Prospective Memory Training: Outlining a New Approach

The Development of a Pilot App Targeting Short-Term and Prospective Memory in People Diagnosed with Dementia

BACKGROUND

According to the World Health Organization, people suffering from dementia exhibit a serious decline in various cognitive domains and especially in memory.

AIMS

This study aims to create a pilot computer app to enhance short-term memory and prospective memory in individuals with dementia using errorless learning based on their individualized needs.

METHODS

Fifteen dementia patients and matched controls, matched for age, sex, and education, were selected. Their daily routines were analyzed, and cognitive abilities were assessed using the MoCA test. Considering the participants' illness severity and daily needs, the pilot app was designed to aid in remembering daily tasks (taking medication and meals), object locations, and familiar faces and names.

RESULTS

An improvement in patients' short-term and prospective memory throughout the training sessions, but not in overall cognitive functioning was observed. A statistically significant difference between patients and healthy controls was indicated in their ability to retain information relevant to them in their short-term memory, or to remember to act in the future following schedules organized at present (p < 0.001).

CONCLUSION

This app appears beneficial for training dementia patients and healthy individuals in addressing memory challenges.

RECOMMENDATION

While the pilot app showed promise, further research with larger samples is recommended.

The effects of implementation intentions on prospective memory in young and older adults

Prospective memory (PM) is the ability to perform a planned action at a future time, while carrying on with other unrelated tasks. Implementation Intentions (II) is a promising metacognitive strategy for improving PM in older adults, though its generalization and longer-term effects are not well-understood. We examined the effects of II on PM in 48 community-dwelling older adults (77% female, M_age = 71.52) and 59 young adults (75% female, M_age = 19.86). Participants were randomly allocated to a conventional instruction or II group and administered a laboratory-based PM task in the first session. In the second session, participants returned to complete a similar but new laboratory-based PM task and an ecological PM task without prompts to use a strategy. We found strong age effects on PM performance whereby older adults performed worse than young adults across all PM tasks. While the overall facilitation effect of II was not statistically significant, there was a trend that this strategy facilitated PM performance on the laboratory-based PM task in the first session for older adults with a medium sized effect (d = 0.37). The generalization and longer-term effect of II were not significant for either the similar laboratory-based or the ecological PM task. These results suggest that a single-session II intervention may not be sufficient to elicit transfer to other similar new PM tasks in healthy populations.

Prospective Memory Training in Older Adults: A Systematic Review and Meta-Analysis

Prospective memory (PM), which enables one to remember to carry out delayed intentions, is crucial for everyday functioning. PM commonly deteriorates upon cognitive decline in older adults, but several studies have shown that PM in older adults can be improved by training. The current study aimed to summarise this evidence by conducting a qualitative systematic analysis and quantitative meta-analysis of the effects of PM training in older adults, for which systematic searches were conducted across seven databases (Cochrane Library, Embase, PubMed, PsycInfo, Web of Science, CINAHL and Scopus). Forty-eight studies were included in the qualitative analysis, and 43% of the assessed PM training interventions showed positive gains in enhancing PM. However, the methodological quality varied across the studies, with 41% of the non-randomised control trials (non-RCTs) rated as having either serious or critical risk of bias. Therefore, only 29 RCTs were included in the subsequent quantitative meta-analysis. We found a significant and moderate immediate efficacy (Hedges' g = 0.54) of PM training in enhancing PM performance in older adults, but no significant long-term efficacy (Hedges' g = 0.21). Two subgroup analyses also revealed a robust training efficacy across the study population (i.e., healthy and clinical population) and the number of training sessions (i.e., single session and programme-based). Overall, this study provided positive evidence to support PM training in older adults. Further studies are warranted to explore the mechanisms by which PM training exerts its effects, and better-quality RCTs are needed to provide more robust evidence supporting our findings.

Prospective Memory Training for Healthy Older Adults: A Systematic Review

OBJECTIVES

This review systematically synthesizes existing evidence of prospective memory training for healthy older adults (> 55 years). Existing prospective memory training include strategy-based, process-based and combined regimens. Strategy-based training focuses on different mnemonics to compensate for aging declines in prospective memory. Process-based training aims to restore related cognitive processes to support prospective memory. Combined training utilizes both strategy-based and process-based regimens to enhance prospective memory performance.

METHODS

A total of 349 studies were identified from the Cochrane Library, EBSCO, PsycINFO and PubMed databases.

RESULTS

Using predefined inclusion and exclusion criteria, 11 studies were included in the review. There were six studies of strategy-based training, two studies of process-based training and three studies of combined training.

