FACTORS AFFECTING SHORT TERM MEMORY:

A CROSS-SECTIONAL STUDY
Chong Jia Xi
Melaka Manipal Medical College, Malaysia

Chew Yuhhui
Melaka Manipal Medical College, Malaysia

Chiang Wei Bian

Melaka Manipal Medical College, Malaysia

Nur Amalina Ismail

Melaka Manipal Medical College, Malaysia

Ghayathiri Pariteppan
Melaka Manipal Medical College, Malaysia

Abstract
Short term memory involves the retention of information in a short period of time
from a few seconds to one hour. Recent research showed that visual short term memory was
limited by the number of objects that can be stored in the brain and the factors that could
affect cognitive functions are malnutrition, fasting and dieting, exercise, and sleep duration.
Objective of this study is to identify significant factors affecting short term memory. This
cross sectional study was conducted with n=285 students in Melaka Manipal Medical College
to study the relationship between these factors and short term memory. Chi-square test,
independent sample t-test were used for data analysis by employing Epi-info version 3.5.1. In
this study, 101 (35.4%) of the students had good short term memory and 184.0 (64.6%) had
poor short term memory. Our study showed that the vegetarian diet has significant
association with good short term memory (OR=2.2, 95%CI 1.2-3.9, p-value 0.008). Other
factors such as fasting, smoking, coffee or tea drinking, sleeping hours and regular exercise
are not significantly associated with short term memory among the students. In conclusion,
there is significant association between vegetarian diet and good short term memory among
students.

Keyword: Cross Sectional Study, Short term memory, Vegetarian diet, Fasting, Exercise

1. INTRODUCTION

Short term memory involves the retention of information in a short period of time from a few
seconds to one hour.1 It is intriguing to find out how short term memory works and what
factors affect it. Research on short term memory had been published since the 19th century2
and a lot of work has been done for the literature review to get published.3 Over the years,
several researches showed that the theories on memory evolved from verbal, analogy based
accounts4,5 to box and arrow schematics6 to abstract mathematical characterizations and
algorithms.7,8,9,10
 Recent research showed that visual short term memory was limited by the number of
objects that can be stored in the brain.11 A study proposed that human memory can retain 7 ±
2 pieces of information in 30 seconds.12
Factors that can affect cognitive functions are malnutrition, fasting and dieting.13
Vegetarian diet is found to have effects on cognitive function, due to its possible lack of
vitamin B-12, which could indirectly result in poor memory.14 On top of that, a study was
conducted to analyze the effects of caffeine on memory. Caffeine inhibited females' recall but
there was no effect on the recall performance of males.15 Besides that, exercise is said to
affect short term memory as well. During a study, it was found that after 45 minutes of
exercise, there was short term improvement in the cognitive function of older adults with
memory complaints.16 It was also hypothesized that sleep deprivation prevents the encoding
of items in short term memory.17
The aim of this study is to identify significant factors affecting short term memory.

2. METHODOLOGY

This observational analytical cross sectional study was conducted in Melaka Manipal
Medical College, Melaka, Malaysia from 23rd July 2012 to 31st August 2012. This study
examined the relationship between short term memory and other variable of interests among
medical students in MMMC in a period of 5 weeks.
A pilot study had been conducted with 30 random students from our group mates, to
identify the expected frequency of short term memory response. With 95% confidence level
with an expected frequency of 80% and with a margin of error of 6% we would require a
sample size of 109 students, however, we conducted the survey on a larger sample size of 285
students to offset non-response.
All Melaka Manipal Medical College students pursuing M.B.B.S. course were
included in the study. Some students who were unwilling to participate in the survey were
excluded. Universal sampling was used where by every individual from the respective chosen
batches were asked to participate in the survey. Collection of data was performed through
questionnaire and a short term memory test. The questionnaire composed of questions
regarding demographic profile, social characteristics, fasting particulars, diet type etc which
will affect short term memory. This survey was conducted by holding students in their
respective lecture halls after their lecture ends, where each student was given a questionnaire
to be filled up in 5 minutes, and subsequently followed by the short term memory test 1 and
test 2. All the students took the memory tests simultaneously through LED projection. Each
test slides containing 12 words were projected for 12 seconds and student were given 1
minute to fill up the words which they could recall, over the next 40 seconds. After that, the
forms were collected and compiled for data analysis.
Data processing was done by using Microsoft Office Excel 2007.
Data analysis was performed by employing StatCalc and Epi-info version 3.5.1. The
data were processed with descriptive analysis to find the mean of the short term memory test
results, as well as the frequency of each social and demographic variables. As for the
dispersion of data, standard deviation was calculated to identify the degree of dispersion of
our data. Inferential analysis were also used to analyze the data. Hypothesis testing was done
using unpaired t-test for the significance of difference between short term memory of the
fasting and non-fasting group of students. Odd ratio and Pearson’s Chi-Squared test were also
employed respectively to determine the measure of association and significance of difference
between students with good and poor memory (score < 7 for poor short term memory, ≥ 7
for good short term memory based on Atkinson study). The significance level was set as p-
value < 0.05. The results would be presented using tables for mean and frequency, and bar
charts for depiction of Short term memory result with respect to all the variables.

