The role of prospective memory in medication adherence: a review of an emerging literature

Prospective memory slips are associated with forgetting to take glucose-lowering therapies among adults with diabetes: results from the second Diabetes MILES - Australia (MILES-2) survey

AIMS

Prospective memory has been long considered a fundamental cognitive ability for optimal medication taking, but the role of prospective memory errors (termed 'slips') in diabetes self-care is unclear. Our aim was to examine associations between prospective memory and medication taking in adults with Type 1 and Type 2 diabetes mellitus.

METHODS

Some 901 adults with Type 1 diabetes and 927 with Type 2 diabetes completed a cross-sectional survey focused on the psychological and behavioural aspects of living with diabetes. Respondents reported whether they had forgotten to take their diabetes medication over the previous 14 days.

RESULTS

Twenty-four per cent (n = 220) of adults with Type 1 diabetes and 23% (n = 211) with Type 2 diabetes reported that they had forgotten their medication at least once over the previous 14 days. This was associated with more prospective memory slips in adults with Type 1 diabetes [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.05 to 1.13; P < 0.001] and Type 2 diabetes (OR 1.10, 95% CI 1.05 to 1.15; P < 0.001); and with younger age (both groups), insulin pump use (Type 1 diabetes), insulin treatment (Type 2 diabetes), less frequent blood glucose checks (Type 1 diabetes) and higher HbA_1c (Type 1 diabetes).

CONCLUSIONS

These findings suggest that forgetting medication is relatively common among adults with Type 1 or Type 2 diabetes, and provide preliminary evidence for its relationship with self-reported prospective memory slips.

The general facilitation effect of implementation intentions on prospective memory performance in patients with schizophrenia

INTRODUCTION

Prospective memory (PM) refers to remembering to execute a planned intention in the future. It can be divided into event- and time-based, according to the nature of the PM cue. Event-based PM cues can be classified as focal or non-focal. Patients with schizophrenia (SCZ) have been found to be impaired in both event- and time-based PM. PM has been found to be improved by implementation intentions, which is an encoding strategy in the format of "if X then Y". This study examined the effect of implementation intentions on a non-focal event-based and a time-based PM task in patients with SCZ.

METHODS

Forty-two patients with SCZ and 42 healthy controls were allocated to either an implementation intention or a control PM instruction condition and were asked to complete two PM tasks.

RESULTS

Implementation intentions was found to improve performance in both the non-focal event-based and time-based PM tasks in patients with SCZ and healthy controls, with no costs to the ongoing task. The improvement in time-based PM performance in the implementation intentions condition was partially mediated by the frequency of clock checking behaviour.

CONCLUSIONS

Implementation intentions can facilitate PM performance in patients with SCZ and has the potential to be used as a clinical intervention tool.

Assessment of medication management capacity in a predominantly African American and Caribbean American sample of adults with intractable epilepsy

INTRODUCTION

Suboptimal or partial adherence to antiepileptic drugs (AEDs) is an avoidable cause of seizures and deleterious outcomes in epilepsy. As self-rated adherence may be unreliable, suboptimal adherence may go undetected. This study assessed generalizability of a performance-based measure of medication management to patients with intractable epilepsy.

MATERIALS AND METHODS

Participants were 50 adults (age = 42 ± 14 years, 60% female, 82% Black, 20% Hispanic/Latino) with ≥2 seizures in the preceding 6 months. Antiepileptic drug adherence was electronically monitored for one month via Medication Event Monitoring Systems (MEMS) and self-rated (1 = very poor to 6 = excellent). The Medication Management Ability Assessment (MMAA) was administered at follow-up and scored by raters blind to adherence results. Spearman correlations and Poisson regressions assessed their associations.

RESULTS

On average, participants self-reported good-to-very good adherence. According to MEMS, participants took AEDs as prescribed 73% of the time; most participants (58%) missed ≥3 doses. The MMAA demonstrated strong internal consistency (Kuder-Richardson 20 = 0.81) and was associated with MEMS: percentage of days doses were taken correctly (r_s = 0.29, p = 0.04) and frequency of missed doses (r_s = -0.31, p = 0.03). The MMAA was not associated with self-rated adherence. Poisson regressions showed that self-ratings and MMAA performance accounted for unique variance in frequency of missed AED doses.

CONCLUSIONS

These findings provide evidence of the MMAA's criterion validity as a measure of capacity to manage AEDs. It may prove useful in cases where suboptimal adherence is suspected but unreported by patients. Its lack of significant association with self-rated adherence is consistent with prior reports; however, future studies should replicate these findings with larger samples.

