The Benefits of Errorless Learning for Serial Reaction Time Performance in Alzheimer's Disease

Performance Differences of a Touch-Based Serial Reaction Time Task in Healthy Older Participants and Older Participants With Cognitive Impairment on a Tablet: Experimental Study

BACKGROUND

Digital neuropsychological tools for diagnosing neurodegenerative diseases in the older population are becoming more relevant and widely adopted because of their diagnostic capabilities. In this context, explicit memory is mainly examined. The assessment of implicit memory occurs to a lesser extent. A common measure for this assessment is the serial reaction time task (SRTT).

OBJECTIVE

This study aims to develop and empirically test a digital tablet-based SRTT in older participants with cognitive impairment (CoI) and healthy control (HC) participants. On the basis of the parameters of response accuracy, reaction time, and learning curve, we measure implicit learning and compare the HC and CoI groups.

METHODS

A total of 45 individuals (n=27, 60% HCs and n=18, 40% participants with CoI-diagnosed by an interdisciplinary team) completed a tablet-based SRTT. They were presented with 4 blocks of stimuli in sequence and a fifth block that consisted of stimuli appearing in random order. Statistical and machine learning modeling approaches were used to investigate how healthy individuals and individuals with CoI differed in their task performance and implicit learning.

RESULTS

Linear mixed-effects models showed that individuals with CoI had significantly higher error rates (b=-3.64, SE 0.86; z=-4.25; P<.001); higher reaction times (F1,41=22.32; P<.001); and lower implicit learning, measured via the response increase between sequence blocks and the random block (β=-0.34; SE 0.12; t=-2.81; P=.007). Furthermore, machine learning models based on these findings were able to reliably and accurately predict whether an individual was in the HC or CoI group, with an average prediction accuracy of 77.13% (95% CI 74.67%-81.33%).

CONCLUSIONS

Our results showed that the HC and CoI groups differed substantially in their performance in the SRTT. This highlights the promising potential of implicit learning paradigms in the detection of CoI. The short testing paradigm based on these results is easy to use in clinical practice.

Does Cognitive Impairment Impact Motor Learning? A Scoping Review of Elderly Individuals With Alzheimer's Disease and Mild Cognitive Impairment

Individuals with cognitive impairment may have motor learning deficits due to the high engagement of cognitive mechanisms during motor skill acquisition. We conducted a scoping review to address the quality of current research on the relationship between cognitive impairments (i.e., deficits in attention, memory, planning and executive functions) and motor learning among older adults with Alzheimer's Disease or Mild Cognitive Impairment. After screening thousands of articles, we selected 15 studies describing cognitive assessment tools, experimental designs, and the severity of cognitive impairment. Although seven studies reported that cognitive impairment impaired motor learning, most studies included a high risk of bias. We identified multiple assessment tools across these studies that make comparisons among findings difficult. Future research in this area should focus on the influence of increased practice days during motor learning acquisition and incorporate both retention and transfer tests. Cognitive assessments should target the specific cognitive skills or deficits most closely related to the motor learning process.

Implicit Motor Learning Strategies Benefit Dual-Task Performance in Patients with Stroke

Background and Objectives: In stroke rehabilitation, the use of either implicit or explicit learning as a motor learning approach during dual tasks is common, but it is unclear which strategy is more beneficial. This study aims to determine the benefits of implicit versus explicit motor learning approaches in patients with stroke. Materials and Methods: Seventeen patients with stroke and 21 control participants were included. Motor learning was evaluated using the Serial Reaction Time Task (SRTT) in the context of dual-task conditions. The SRTT was conducted on two separate days: one day for implicit learning conditions and the other day for explicit learning conditions. Under the explicit learning conditions, a task rule was given to the participants before they started the task, but not under the implicit learning conditions. Learning scores were calculated for both implicit and explicit learning, and these scores were then compared within groups for patients with stroke and controls. We calculated the difference in learning scores between implicit and explicit learning and conducted a correlation analysis with the Trail Making Test (TMT) Parts A and B. Results: Learning scores on the SRTT were not different between implicit and explicit learning in controls but were significantly greater in patients with stroke for implicit learning than for explicit learning. The difference in learning scores between implicit and explicit learning in patients with stroke was correlated with TMT-A and showed a correlation trend with TMT-B. Conclusions: Implicit learning approaches may be effective in the acquisition of motor skills with dual-task demands in post-stroke patients with deficits in attention and working memory.

What neurological diseases tell us about procedural perceptual-motor learning? A systematic review of the literature

INTRODUCTION

Procedural perceptual-motor learning of sequences (PPMLS) provides perceptual-motor skills in many activities of daily living. Based on behavioral and neuroimaging results, theoretical models of PPMLS postulate that the cortico-striatal loop, the cortico-cerebellar loop and the hippocampus are specifically involved in the early stage of PPMLS while the cortico-striatal loop would be specifically involved in the late stage of PPMLS. Hence, current models predict that the early stage of PPMLS should be impaired in Parkinson's disease (PD: lesion of the cortico-striatal loop), in cerebellar disease (CD: lesion of the cortico-cerebellar loop) and in Alzheimer's disease (AD: lesion of the hippocampus), whereas the late stage of PPMLS should be specifically impaired in PD.