CONCLUSIONS

Overall, strategy-based training appears to facilitate prospective memory for healthy older adults. However, it is impossible to draw conclusions for process-based and combined training due to the preliminary nature of current evidence.

CLINICAL IMPLICATIONS

Mental imagery or the use of external aids can be useful strategy-based approaches to facilitate prospective memory in older adults. Strategy-based training should target multiple prospective memory phases simultaneously to encourage transfers. Further studies will be required to draw conclusions on the effectiveness of process-based and combined training.

Effective external reminders impair the practice effect of time-based prospective memory

The practice effect of time-based prospective memory (TBPM) refers to the phenomenon that TBPM task performance can be significantly improved by repetitive behavioural training. However, reminders are a common strategy for people to perform TBPM tasks in daily life. A large amount of evidence shows that reminders can improve TBPM performance when individuals pay less attention to time information. However, the present study was the first to explore whether external reminders might simultaneously impede the practice effect of TBPM. In this study, 81 undergraduate students were randomly assigned to control group (N = 27, M_age  = 20.00, SD_age  = 1.04), reminder group (N = 26, M_age  = 20.35, SD_age  = 1.70) and non-reminder group (N = 28, M_age  = 20.25, SD_age  = 1.17). In the training stage, the reminder group could receive effective external reminders, while the non-reminder group could not. The results of the training stage revealed that compared with the non-reminder group, the reminder group had fewer time monitoring times and better TBPM performance. In the testing stage, when reminders were removed from the reminder group, we found that compared with the control group without TBPM training, the TBPM performance of the reminder group failed to improve, while that of the non-reminder group improved significantly. Meanwhile, the time estimation ability of the reminder group was not as improved as that of the non-reminder group.

Effectiveness of a Visual Imagery Training Program to Improve Prospective Memory in Older Adults with and without Mild Cognitive Impairment: A Randomized Controlled Study

Prospective memory (PM) problems in aging and, to a greater extent, in mild cognitive impairment (MCI), compromise functional independence. This study examined the effectiveness of a cognitive training program based on visual imagery to improve PM among older adults with and without MCI. Participants were older adults, 24 with MCI and 24 cognitively healthy (HOA). Half of them (12 MCI and 12 HOA) were randomly assigned to the PM training program, the other half to the no-training control group. All participants also completed a pre- and post-test evaluation, including neuropsychological tests, questionnaires, and the Ecological Test of Prospective Memory (TEMP). There was no significant effect of the intervention on the TEMP total, event-based or time-based scores for either the MCI or HOA groups. However, the trained MCI group committed fewer false alarms (i.e., more efficient identification of prospective cues) in the event-based condition of the TEMP at post-test. On the other hand, all trained participants performed better than control participants on retrospective memory tests, which suggests that visual imagery-based training is more effective to improve retrospective memory than PM. Possible explanations for these results are explored.

Effects of a Multi-Component Training Program on Healthy Older Adults' Prospective Memory Performance: Assessing Change Over Time

Prospective Memory (PM) is a cognitive function affected by aging. PM is the memory of future intentions and is significantly involved in everyday life, especially among older adults. Nevertheless, there are a few studies focused on PM training among healthy older adults and these studies did not report the optimal duration of training regarding improving PM performance among older adults. The present study aimed to determine the effective duration for training PM performance among healthy older adults. The current study was a randomized, controlled, single-blind, within-participants crossover trial including a training program with a duration of 12 h. The sample of 25 older adults aged 55 to 74 years recruited from the active members of the University of the Third Age (U3A), Kuala Lumpur/Selangor, their family members, and friends. The study design ensured some participants would receive the training after baseline while others would wait for 6 weeks after the baseline before receiving the training. All participants were evaluated five times: at baseline, 6, 12, 16, and at 24 weeks post-baseline. Moreover, the training program ensured all participants were assessed after each training session. The minimum number of hours to achieve training effects for this multi-component training program was eight. Results supported the efficacy of the training program in improving PM performance among healthy older adults. Also, the optimal duration for the multicomponent training program on PM performance among healthy older adults was obtained. This trial is registered at isrctn.com (#ISRCTN57600070).

Event-Based but Not Time-Based Prospective Memory Is Related to Oral Health in Late Adulthood

BACKGROUND

Most evidence now indicates that cognitive function is related to poorer oral health in late adulthood, but that this relationship is not invariant across specific cognitive domains. Prospective memory (PM) is a core memory skill that refers to memory for future intentions and is known to be related to the formation of habits such as tooth flossing. However, the relationship between PM and oral health has been subject to only limited empirical study.

OBJECTIVE

The two studies reported in this paper were designed to test whether PM is related to oral health in older adults of varying vulnerability status.

