POST: name of company

NOTES:

NOTES:

NOTES:

Interviewer: At all POST testing sessions, if the job recalled is different than the job given at PRE, remind the subject of the original job and date provided, and proceed with questions 1-5.

QUESTION 1: WHAT WAS YOUR TITLE WHEN LAST WORKING AT THIS JOB? score score 2 MOS POST: job title 4 MOS POST: job title 6 MOS POST: job title

score

QUESTION 2: WHAT WAS THE FIRST AND LAST NAME OF YOUR SUPERVISOR? 2 MO POST: supervisor's name score 4 MO POST: supervisor's name score 6 MO POST: supervisor's name

score

QUESTION 3: WHAT WAS THE COMPLETE ADDRESS OF THE BUILDING WHERE YOU WORKED? score score score 2 MOS POST: address 4 MOS POST: address 6 MOS POST: address number & street:

city:

number & street:

state:

zip code:

city:

number & street:

state:

zip code:

city:

state:

zip code:

QUESTION 4: WHAT WAS YOUR PHONE NUMBER WITH AREA CODE AT THIS JOB? score score 2 MOS POST: phone number 4 MOS POST: phone number 6 MOS POST: phone number

score

QUESTION 5: IN WHAT MONTH AND YEAR DID YOU FIRST START WORKING FOR THIS EMPLOYER? 2 MO POST: mo & yr job began score 4 MO POST: mo & yr job began score 6 MO POST: mo & yr job began score


Page 10




Page 33

PART 6: PHYSICAL

11

ILLNESS Interviewer: You will begin this section by asking the subject to recall the MOST RECENT physical illness for which he/she consulted a physician, before entering the program. If the subject's most recent doctor's visit was for a check-up, ask him/her to recall the most recent visit that involved a physical complaint. I AM GOING TO ASK YOU SOME QUESTIONS ABOUT THE LAST TIME YOU CONSULTED A PHYSICIAN FOR A PHYSICAL COMPLAINT OR ILLNESS BEFORE YOU ENTERED THIS PROGRAM. WHY DID YOU GO TO SEE A DOCTOR; WHAT WERE YOUR COMPLAINTS? PRE: complaint POST: complaint NOTES:

NOTES:

IN WHAT MONTH AND YEAR DID THIS CONSULTATION TAKE PLACE? PRE: month & year of visit NOTES:

Interviewer: At POST, if the illness recalled is different than the one given at PRE, remind the subject of the original illness and date, and proceed with questions 1-5.

QUESTION 1: WHAT WAS THE FIRST AND LAST NAME OF THE DOCTOR WHOM YOU SAW AT THIS TIME? score score PRE: Dr.'s name POST: Dr.'s name

NOTES:

QUESTION 2: WHAT WAS THE NAME AND ADDRESS OF THE BUILDING OR HOSPITAL WHERE YOU SAW YOUR DOCTOR? score score PRE: Dr.'s address POST: Dr.'s address NOTES: name of building or hospital:

name of building or hospital:

number & street:

number & street:

city:

state:

zip code:

city:

state:

zip code:

QUESTION 3: ON WHAT FLOOR OF THIS BUILDING OR HOSPITAL WAS YOUR APPOINTMENT? score score PRE: floor POST: floor

NOTES:

QUESTION 4:

WHAT TREATMENTS OR MEDICATIONS WERE PRESCRIBED FOR YOU? score PRE: treatment POST: treatment

score

IN WHAT MONTH AND YEAR DID YOU FIRST NOTICE YOUR SYMPTOMS? score PRE: mo & yr symps POST: mo & yr symps

score

NOTES:

QUESTION 5: NOTES:

PRE: total score

Page 11

POST: total score


Page 34

PART 6: PHYSICAL ILLNESS

12

Interviewer: You will begin this section by asking the subject to recall the MOST RECENT physical illness for which he/she consulted a physician before entering the program. If the subject's most recent doctor's visit was for a check-up, ask him/her to recall the most recent visit that involved a physical complaint.

I AM GOING TO ASK YOU SOME QUESTIONS ABOUT THE LAST TIME YOU CONSULTED A PHYSICIAN FOR A PHYSICAL COMPLAINT OR ILLNESS BEFORE YOU ENTERED THIS PROGRAM. WHY DID YOU GO TO SEE A DOCTOR; WHAT WERE YOUR COMPLAINTS? 2 MOS POST: complaint 4 MOS POST: complaint 6 MOS POST: complaint

NOTES:

NOTES:

NOTES:

Interviewer: At all POST testing sessions, if the illness recalled is different than the one given at PRE, remind the subject of the original illness and date, and proceed with questions 1-5.

QUESTION 1: WHAT WAS THE FIRST AND LAST NAME OF THE DOCTOR WHOM YOU SAW AT THIS TIME? score score score 2 MOS POST: Dr.'s name 4 MOS POST: Dr.'s name 6 MOS POST: Dr.'s name

QUESTION 2: WHAT WAS THE NAME AND ADDRESS OF THE BUILDING OR HOSPITAL WHERE YOU SAW YOUR DOCTOR? score score score 2 MOS POST: Dr.'s address 4 MOS POST: Dr.'s address 6 MOS POST: Dr.'s address name of building or hospital:



number & street:

number & street:

number & street:

city:

state:

zip code:

city:

state:

zip code:

city:

state:

zip code:

QUESTION 3: ON WHAT FLOOR OF THIS BUILDING OR HOSPITAL WAS YOUR APPOINTMENT? score score score 2 MOS POST: floor 4 MOS POST: floor 6 MOS POST: floor

QUESTION 4: WHAT TREATMENTS OR MEDICATIONS WERE PRESCRIBED FOR YOU? score score 2 MOS POST: treatment 4 MOS POST: treatment 6 MOS POST: treatment

score

QUESTION 5: IN WHAT MONTH AND YEAR DID YOU FIRST NOTICE YOUR SYMPTOMS? score score 2 MOS POST: mo & yr symps 4 MOS POST: mo & yr symps 6 MOS POST: mo & yr symps

score


Page 12




Page 35

SCORE SUMMARY PRE PART 1 TOTAL

PART 2 TOTAL

PART 3 TOTAL

PART 4 TOTAL

13

POST

PRE: total score

POST: total score

PRE: total score

POST: total score

PRE: total score

POST: total score

PRE: total score

POST: total score

PRE: total score

POST: total score

PRE: total score

POST: total score

PART 5 TOTAL

PART 6 TOTAL

PRE: GRAND TOTAL

POST: GRAND TOTAL

DIVIDE POST GRAND TOTAL BY PRE GRAND TOTAL AND MULTIPLY BY 100 TO OBTAIN AMNESIA SCORE

POST/PRE X 100 = A.S.

X 100 =

PRE GRAND TOTAL

Page 13

POST AMNESIA SCORE


Page 36

SCORE SUMMARY 2 MOS POST PART 1 TOTAL

PART 2 TOTAL

PART 3 TOTAL

PART 4 TOTAL

14

4 MOS POST

6 MOS POST



















PART 5 TOTAL

PART 6 TOTAL

2 MOS POST: GRAND TOTAL


DIVIDE 2 MOS POST GRAND TOTAL BY PRE GRAND TOTAL AND MULTIPLY BY 100 TO OBTAIN AMNESIA SCORE


2 MOS POST/PRE X 100 = A.S.

X 100 =

2 MOS POST AMNESIA SCORE

Page 14


X 100 =





X 100 =


the autobiographical memory interview - short form

the autobiographical memory interview - short form

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