3. RESULTS

n=285 medical students from batch 22, 23, 24 and 25 from Melaka Manipal Medical college
participated in this survey.

Table 1: Demographic characteristics of respondents (n=285)

Variables Frequency ( % )
Age (Mean ± Standard Deviation) 23.3 ± 1.1
Gender
Male 96 (33.7%)
Female 189 (66.3%)
Race
Malay 131 (46%)
Chinese 81 (28.4%)
Indian 59 (20.7%)
Others 14 (4.9%)
Religion
Muslim 133 (46.7%)
Buddhist 53 (18.6 %)
Christian 40 (14.0%)
Hindu 47 (16.5 %)
Others 12 (4.2 %)
BMI (Mean ± Standard Deviation) 21.9 ± 4.8

Table 1 shows the frequency, mean and standard deviation of the variables. The mean and
standard deviation of the age of the students is 23.3 ± 1.1. There were 96 (33.7%) male
students and 189 (66.3%) female students. Among the 285 participants, 131 (46%) belonged
to the Malay ethnic group, 81 (28.4%) students were Chinese, 59 (20.7%) were Indians and
there were 14 (4.9%) which were belonged to other ethnic group. There were 133 (46.7%)
Muslims, 53 (18.6%) Buddhists, 40 (14.0%) Christians, 47 (16.5%) Hindu and 12 (4.2%)
others which are of different religion as mentioned above. The mean and standard deviation
for birth order and BMI are 2.2 ± 1.4 and 21.9 ± 4.8 respectively.
Table 2 : Social characteristics of respondents (n=285)
Health condition
Anemia 10 (3.5 %)
Asthma 9 (3.2 %)
Seizures 2 (0.7%)
Others( eg. PID, Sinusitis, Allergic Rhinitis) 10 (3.5%)
Smoking status
Yes 10 (3.5%)
No 275 (96.5%)
CNS Stimulants
Coffee 139 (48.8%)
Tea 74 (26.0%)
Coke 16 (5.6 %)
Gingko 8 (2.8%)
Brahmi 1 (0.4%)
Lecithin 5 (1.8%)
Others 19 (6.7%)
None 98 (34.4%)
Sleeping hours
< 5 hours 49 (17.2 %)
5 - 10 hours 230 (80.7 %)
> 10 hours 6 (2.1 %)
Exercise
Yes 115 (40.4%)
No 170 (59.6%)
Relaxation exercise
Yes 34 (11.9%)
No 251 (88.1%)
Number of mental exercises (Mean ± Standard Deviation) 0.7 ± 0.9

Vegetarian
Yes 60 (21.1%)
No 225 (78.9%)

Table 2 shows that 10 (3.5%) of the participants have anemia, 9 (3.2%) have asthma, 2
(0.7%) have seizures and 10 (3.5%) have other conditions such as PID, Allergic Rhinitis, and
Sinusitis. Also, 10 (3.5%) participants smoke and 275 (96.5%) participants do not smoke. For
use of Central Nervous System stimulants, 139 ( 48.8%) took coffee whilst 74 (26%)
participants took tea, 16 (5.6%) took coke, 8 (2.8%) took gingko, 1.0 (0.4%) took Brahmi, 5.0
(1.8%) took Lecithin, 19.0 (6.7%) took other stimulants and 98 (34.4%) participants do not
take any stimulants.
230 (80.7%) participants sleep for 5-10 hours per day, 49 (17.2%) participants sleep <
5 hours and 6 (2.1%) participants sleep > 10 hours per day. 115 (40.4%) of them exercise
while 170 (59.6%) do not exercise. As for practicing relaxation exercises like meditation,
yoga etc, only 34 (11.9%) participants practice it but 251 (88.1%) do not practice it. The
mean and standard deviation for number of participants doing mental exercises are 0.7 ± 0.9.
225 (78.9%) are not vegetarians while 60 (21.1%) are vegetarians.
Table 3 : Fasting Particulars (n=285)
Fasting Group (n=130)
Number of days fasting (Mean ± Standard Deviation) 6.7 ± 1.1
Years of fasting (Mean ± Standard Deviation) 15.8 ± 3.0
Hours into fasting (Mean ± Standard Deviation) 2.5 ± 0.8
Hours since last meal (Mean ± Standard Deviation) 11.1 ± 3.1
Activity
Mild 67 (23.5%)
Moderate 46 (16.1%)
Vigorous 13 (4.6%)
Non – Fasting Group (n=155)
Number of meals per day (Mean ± Standard Deviation) 3.4 ± 1.0
Hours since last meal (Mean ± Standard Deviation) 4.0 ± 2.9