Memory complaints in amnestic Mild Cognitive Impairment: More prospective or retrospective?

OBJECTIVE

Patients with amnestic Mild Cognitive Impairment (aMCI), usually considered an early stage of Alzheimer's disease, have deficits not only in retrospective memory (RM), that is, recalling of past events, words or people, but also on prospective memory (PM), the cognitive ability of remembering to execute delayed intentions in the future. This study investigated whether patients with aMCI refer more PM complaints as compared with RM complaints, and whether this might depend upon short-term vs long-term items or time-based vs event-based tasks.

METHODS

Patients with aMCI (n = 178) and healthy controls (n = 160) underwent the Prospective and Retrospective Memory Questionnaire (PRMQ), a 16-item instrument to appraise differences between PM and RM complaints, as well as a general mental state examination, a subjective memory complaints questionnaire, objective memory tests, and assessment of depressive symptoms and activities of daily living.

RESULTS

Patients with aMCI reported more memory complaints evaluated with the PRMQ (total score = 44.3 ± 10.8) as compared with controls (36.7 ± 9.8, P < 0.001). Using a mixed effect repeated-measures analysis of covariance (ANCOVA) showed that participants generally referred more retrospective than prospective memory complaints. Patients with aMCI had significantly more complaints on short-term memory as compared with long-term memory, and more complaints in time-based (auto-initiated) as compared with event-based tasks, than healthy controls.

CONCLUSION

Patients with aMCI reported significantly more difficulties on short-term memory, presumably reflecting internal temporal lobe pathology typical of Alzheimer's disease, and more complaints on time-based tasks, which are cognitively very demanding, but did not seem particularly troubled regarding prospective memory.

Automatic processes and self-regulation of illness

Research on the Commonsense Self-Regulation Model has emphasised reflective/conscious perceptual processes regarding illness threat (beliefs about symptoms, consequences, timeline, and curability) in predicting and changing coping behaviours. Understanding of illness self-regulation and avenues for intervention might be enriched by consideration of automatic processes that influence the recognition and identification of illness, response to illness, and ongoing management. This article adopts an integrative approach to (1) outline the theoretical importance of implicit processes in patients' self-regulation of illness and methods to study them; (2) review research evidence for these processes, including interventions tested to modify them; and (3) outline avenues for future research. A substantial body of research on implicit processes (cognitive bias and interpretational bias) in illness maintenance in chronic illness has recently been extended to detection and interpretation of acute illness and new perspectives relating to the self-system. There is encouraging evidence that cognitive accessibility of coping and implicit attitudes may impact upon coping behaviours. Procedures that strategically automatise coping responses and create habits have considerable promise. We outline an agenda for future research in which health psychology accepts the challenge posed by the interplay of the reflective and associative systems in promoting effective self-regulation of illness.

How to Identify and Manage Cognitive Dysfunction After Breast Cancer Treatment

Attention and memory dysfunction is a common complaint among patients with breast cancer that can be reported during and up to several years after treatment. It can negatively affect patients' quality of life and their ability to work. This phenomenon has mainly been studied in patients with breast cancer who are treated with adjuvant chemotherapy. Women describe concentration problems and difficulties with word finding, multitasking, or remembering new information, as well as more effort and time needed to accomplish these tasks. Such cognitive dysfunction is subtle or moderate and occurs in 15% to 25% of patients. Older patients seem more likely to experience cognitive decline with chemotherapy than do young women with breast cancer. Patients who report that cognitive dysfunction has affected their daily lives for 6 to 12 months after the end of chemotherapy or during hormone therapy may need referral to a neuropsychologist. During the cognitive assessment, the etiology of their cognitive complaints is sought and neuropsychological tests are administered to assess objective cognitive functioning. Psychological factors-fatigue and pain-should be assessed systematically with cognitive complaints to identify precisely the cause of the problems. A nonpharmacologic approach-mainly cognitive rehabilitation-seems to be the most promising for the management of these difficulties, but these preliminary results require confirmation. In the future, early detection of cognitive impairment and cognitive rehabilitation should be included in the portfolio of oncology supportive care to facilitate the return to work of young women and to avoid potential repercussions on adherence to oral treatments and on autonomy in older patients.

Cognitive Changes After Adjuvant Treatment in Older Adults with Early-Stage Breast Cancer

BACKGROUND

Group-based trajectory modeling is particularly important to identify subgroups of patients with pathological cognitive changes after cancer treatment. To date, only one study has explored cognitive trajectories in older patients with cancer. The present article describes objective cognitive changes before to after adjuvant treatment in older adults with early-stage breast cancer (EBC) after adjuvant treatment compared with healthy controls.