METHODS

Study 1 sampled community-dwelling older adults (N = 172) living independently in the community; Study 2 sampled older adults living in a retirement village (N = 32). Participants in both studies were asked to complete a behavioural measure of PM, with their oral health indexed via self-report (Study 1) or an objective oral health exam (Study 2).

RESULTS

In both studies, relationships emerged between event-based PM and oral health, with Study 2 showing that these relationships were specific to oral health measures of plaque and calculus.

CONCLUSIONS

Older adults are particularly vulnerable to dental pathology, with important implications for their broader health and well-being. By showing that there is a relationship between oral health and a particular type of PM, this work will have potential implications for the development of more effective interventions focused on enhancing oral health outcomes in this group, such as those focused on strengthening habit formation.

Fostering Self-Management of Everyday Memory in Older Adults: A New Intervention Approach

Traditional memory strategy training interventions improve older adults' performance on tests of episodic memory, but have limited transfer to episodic memory tasks, let alone to everyday memory. We argue that an alternative approach is needed to assist older adults to compensate for age-related cognitive declines and to maintain functional capacity in their own natural ecologies. We outline a set of principles regarding how interventions can successfully train older adults to increase successful goal pursuit to reduce risks of everyday memory failures. We argue that training individuals to use metacognitive self-regulatory strategies to proactively manage formulation and pursuit of daily goals can compensate for age-related cognitive changes and increase the likelihood of goal attainment. We then describe an intervention approach that instantiates these principles in a multi-modal intervention that is unique in its three-phase approach: (1) individualized assessment of an individual's current approaches to self-regulation; (2) training memory strategies, self-management skills, and new habits of mind in a group training context; and (3) a behavioral shaping period in which individuals receive coaching and feedback on their efforts to use trained procedures to improve everyday cognition. A recently completed study conducted an initial test of the intervention, with highly encouraging results. We advocate further efforts to replicate, extend, and fine-tune this type of intervention. The ultimate goal is to be able to deliver the intervention in a way that increases its potential reach, including to subpopulations of older adults at risk for everyday cognitive impairments.

Examining the effects of training on young and older adult implementation of spaced retrieval strategies

Although the benefits of spaced retrieval are well established, research suggests that young and older adults often fail to optimally implement this strategy. The present study examined how task experience with feedback influenced participant-implemented spaced retrieval and its effect on short and long-term memory retention. Young and older adults were instructed to either equally space or expand their retrieval of face-name associations throughout an ongoing reading task. Participants were then provided feedback on the accuracy with which they implemented experimenter instructions. Results showed that feedback improved utilization of retrieval practice in both young and older adults. Moreover, both age groups successfully produced a pattern of expanded retrieval when instructed to do so, but failed to properly implement equal spacing. Consistent with extant research utilizing experimenter-determined spaced retrieval schedules, our study showed that the inclusion of a longer spacing interval immediately following acquisition resulted in reduced forgetting across the retention interval.

The Cognitive Mechanism of the Practice Effect of Time-Based Prospective Memory: The Role of Time Estimation

Remembering to perform delayed intentions at a specific time point or period is referred to as time-based prospective memory (TBPM). The practice effect of TBPM is the phenomenon that TBPM performance improves via repeated PM training. In the present study, our main purpose was to explore the cognitive mechanism of the practice effect of TBPM, specifically the role of time estimation in the practice effect. We adopted a simple retrospective component of TBPM (pressing 1 key) in the present study, facilitating a closer look at the role of time estimation. In Experiment 1, the experimental group received 20 TBPM tasks training and some ongoing tasks training, while the control group only received some ongoing tasks training. We found that TBPM and time estimation abilities of experimental group were all better than those of control group. It proved that the practice effect of TBPM was closely related to the improvement of time estimation ability. In Experiment 2, we used time estimation training instead of TBPM training used in Experiment 1. The results of Experiment 2 were basically the same as those of Experiment 1. It further confirmed that time estimation played a key role in the practice effect of TBPM.

The role of time-monitoring behaviour in time-based prospective memory performance in younger and older adults

Time-based prospective memory (TB-PM) is the ability to remember to perform an action at a specific moment in the future. Accurate TB-PM performance requires several cognitive processes that are known to decline in normal ageing. This study aimed to examine associations between TB-PM performance and executive functions and time perception in younger and older adults. TB-PM was assessed with the Virtual Week paradigm. Using a within-subjects experimental manipulation, participants performed TB-PM tasks both when a clock was in constant view and when it was hidden behind a button. Results showed that younger adults performed significantly better than older adults on all TB-PM task types, and checked the clock more often, and more strategically. Clock availability improved TB-PM performance in all participants. Correlational analyses showed that TB-PM accuracy was positively related to clock-checking frequency but unrelated to time perception. Relationships between executive functions and TB-PM differed across age groups as well as TB-PM task types. The findings suggest that different cognitive processes are required for different types of TB-PM tasks and in different ages. These results highlight the importance of considering TB-PM task parameters when investigating the role of cognitive processes in PM performance and their contribution to age-related PM decline.

