Investigating the dynamic relationship between anxiety and spatial memory using autonomous ecological momentary assessment

Anxiety has been extensively studied in relation to memory, yet its dynamic association with spatial episodic memory in naturalistic clinical settings remains largely unexplored. We developed an anxiety-spatial-memory EMA protocol (asm-EMA) and deployed it in 30 epilepsy patients undergoing inpatient EEG monitoring, delivering combined momentary anxiety ratings and a validated spatial memory task pseudo-randomly every 90-150 minutes across multiple days. Subject-level asm-EMA average and session-to-session variability correlated with standard neuropsychological assessments, supporting the clinical validity of the protocol. Momentary anxiety was not associated with reduced spatial memory accuracy. Higher within-person STAI-6 was associated with faster retrieval responses, but this association was attenuated after accounting for prior task exposure, suggesting that response-time effects may partly reflect task familiarity. Temporal analyses identified both gradual hospital-day change and short-term carry-over across anxiety, pain, and spatial memory measures. STAI-6 anxiety and spatial memory showed stronger hospital-day trends, whereas VAS anxiety showed the clearest carry-over from one session to the next. The asm-EMA protocol provides a feasible, autonomous framework for capturing moment-to-moment anxiety-memory dynamics in naturalistic settings.