PATIENTS AND METHODS

Participants were patients ≥65 years of age with newly diagnosed EBC and healthy controls (age-, sex-, and education-matched). The pretreatment assessment was conducted before adjuvant therapy, and the post-treatment assessment after the end of the first adjuvant treatment. Objective cognitive changes before to after treatment were evaluated based on the Reliable Change Index for cognitive decline accounting for cognitive impairment status.

RESULTS

The sample consisted of women newly diagnosed with EBC (n = 118) and healthy controls (n = 62). Five patterns of changes before to after treatment were identified based on the presence of cognitive decline and cognitive impairment. The distribution of these five change patterns was statistically significant (p = .0001). Thirty-six percent of patients had phase shift changes, 31% without initial objective cognitive impairment developed impairment, 15% had a normal aging, 12% had a nonpathological decline, and 6% experienced accelerated cognitive decline.

CONCLUSION

This study described for the first time objective cognitive changes before to after treatment of older adults with EBC immediately after the end of adjuvant treatment. A longer-term remote follow-up of adjuvant treatment is needed to better understand the cognitive trajectories of older patients with EBC.

IMPLICATIONS FOR PRACTICE

After the end of adjuvant treatment, 31% of older adults with early-stage breast cancer without initial objective cognitive impairment developed impairment, and 6% experienced accelerated cognitive decline. Initial cognitive functioning should be included in the balance of benefits and harms of systemic therapy for patients who are likely to be at highest risk for cognitive decline after cancer treatments. Regular cognitive follow-up of patients who had cognitive impairment before cancer treatment should monitor symptoms suggestive of neurodegenerative disease and avert the effect of cognitive disorders on patients' autonomy.

Thought probes during prospective memory encoding: Evidence for perfunctory processes

For nearly 50 years, psychologists have studied prospective memory, or the ability to execute delayed intentions. Yet, there remains a gap in understanding as to whether initial encoding of the intention must be elaborative and strategic, or whether some components of successful encoding can occur in a perfunctory, transient manner. In eight studies (N = 680), we instructed participants to remember to press the Q key if they saw words representing fruits (cue) during an ongoing lexical decision task. They then typed what they were thinking and responded whether they encoded fruits as a general category, as specific exemplars, or hardly thought about it at all. Consistent with the perfunctory view, participants often reported mind wandering (42.9%) and hardly thinking about the prospective memory task (22.5%). Even though participants were given a general category cue, many participants generated specific category exemplars (34.5%). Bayesian analyses of encoding durations indicated that specific exemplars came to mind in a perfunctory manner rather than via strategic, elaborative mechanisms. Few participants correctly guessed the research hypotheses and changing from fruit category cues to initial-letter cues eliminated reports of specific exemplar generation, thereby arguing against demand characteristics in the thought probe procedure. In a final experiment, encoding duration was unrelated to prospective memory performance; however, specific-exemplar encoders outperformed general-category encoders with no ongoing task monitoring costs. Our findings reveal substantial variability in intention encoding, and demonstrate that some components of prospective memory encoding can be done "in passing."

Google Calendar Enhances Prospective Memory in Alzheimer's Disease: A Case Report

We investigated whether an external memory aid (i.e., Google Calendar) would alleviate prospective memory compromise in a patient with mild Alzheimer's disease. The patient was asked in the baseline phase to perform three prospective targeted events (e.g., attending her weekly bridge game at the community club) and three prospective control events (e.g., buying her weekly magazine). The same six prospective events were assessed in the intervention phase but the targeted-events were cued by Google Calendar while the control-events were not. Results showed less omission of the targeted events in the training phase than in the baseline phase, suggesting a positive effect of Google Calendar. This case report offers a unique view into how smartphone calendars may alleviate prospective memory compromise in patients with mild Alzheimer's disease.

Is episodic memory performance more vulnerable to depressive affect in older adulthood?

This study examined how age, depressive symptoms, demographic variables, frailty, and health factors jointly influence episodic memory across the lifespan in two large, diverse samples. Hierarchical regression analyses from both samples showed that depressive symptoms negatively impacted episodic memory performance with the effect being more pronounced for older adults. Health and frailty tended not to be associated with episodic memory. However, the main effect of depressive symptoms tended to remain significant over and above other predictors, while the interaction with age was weakened with the addition of demographic variables. The unique contribution of this study is demonstrating that the relationship between depressive symptoms and episodic memory is moderated by age across relatively large non-clinical lifespan samples of adults. The findings indicate the importance of measuring and studying depressive symptoms during the course of aging in order to better understand the complex relationship between age, affect, physical functioning, and memory.