Table 3 shows that 130 (45.6%) fast while 155 (54.5%) participants do not fast. The mean
and standard deviation of the number of days for participants who fast and the results are 6.7
± 1.1. The mean and standard deviation for years of fasting was 15.8 ± 3.0.
2.5 ± 0.8 and 11.1 ± 3.1 are the mean and standard deviation for hours into fasting and
hours since last meal respectively. As for the activity levels for those who fast, 67 (23.5%)
rated their activities before fasting as mild while 46 (16.1%) rated their activities as moderate
and 13 (4.6%) rated their activities as vigorous.
The mean and standard deviation of number of meals per day for participants who do
not fast is 3.4 ± 1.0 and as for hours since last meal, the mean and standard deviation is 4.0 ±
2.9.

Figure 1: Fasting Status of respondents (n=285)

Figure 1 depicts the students with regards to fasting status. It is seen that among 285 students,
45.6% of them fasts and 54.4% do not fast.
Table 4 : Factors affecting short term memory (n=285)
Independent Good (n= 101) Bad (n=184) OR (95% CI) Chi- p-value
Variables Frequency (%) Frequency (%) square
Gender
Female 73 (72.3) 116 (63.0) 1.0 (reference)
Male 28 (27.7) 68 (37.0) 0.7 (0.4-1.1) 2.49 0.115
Race
Chinese 28 (27.7) 53 (28.8) 1.0 (reference)
Indian 21 (20.8) 38 (20.7) 1.1 (0.5-2.2) 0.02 0.900
Malay 47 (46.5) 84 (45.7) 1.1 (0.6-2.0) 0.04 0.846
Others 5 (5.0) 9 (4.9) 1.1 (0.3-3.9) 1.000#
Religion
Buddhist 18 (17.8) 35 (19.0) 1.0 (reference)
Christian 17 (16.8) 23 (12.5) 1.4 (0.6-3.7) 0.71 0.400
Hindu 15 (14.9) 32 (17.4) 0.9 (0.4-2.3) 0.05 0.828
Muslim 48 (47.5) 85 (46.2) 1.1 (0.5-2.3) 0.07 0.784
Others 3 (3.0) 9 (4.9) 0.7 (0.1-3.1) 0.737#
Smoking
Non-smoker 96 (95.0) 179 (97.3) 1.0 (reference)
Smoker 5 (5.0) 5 (2.7) 1.9 (0.5-6.6) 0.333#
Health
Condition 93 (92.1) 163 (88.6) 1.0 (reference)
No Health 2 (2.0) 8 (4.3) 0.4 (0.1-2.3) 0.503#
Condition 2 (2.0) 7 (3.8) 0.5 (0.1-2.7) 0.497#
Anemia 1 (1.0) 1 (0.5) 1.8 (0.0-64.9) 1.000#
Asthma 3 (2.9) 5 (2.8) 1.1 (0.2-5.2) 1.000#
Seizure
Others
Regular Drinks
Coffee 50 (49.5) 89 (48.4) 1.0 (reference)
Tea 32 (31.7) 42 (22.8) 1.4 (0.7-2.5) 1.08 0.299
Coke 3 (3.0) 13 (7.1) 0.4 (0.1-1.7) 1.89 0.169
Gingko 5 (5.0) 3 (1.6) 3.0 (0.6-16.5) 0.151#
Brahmi 1 (1.0) 0 (0.0) undefined 0.364#
Lecithin 0 (0.0) 5 (2.7) 0.0 (0.0-2.2) 0.164#
Others 10 (9.8) 32 (17.4) 0.6 (0.2-1.3) 2.15 0.142
Daily Sleep
<5 hours 19 (18.8) 30 (16.3) 1.0 (reference)
5-10hours 81 (80.2) 149 (81.0) 0.9 (0.4-1.7) 0.22 0.637
>10hours 1 (1.0) 5 (2.7) 0.3 (0.0-3.2) 0.399#
Exercise
Non-regular 59 (58.4) 111 (60.3) 1.0 (reference)
Regular 42 (41.6) 73 (39.7) 1.1 (0.7-1.8) 0.10 0.753
Relaxation
Exercise 91 (90.1) 160 (87.0) 1.0 (reference)
No 10 (9.9) 24 (13.0) 0.7 (0.3-1.6) 0.61 0.434
Yes
Fasting Status
Non-fasting 53 (52.5) 102 (55.4) 1.0 (reference)
Fasting 48 (47.5) 82 (44.6) 1.1 (0.7-1.8) 0.23 0.631
Activity
Intensity 22 (45.8) 45 (54.9) 1.0 (reference)
Mild 20 (41.7) 29 (35.4) 1.4 (0.6-3.3) 0.78 0.377
Moderate 6 (12.5) 8 (9.8) 1.5 (0.4-5.7) 0.542#
Vigorous
#
Fisher exact was used
Table 4 shows the factors affecting short term memory. There were no significant association
between gender, race, religion, health condition, smoking status, having regular drinks,
duration of sleep, regular exercise, relaxation exercise, fasting status, activity intensity and
short term memory.