The Practice Effect on Time-Based Prospective Memory: The Influences of Ongoing Task Difficulty and Delay

The practice effect on prospective memory refers to the phenomenon that prospective memory performance can improve with behavior training. Some studies have found that event-based prospective memory (EBPM) can benefit from practice. However, only a few studies have focused on the practice effect on time-based prospective memory (TBPM). In the present study, we planned to explore whether the practice effect on TBPM existed and what its processing mechanism was. In Experiment 1, we tested whether the practice effect existed at all under different background task conditions. The results showed that the practice effect existed only under an easy ongoing task condition. When a 600 ms delay was added after each difficult ongoing task in Experiment 2, we found the same effect as for the easy ongoing task condition in Experiment 1. In addition, the results also suggested that the practice effect was closely related to the improvement in the effectiveness of time monitoring. The present study confirmed the existence of practice effect of TBPM under some conditions of sufficient attention resources and further explored its causes for the first time, which made us have a deeper understanding of the plasticity of TBPM caused by behavior training.

Implementation intention training for prospective memory in schizophrenia: A 3-month follow-up study

The beneficial effect of implementation intentions (II) on prospective memory (PM) deficits in patients with schizophrenia has been reported. However, these studies were limited to brief interventions such that the transfer and long-term effects of II training remains unclear. This study examined whether a 10-session II programme could improve PM performance, social functioning and functional capacity in patients with schizophrenia immediately after training and at 3-month follow-up. Patients with schizophrenia (n = 42) recruited from the community were randomly assigned to II training (n = 21) or treatment as usual (TAU) (n = 21). Participants in the II group learned the verbal and imagery component of II and were encouraged to apply these strategies in their daily lives. We found that the II group performed better than the TAU group on computer-based PM tasks and a daily life PM task (telephone call at specified date and time) at post-treatment and at 3-month follow-up. The II group also exhibited better working ability than the TAU group at post-treatment. Our results suggest that the II intervention programme may have lasting beneficial effects in PM performance and significant transfer effects to functional capacity in schizophrenia patients.

Challenges faced and lessons learned A multi-component prospective memory training program for Malaysian older adults

The surrounding circumstances and environments of Malaysian older adults could make conducting interventions (mainly in terms of clinical or randomized controlled trials) a challenge. Working with older adults and facing cultural issues could be challenging.

A Case Study of the Long-Lasting Effects of Cognitive Training on Similar Tasks in Alzheimer's Disease

OBJECTIVE

Cognitive training allows patients with Alzheimer's disease (AD) to reinforce their cognitive abilities. Here, we investigated the generalizability of trained skills to novel tasks, and their stability over time.

METHOD

One patient underwent a structured cognitive training using the GEO (Geographical Exercise for cognitive Optimization) task, whereas 10 patients underwent a control intervention. Participants' performances on the GEO task, on a similar untrained task, and on a different untrained task were recorded before and after the intervention, and at the 24-month follow-up.

RESULTS

On both the trained and the similar untrained tasks, patient's and controls' performance significantly differed from one another, with trained patient showing a significant acquirement of procedural skills that were maintained over time.

CONCLUSION

Our preliminary evidence showed that a cognitive training could allow patients to acquire and maintain new skills not only on performing a trained task but surprisingly also on a similar untrained task.

Effects of cognitive training with and without aerobic exercise on cognitively demanding everyday activities

We investigated the potential benefits of a novel cognitive-training protocol and an aerobic exercise intervention, both individually and in concert, on older adults' performances in laboratory simulations of select real-world tasks. The cognitive training focused on a range of cognitive processes, including attentional coordination, prospective memory, and retrospective-memory retrieval, processes that are likely involved in many everyday tasks, and that decline with age. Primary outcome measures were 3 laboratory tasks that simulated everyday activities: Cooking Breakfast, Virtual Week, and Memory for Health Information. Two months of cognitive training improved older adults' performance on prospective-memory tasks embedded in Virtual Week. Cognitive training, either alone or in combination with 6 months of aerobic exercise, did not significantly improve Cooking Breakfast or Memory for Health Information. Although gains in aerobic power were comparable with previous reports, aerobic exercise did not produce improvements for the primary outcome measures. Discussion focuses on the possibility that cognitive-training programs that include explicit strategy instruction and varied practice contexts may confer gains to older adults for performance on cognitively challenging everyday tasks.