Prospective Memory Performance in Persons With Schizophrenia and Bipolar Disorder and Healthy Persons

PURPOSE

There is a paucity of studies comparing prospective memory (PM) impairment between persons with schizophrenia and bipolar disorder. The aim of this study was to directly compare PM performances of these two groups and healthy controls.

DESIGN AND METHODS

A total of 44 persons with schizophrenia and 76 with bipolar disorder, and 44 healthy controls formed the study sample.

FINDINGS

Patients were found to be impaired in PM relative to controls and the two patient groups showed similar level of PM performance after controlling confounding sociodemographic and clinical variables.

PRACTICE IMPLICATIONS

The findings add to the evidence concerning the neurocognitive similarity between cohorts of schizophrenia and bipolar disorder with respect to PM. Rehabilitative effort in PM remedies for both patient groups is warranted.

Neuropsychological Assessment: Past and Future

Neuropsychological assessment tools are the staple of our field. The development of standardized metrics sensitive to brain-behavior relationships has shaped the neuropsychological questions we can ask, our understanding of discrete brain functions, and has informed the detection and treatment of neurological disorders. We identify key turning points and innovations in neuropsychological assessment over the past 40-50 years that highlight how the tools used in common practice today came to be. Also selected for emphasis are several exciting lines of research and novel approaches that are underway to further probe and characterize brain functions to enhance diagnostic and treatment outcomes. We provide a brief historical review of different clinical neuropsychological assessment approaches (Lurian, Flexible and Fixed Batteries, Boston Process Approach) and critical developments that have influenced their interpretation (normative standards, cultural considerations, longitudinal change, common metric batteries, and translational assessment constructs). Lastly, we discuss growing trends in assessment including technological advances, efforts to integrate neuropsychology across disciplines (e.g., primary care), and changes in neuropsychological assessment infrastructure. Neuropsychological assessment has undergone massive growth in the past several decades. Nonetheless, there remain many unanswered questions and future challenges to better support measurement tools and translate assessment findings into meaningful recommendations and treatments. As technology and our understanding of brain function advance, efforts to support infrastructure for both traditional and novel assessment approaches and integration of complementary brain assessment tools from other disciplines will be integral to inform brain health treatments and promote the growth of our field. (JINS, 2017, 23, 778-790).

Medication Management Apps: Usable by Older Adults?

For older adults, managing medications can be a burden and could lead to medication non-adherence. To decrease risks associated with medication non-adherence, healthcare providers may recommend medication reminder apps as an assistive tool. However, these apps are often not designed with consideration of older adults' needs, capabilities, and limitations. To identify whether available apps are suitable for older adults, we conducted an in-depth cognitive walkthrough and a heuristic evaluation of the most commonly downloaded medication reminder app. Findings revealed three main issues: 1) difficulty in navigation, 2) poor visibility, and 3) a lack of transparency. We also selected the top five downloaded medication reminder apps and categorized user reviews to assess app functionality and usability problems. The results of our analysis provide guidance for app design for older adult users to provide effective tools for managing medications and supporting patient/user health.

Neuropsychological functioning, age, and medication adherence in bipolar disorder

Objectives

Poor adherence to medication is frequent in bipolar disorder (BD) and has been associated with several factors. To date, the relationship between low adherence and neuropsychological functioning in BD is still unclear. As age and neuropsychological functioning might have opposing influences on adherence, our aim was to investigate this link with a particular focus on the effect of age.

Methods

In a cross-sectional study, we included 353 patients divided into two age-groups (16–46; 47–71) from a French cohort diagnosed with BD (type I, II, NOS) and strictly euthymic. All patients had a standardized clinical and neuropsychological assessment and were categorized as high (n = 186) or low (n = 167) adherent based on their score from the Medication Adherence Rating Scale. Clinical information was collected based on a standardized interview and clinical validated scales. Neuropsychological performances were evaluated with an established standardized neuropsychological battery for bipolar disorder patients. After univariate analysis, neuropsychological and clinical predictors of low adherence were included in two age-specific stepwise multiple logistic regressions.