Table 5: The relationship of the students’ diet to short term memory

Independent Good (n= 101) Bad (n=184) OR (95% CI) Chi- p –value
Variables square
Frequency (%) Frequency (%)
Diet
Non-vegetarian 71 (70.3) 154 (83.7) 1.0 (reference)
Vegetarian 30 (29.7) 30 (16.3) 2.2 (1.2-3.9) 7.04 0.008 *
* (p value <0.05) = significant

Table 5 shows the relationship of the students’ diet to short term memory. Diet have
significant effect on short term memory as vegetarian are 2.2 times more likely to have short
term memory with 95% CI of 1.2-3.9 and p-value = 0.008.

Figure 2: Diet type against short term memory

Figure 2 shows food preference with test results in order to establish its influence on short
term memory. As depicted above, there are more students on non vegetarian diet, and among
students who are taking vegetarian diet, the proportion of good and bad result is equal, i.e. 30
each. Also, among students who are taking non vegetarian diet, the number of students with
poor memory is almost double of the number of students with good memory.
TABLE 6 : Relationship between quantitative variables and short term memory (n=
285)
Vegetarian Non-vegetarian Student t- p-
Independent Variables (Mean±SD) (Mean±SD) test value
Age 23.5 (1.6) 23.3 (0.9) 1.23 0.221
Birth Order 2.1 (1.3) 2.2 (1.5) 0.86 0.392
BMI 21.3(5.2) 22.1 (4.6) 1.10 0.274

Number of hours since last meal 6.2 (4.4) 7.4 (4.7) 1.65 0.100
Number of meals per day 2.8 (0.9) 2.7 ( 1.0) 0.46 0.644

Table 6 depicts the results of independent t-tests and p-values of quantitative variables in this
study. Age, birth order, BMI, number of hours since last meal, and number of meals per day
do not have significant association with short term memory.

