Han, C. Z.; Zhao, K. C.; Wang, L. M.; Zhu, H.; Li, Y.; Kolibius, L. D.; Velazquez, A. G.; Song, Y. L.; Cami, A.; Carmona, J.; Hamberger, M.; Auerbach, R. P.; Schevon, C.; Jacobs, J.; Youngerman, B. E.

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 means and session-to-session variability both correlated significantly with standard neuropsychological assessments, supporting the clinical validity of our design. Elevated within-person STAI-6 was selectively associated with faster retrieval responses, yet spatial memory accuracy was independent of all three anxiety measures, suggesting a shift in response strategy rather than memory impairment. Within-day anxiety showed short-term carryover between consecutive sessions, with little persistence beyond the next session. The asm-EMA protocol provides a feasible, autonomous framework for capturing moment-to-moment anxiety-memory dynamics in naturalistic settings.