Results

A smaller number of hospitalizations (OR = 0.846, p = 0.012), a shorter illness duration (OR = 0.937, p = 0.003) and higher adverse effects (OR = 1.082, p<0.001) were associated with a greater risk of low adherence in the younger patients. In the older patients, low adherence was also predicted by a smaller number of hospitalizations (OR = 0.727, p = 0.008) and higher adverse effects (OR = 1.124, p = 0.005). Interestingly poor inhibition performance was also a significant predictor of low adherence in older patients (OR = 0.924, p = 0.030).

Conclusions

We found an age-specific relationship between cognitive functioning and adherence in patients with BD. Poor inhibition performances predicted low adherence in older patients only. Our results highlight the need to provide age-adapted therapeutic interventions to improve adherence in patients with BD.

Prospective memory in youth with perinatally-acquired HIV infection

Youth with perinatal HIV infection (PHIV) are at increased risk for neurocognitive impairment (NCI). Prospective memory (PM) is a complex neurocognitive function that has been shown to be impaired in adults with HIV disease and independently associated with poorer daily living skills, including medication nonadherence. The current study sought to determine the presence and extent of PM deficits in youth with PHIV. Participants included 173 youth with PHIV and 85 youth perinatally HIV-exposed but uninfected (PHEU), mean age 14.1 years, 75% black, 18% Hispanic. Among youth with PHIV, 26% had a past AIDS-defining condition (Centers for Disease Control and Prevention [CDC], Class C), 74% did not (non-C). Adjusted generalized estimating equation models were used to compare groups (PHIV/C, PHIV/non-C, and PHEU) on the Naturalistic Event-Based Prospective Memory Test (NEPT) and the Prospective Memory Assessment for Children & Youth (PROMACY). Secondarily, subgroups defined by HIV serostatus and global NCI were compared (PHIV/NCI, PHIV/non-NCI, PHEU). PHIV/C had significantly lower NEPT scores than PHEU, with decreases of 40% in mean scores, but did not differ from PHIV/non-C. PHIV/NCI had 11-32% lower PROMACY scores and 33% lower NEPT scores compared to PHIV/non-NCI (all p < .05); significantly, lower scores for PHIV/NCI versus PHEU also were observed for PROMACY and NEPT indices. Findings suggest a subset of youth with PHIV (those with a prior AIDS-defining diagnosis) is vulnerable to PM deficits. The extent to which PM deficits interfere with development and maintenance of independent living and health-related behaviors during transition to adulthood requires further study.

Improving Prospective Memory in Healthy Older Adults and Individuals with Very Mild Alzheimer's Disease

OBJECTIVES

To test the utility of a memory-encoding strategy for improving prospective memory (PM), the ability to remember to execute future goals (e.g., remembering to take medications), which plays an important role in independent living in healthy older adults and those with very mild Alzheimer's disease (AD).

DESIGN

Participants were randomly assigned to an encoding strategy condition or a standard encoding condition.

SETTING

A longitudinal study conducted at an Alzheimer's disease research center. Testing took place at the center and in a university testing room.

PARTICIPANTS

Healthy older adults (Clinical Dementia Rating (CDR) = 0.0, n = 38) and those classified as being in the very mild stage of AD (CDR = 0.5, n = 34).

INTERVENTION

A simple strategy ("If I see Cue X, then I will perform Intention Y") was used to strengthen PM encoding and reduce the probability of forgetting to execute one's future plans.

MEASUREMENTS

PM was assessed using Virtual Week, a laboratory task that requires the simulation of common PM tasks (the types of tasks performed in everyday life), such as taking one's medication at breakfast.

RESULTS

The encoding strategy significantly reduced PM failures in healthy older adults and those with very mild AD and was effective regardless of the individual's episodic memory ability.

CONCLUSION

This encoding strategy was successful in reducing PM errors in healthy older adults and those with mild AD with a range of memory abilities.

A randomized controlled trial to treat impaired learning and memory in multiple sclerosis: The self-GEN trial

Background:

Difficulties in learning and memory are among the most persistent and frequently reported cognitive symptoms in individuals with multiple sclerosis (MS).

Objective:

To examine the efficacy of the self-generation learning program ( self-GEN trial) that consist of behavioral intervention sessions, teaching self-generation technique while using metacognitive strategies to improve learning and memory abilities in persons with MS. Additionally, the treatment aimed to address generalization of the treatment to activities of daily living.

Methods:

This double-blind, placebo-controlled, randomized clinical trial included 35 participants with clinically definite MS, 19 in the treatment group and 16 in the placebo control group. Participants completed a baseline neuropsychological assessment, including questionnaires assessing everyday memory and a repeat assessment immediately post-treatment.