4. DISCUSSION

In this study, we examined the relationship of multiple factors such as fasting status, diet type,
smoking habit and regular exercise, among others with short term memory among medical
students.
Short term memory is defined as the retention of information in a short period of time
from a few seconds to one hour.1 In this study, short term memory is tested by asking
participants to memorize 12 items in 12 seconds. The capability of short term memory was
measured by the number of items participants managed to memorize.
Through our research, we found that there was significant association between
vegetarian status of our subjects and their short term memory. This was shown by the
OR=2.2, 95%CI 1.2-3.9, p-value 0.008 in vegetarians. Richly coloured vegetables such as
broccoli, peppers, carrots and tomatoes are high in antioxidants.21 It was found from a
research that antioxidants play an important role in memory and may have implications for
prevention of progressive cognitive impairments.22 However, some reports refute our study as
vitamin B-12, important for neuronal integrity, is produced in nature only by vitamin B-12–
producing microorganisms. Humans must receive vitamin B-12 solely from the diet.18 The
risk of poor cognitive and neuromotor performance is real among these children with low
vitamin B-12 status19, with experimental data showing that short-term memory and
perception were worse than they were in the group with adequate vitamin B-12.20 On top of
that, it was said that following a vegetarian diet within the guidelines of Mediterranean
tradition may decrease your risks of heart disease, cancer and Alzheimer's disease. 23
We found that there is no significant association between the fasting and short term
memory. This could be due to the fact that our sample was obtained from an academic group
which are accustomed to memorizing as part of their usual learning method. Similarly, a
study found that there are no significant effects of deprivation of food on sustained attention,
attentional focus, simple reaction time or immediate memory.24 However, a few studies
dispute that and examined the relationship of nutrients, elements of eating pattern in the
cognitive function. Previous studies showed an array of cognitive deficits associated with
malnutrition in the early childhood.15 The brain is sensitive to glucose and glucose
deprivation would result in deleterious effect of the body system including cognitive
function.15 Fasting has an adverse effect on the accuracy of responses in problem solving, but
it had a beneficial effect on immediate recall in short-term memory.25 On the other hand,
there are also some other factors which could affect short term memory such as fasting,
smoking status, the use of CNS stimulants, exercise and sleep.
Our research showed that there was no significant association between smoking and
short term memory. The reason for insignificant findings in this research was due to lack of
sample size of smokers among the participants. There were only 10 smokers and among the
10 smokers, only 2 have poor memory. It is known that tobacco smoking leads to a range of
adverse health consequences, including an array of cancers, respiratory complications and
coronary heart disease which could later impair memory of a person.26 Furthermore, nicotine
is said to be able to activate the release of dopamine and increases the strength of synaptic
connections in the hippocampus hence improving memory.27 However, cigarette smoke also
contain other components like carbon monoxide, lead, arsenic and hydrogen cyanide which
can induce inflammations and results in memory impairment.28
In our research, we found no significance between Central Nervous System stimulants
consumption such as caffeine, ginkgo, lecithin and the improvement of short term memory.
The use of gingko, marketed over-the-counter as a memory enhancer, did not enhance
performance on standard neuropsychological tests of learning, memory, naming and verbal
fluency, or attention and concentration.29 Other than that, caffeine interferes with tasks that
require processing explicit, as opposed to implicit, information - like recalling a specific
word.30 It is also studied that caffeine has different effects on cognitive performance in
different age-groups.31
This study also found that sleep does not affect short term memory. Another study
showed that sleep deprivation increases the occurrence of lapses, periods of lowered reactive
capacity, which prevent the encoding of items in short-term memory.32 REM sleep is needed
for the consolidation of short term memory to long term memory and thus deprivation of
sleep may not directly affect short term memory. 33 In another study done on mice, the mice
that were allowed to sleep after being trained remembered what they had learned far better
than those deprived of sleep for several hours afterward.34
We also discovered that exercise has no significant effect on short term memory. Our
subjects did not specify the type of physical exercise that they performed. Therefore, this
could lead to the insignificance of our result. Other research showed that exercise did
improve short-term memory in college-age adults.35 It was also reported that physical
exercise had neuroprotective effect on hippocampal injury that induces memory impairment
and it helped boost recovery from injury and improved cognitive function. 36 In a randomized
control study design in elderly patients, results show a greater improvement in cognitive
function following exercise, compared to control. 37
Observational analytical cross sectional study was conducted by our group. This
method was chosen as there is a stronger likelihood of participation due to convenience,
quick results could be ascertained, association of several factors with short term memory
could be studied and it was also relatively inexpensive.
During our research, the data collection for all the samples were done during 4
different timings, according to the convenience and lecture schedule of the students which
could have altered the results to a small extent. One of the groups of students had a sessional
examination before we conducted our short term memory test. Some of the students were not
able to provide full cooperation due to mental tiredness after lecture while some did not
answer correctly to our questions. Also, we found that the majority of students in the fasting
group are from the Malay ethnicity as this is the Ramadhan month for Muslims, thus the
results from fasting respondents were formed mainly by the Malay students. Besides that, the
memory test that we have employed was designed by our research team solely based on the
definition of short term memory, as there were no literature that stated guidelines for standard
short term memory assessment.
Vegetarian diet was found to have positive effect on short term memory ,despite
studies that had concluded otherwise. Further studies can be carried out to identify the
detailed vegetarian diet nutritional content, as well as type of vegetarian diet on the effect of
memory. Cooperative subjects should be taken in the future as we realize the level of
cooperation and focus is very crucial when answering the short term memory tests.

5. ACKNOWLEDGEMENT

We would like to extend our sincere gratitude to our college, MMMC for giving us this
golden opportunity to learn and participate in this poster presentation. Besides that, we would
also like to thank our Professor Adi Negara bin Lutfi Abas, and Assistant Professor Dr. Htoo
Htoo Kyaw Soe, for their patience and unfaltering guidance . Lastly, we would want to
express our appreciation to the volunteers in our study.

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