OBJECTIVE

The aim of the study is (1) to draw a complete picture of experimental results on PPMLS in PD, CD and AD (2) to understand heterogeneity of results as regard to participant and task characteristics.

METHOD

This review is based on the guideline proposed by the PRISMA statement.

RESULTS

Our review reveals (1) that the experimental results clarify the theoretical models and (2) that the impairment of PPMLS depends on both the personal characteristics of the participants and the characteristics of the task to-be-learnt rather than on the disease itself.

CONCLUSION

Our results highlight that these characteristics should be more carefully considered to understand the heterogeneity of results across studies on PPMLS and the effects of rehabilitation programs.

A framework for rehabilitation for older adults living with dementia

Introduction & Background

The aging of the population assures increased prevalence of Individuals Living with Dementia (ILwD) and there will be an increased representation of this cohort requiring physical rehabilitation. If physical therapists (PTs) manage these patients as they do their age-matched, cognitively-intact peers, they will likely be unsuccessful. ILwD have unique needs related to interpersonal and pragmatic components of rehabilitation. Therapeutic nihilism (doubting the benefit of therapy) is well-documented in PTs, either because of existing biases about dementia or previous challenges in working with ILwD. Physical rehabilitation eligibility and placement decisions are often made by PTs without special training in dementia, based upon brief exposure to patients in environments not well-designed for their best functioning. This can lead to underestimation of rehabilitation potential and denial of future PT services. PTs who work with ILwD desire more practical knowledge and targeted skills. Those with more education and training have a more positive attitude and outlook related to ILwD.

Purpose

The purpose of this paper is to introduce a framework for rehabilitation with ILwD equipped with pragmatic ideas to facilitate therapeutic success. The four primary components of the model are: (1) Establish a personal RELATIONSHIP, (2) Use intentional verbal and nonverbal COMMUNICATION, (3) Understand and optimize MOTOR LEARNING capabilities, and (4) Create a safe, purposeful ENVIRONMENT. Specific strategies to help PTs optimize each component are provided with supporting evidence. The model is intended to be dynamic, encouraging PTs to capitalize on the most accessible strategies within their control for a given patient and setting.

Implications

This framework provides a practical resource for working with ILwD with immediate implications for facilitating therapeutic success. The model is displayed in a schematic that reminds the reader of ideas at a glance within the context of each of the components. If an appreciation for this content was among core competencies required among PTs working with ILwD, perhaps there would be significantly fewer patients written off as “uncooperative” or “unable to participate” in PT.

Intact Procedural Knowledge in Patients with Alzheimer's Disease: Evidence from Golf Putting

Can Alzheimer's disease (AD) patients efficiently learn to perform a complex motor skill when relying on procedural knowledge? To address this question, the authors compared the golf-putting performance of AD patients, older adults, and younger adults in 2 different learning situations: one that promotes high error rates (thus increasing the reliance on declarative knowledge) or one that promotes low error rates (thus increasing the reliance on procedural knowledge). Motor performance was poorer overall for AD patients and older adults relative to younger adults in the high-error condition but equivalent between similar groups in the low-error condition. Also, AD patients in the low-error condition had better performance at the final putting distance relative to those in the high-error condition. This performance facilitation for AD patients likely stems from intact procedural knowledge.

People with Dementia Can Learn Compensatory Movement Maneuvers for the Sit-to-Stand Task: A Randomized Controlled Trial

BACKGROUND

A complex motor skill highly relevant to mobility in everyday life (e.g., sit-to-stand [STS] transfer) has not yet been addressed in studies on motor learning in people with dementia (PwD).

OBJECTIVE

To determine whether a dementia-specific motor learning exercise program enables PwD to learn compensatory STS maneuvers commonly taught in geriatric rehabilitation therapy to enhance patients' STS ability.

METHODS

Ninety-seven patients with mild-to-moderate dementia (Mini-Mental State Examination: 21.9±2.9 points) participated in a double-blinded, randomized, placebo-controlled trial with 10-week intervention and 3-month follow-up period. The intervention group (IG, n = 51) underwent a motor learning exercise program on compensatory STS maneuvers specifically designed for PwD. The control group (CG, n = 46) performed a low-intensity motor placebo activity. Primary outcomes were scores of the Assessment of Compensatory Sit-to-stand Maneuvers in People with Dementia (ACSID), which covers the number of recalled and initiated, and of effectively performed compensatory STS maneuvers. Secondary outcomes included temporal and kinematic STS characteristics measured by a body-fixed motion sensor (BFS, DynaPort® Hybrid).

RESULTS

The IG significantly improved in all ACSID scores compared to the CG (p < 0.001). Secondary analysis confirmed learning effects for all BFS-based outcomes (p < 0.001-0.006). Learning gains were sustained during follow-up for most outcomes.

CONCLUSION

People with mild-to-moderate dementia can learn and retain compensatory STS maneuvers in response to a dementia-specific motor learning exercise program. This is the first study that demonstrated preserved motor learning abilities in PwD by using a motor skill highly relevant to everyday life.