Results:

The treatment group showed significantly improved learning and memory, self-regulation, and metacognition relative to the placebo post-treatment. Similar results were noted on measures of depression, functional status, and quality of life (QOL).

Conclusion:

This study provides initial Class I evidence that the self-GEN behavioral intervention improves memory, self-regulation, functional status, affective symptomatology, and QOL in patients with MS.

'A necessary evil': associations with taking medication and their relationship with medication adherence

Cognitive factors, like beliefs, have been studied extensively as determinants of medication adherence, while affect associated with taking medicines has been studied much less. In the present study (N = 525), we investigated affect by assessing patients' first associations with taking their medicines. Results showed that these associations were related to self-reported medication adherence: Patients who associated taking medicines with negative affect were the least adherent, while those associating taking medicines with the need to take medicines were the most adherent. Our results support the idea that affect should be considered an important determinant of adherence.

Memory for medication side effects in younger and older adults: the role of subjective and objective importance

Older adults often experience memory impairments, but sometimes they can use selective processing and schematic support to remember important information. In the present experiments, we investigated the degrees to which younger and healthy older adults remembered medication side effects that were subjectively or objectively important to remember. Participants studied a list of common side effects and rated how negative these effects would be if they were to experience them, and they were then given a free recall test. In Experiment 1, the severity of the side effects ranged from mild (e.g., itching) to severe (e.g., stroke), and in Experiment 2, certain side effects were indicated as being critical to remember (i.e., "contact your doctor if you experience this"). We observed no age differences in terms of free recall of the side effects, and older adults remembered more severe side effects than mild effects. However, older adults were less likely to recognize the critical side effects on a later recognition test, relative to younger adults. These findings suggest that older adults can selectively remember medication side effects but have difficulty identifying familiar but potentially critical side effects, and this has implications for monitoring medication use in older age.

Understanding the use of contextual cues: design implications for medication adherence technologies that support remembering

Objective

Forgetfulness is one of the main reasons of unintentional medication non-adherence. Adherence technologies that help people remember to take their medications on time often do not take into account the context of people’s everyday lives. Existing evidence that highlights the effectiveness of remembering strategies that rely on contextual cues is largely based on research with older adults, and thus it is not clear whether it can be generalized to other populations or used to inform the design of wider adherence technologies that support medication self-management. Understanding how younger populations currently remember medications can inform the design of future adherence technologies that take advantage of existing contextual cues to support remembering.

Methods

We conducted three surveys with a total of over a thousand participants to investigate remembering strategies used by different populations: women who take oral contraception, parents and carers who give antibiotics to their children, and older adults who take medications for chronic conditions.

Results

Regardless of the population or the type of regimen, relying on contextual cues—routine events, locations, and meaningful objects—is a common and often effective strategy; combinations of two or more types of cues are more effective than relying on a single cue.

Conclusions

To effectively support remembering, adherence technologies should help users recognize contextual cues they already have at their disposal and reinforce relevant cues available in their environment. We show that, given the latest developments in technology, such support is already feasible.

The effect and mechanisms of implementation intention in improving prospective memory performance in schizophrenia patients

People with schizophrenia (SCZ) have been shown to have prospective memory (PM) deficits. PM refers to the ability to remember to perform delayed intentions in the future and plays an important role in everyday independent functioning in SCZ. To date, few studies have investigated methods to improve PM in SCZ. This study aimed to examine whether implementation intention can improve PM performance and to explore its underlying mechanisms. Fifty people with SCZ and 50 demographically matched healthy controls (HC) participated in this study. Participants were randomly assigned to an implementation intention condition or a control instruction condition. Participants were required to make PM responses when PM cue words appeared while they were undertaking an ongoing task with two levels of cognitive load (1-back or 2-back). Results showed that people with SCZ were impaired in PM, and implementation intention improved PM performances for both SCZ and HC. Implementation intention improved PM performance in SCZ in both the low and the high cognitive load conditions without ongoing task cost, suggesting that implementation intention improved PM remembering in an automatic way. These results indicate that implementation intention may be a beneficial technique for improving PM performances in people with SCZ.

Initial feasibility and validity of a prospective memory training program in a substance use treatment population

Individuals with substance use disorders have shown deficits in the ability to implement future intentions, called prospective memory. Deficits in prospective memory and working memory, a critical underlying component of prospective memory, likely contribute to substance use treatment failures. Thus, improvement of prospective memory and working memory in substance use patients is an innovative target for intervention. We sought to develop a feasible and valid prospective memory training program that incorporates working memory training and may serve as a useful adjunct to substance use disorder treatment. We administered a single session of the novel prospective memory and working memory training program to participants (n = 22; 13 men, 9 women) enrolled in outpatient substance use disorder treatment and correlated performance to existing measures of prospective memory and working memory. Generally accurate prospective memory performance in a single session suggests feasibility in a substance use treatment population. However, training difficulty should be increased to avoid ceiling effects across repeated sessions. Consistent with existing literature, we observed superior performance on event-based relative to time-based prospective memory tasks. Performance on the prospective memory and working memory training components correlated with validated assessments of prospective memory and working memory, respectively. Correlations between novel memory training program performance and established measures suggest that our training engages appropriate cognitive processes. Further, differential event- and time-based prospective memory task performance suggests internal validity of our training. These data support the development of this intervention as an adjunctive therapy for substance use disorders. (PsycINFO Database Record

Medication Adherence in Patients with Bipolar Disorder: A Comprehensive Review

Poor medication adherence is a pervasive problem that causes disability and suffering as well as extensive financial costs among individuals with bipolar disorder (BD). Barriers to adherence are numerous and cross multiple levels, including factors related to bipolar pathology and those unique to an individual's circumstances. External factors, including treatment setting, healthcare system, and broader health policies, can also affect medication adherence in people with BD. Fortunately, advances in research have suggested avenues for improving adherence. A comprehensive review of adherence-enhancement interventions for the years 2005-2015 is included. Specific bipolar adherence-enhancement approaches that target knowledge gaps, cognitive patterns, specific barriers, and motivation may be helpful, as may approaches that capitalize on technology or novel drug-delivery systems. However, much work remains to optimally facilitate long-term medication adherence in people with BD. For adherence-enhancement approaches to be widely adapted, they need to be easily accessible, affordable, and practical.

Forget about forgetting: structural barriers and severe non-adherence to antiretroviral therapy

HIV infection is now clinically manageable with antiretroviral therapy (ART). However, a significant number of people with HIV do not benefit from ART because of non-adherence. This study examined the use of adherence strategies and barriers to adherence among persons at substantial risk for developing resistant virus (less than 75% adherent). People living with HIV (n = 556) who were less than 95% adherent to ART completed computerized interviews, were screened for active drug use, provided medical records for HIV viral load, and completed unannounced pill counts to monitor ART adherence and an assessment of adherence barriers. Based on pill counts, participants were defined as severely non-adherent (≤75% medications taken) and moderately non-adherent (>75% and <95% adherent). Results showed a broad array of memory devices were used to no avail across non-adherence groups. Individuals who were severely non-adherent were significantly more likely to attribute missing medications due to substance use and structural barriers, including running out of medications, inability to get to pharmacy, and inability to afford medications. Results suggest that interventions focused on memory lapses will be insufficient and should rather concentrate on substance use treatment and providing case management to resolve structural barriers to adherence.

Prospective Memory in Posttraumatic Stress Disorder

OBJECTIVES

Neuropsychological studies of posttraumatic stress disorder (PTSD) have revealed deficits in attention/working memory, processing speed, executive functioning, and retrospective memory. However, little is known about prospective memory (PM) in PTSD, a clinically relevant aspect of episodic memory that supports the encoding and retrieval of intentions for future actions.

METHODS

Here we examined PM performance in 40 veterans with PTSD compared to 38 trauma comparison (TC) veterans who were exposed to combat but did not develop PTSD. All participants were administered the Memory for Intentions Test (MIST; Raskin, Buckheit, & Sherrod, 2010), a standardized and validated measure of PM, alongside a comprehensive neurocognitive battery, structured diagnostic interviews for psychiatric conditions, and behavioral questionnaires.

RESULTS

Veterans with PTSD performed moderately lower than TC on time-based PM, with errors primarily characterized as PM failure errors (i.e., omissions). However, groups did not differ in event-based PM, ongoing task performance, or post-test recognition of PM intentions for each trial. Lower time-based PM performance was specifically related to hyperarousal symptoms of PTSD. Time-based-performance was also associated with neuropsychological measures of retrospective memory and executive functions in the PTSD group. Nevertheless, PTSD was significantly associated with poorer PM above and beyond age and performance in retrospective memory and executive functions.

DISCUSSION

Results provide initial evidence of PM dysfunction in PTSD, especially in strategic monitoring during time-based PM tasks. Findings have potential implications for everyday functioning and health behaviors in persons with PTSD, and deserve replication and future study. (JINS, 2016, 22, 724-734).

Prospective and retrospective memory are differentially related to self-rated omission and commission errors in medication adherence in multimorbidity

We investigated the relations of self-rated omission errors (i.e., forgetting to take one's medication) and commission errors (i.e., unnecessary repetitions of medication intake because of forgetting that it has already been taken) in medication adherence in multimorbidity to prospective and retrospective memory performance. Moreover, we examined whether these relations were moderated by the number of medications that had to be taken. Eighty-four patients with multimorbidity (aged 28-84 years, M = 62.4) reported medication adherence regarding the last seven days and the number of medications they had to take. In addition, we administered psychometric tests on prospective memory (PM) and retrospective memory performance. We found that reported omission errors in medication adherence were related significantly to lower PM performance. This relationship was increased in individuals with a lower number of medications. In comparison, reported commission errors in medication adherence were related significantly to lower retrospective memory performance. This relationship was increased in individuals with a larger number of medications. Present data suggest that omission errors in medication adherence in multimorbidity may reflect primarily PM errors, particularly if few medications have to be taken, while commission errors may reflect mainly retrospective memory failures, especially with a large number of medications that need to be taken as prescribed. From an applied neuropsychological perspective, these results underline the importance of trying to enhance PM and retrospective memory performance in patients with multimorbidity.

Pill Burden Influences the Association Between Time-Based Prospective Memory and Antiretroviral Therapy Adherence in Younger But Not Older HIV-Infected Adults

Prospective memory (PM) is associated with antiretroviral (ARV) adherence in HIV, but little is known about how pill burden and age might affect this association. One hundred seventeen older (≥50 years) and 82 younger (<50 years) HIV-infected adults were administered a measure of PM in the laboratory and subsequently were monitored for ARV adherence for 30 days using the Medication Event Monitoring System. In the older group, better time-based PM performance was associated with higher likelihood of adherence, irrespective of pill burden. Within the younger sample, time-based PM was positively related to adherence only in participants with lower pill burdens. Younger HIV-infected individuals with higher pill burdens may overcome the normal effects of time-based PM on adherence through compensatory medication-taking strategies, whereas suboptimal use of these strategies by younger HIV-infected individuals with lower pill burdens may heighten their risk of ARV nonadherence secondary to deficits in time-based PM.

Retrieval cue and delay interval influence the relationship between prospective memory and activities of daily living in older adults

OBJECTIVE

Older adults commonly experience mild declines in everyday functioning and the strategic aspects of prospective memory (PM). This study used multiprocess theory to examine whether the strategic demands of retrieval cue type (event vs. time based) and delay interval length (2 vs. 15 min) influence the relationship between PM and activities of daily living (ADLs) in older adults.

METHOD

Participants included 97 community-dwelling older adults recruited from the Western Australia Participant Pool. Participants were administered the Memory for Intentions Screening Test (MIST) and Prospective and Retrospective Memory Questionnaire (PRMQ) as part of a larger neurocognitive assessment. A knowledgeable informant completed the Activities of Daily Living Questionnaire (ADLQ), from which a cutpoint of ≥ 1 was used to classify participants into "ADL normal" (n = 37) or "mild ADL problems" (n = 60) groups. Repeated measures multivariate analysis of variance (MANOVA) controlling for age was conducted with ADL group as the between-subjects factor and either MIST or PRMQ cue and delay scores as the within-subjects factors.

RESULTS

We observed a significant ADL group by PM interaction on the MIST, with pair-wise analyses showing that the mild ADL problems group performed worse than ADL normal participants on the 15-min time-based scale (p < .001, Cohen's d = 0.71). No other MIST or PRMQ cue-delay variable differed between the two ADL groups (ps > .10).

CONCLUSION

Findings indicate that decrements in strategically demanding cue monitoring and detection over longer PM delays may partly explain older adults' mild problems in everyday functioning. Findings may inform neuropsychological interventions aimed at maintaining ADL independence and enhancing quality of life in older adults.

Memory dysfunction

PURPOSE OF REVIEW

This article highlights the dissociable human memory systems of episodic, semantic, and procedural memory in the context of neurologic illnesses known to adversely affect specific neuroanatomic structures relevant to each memory system.

RECENT FINDINGS

Advances in functional neuroimaging and refinement of neuropsychological and bedside assessment tools continue to support a model of multiple memory systems that are distinct yet complementary and to support the potential for one system to be engaged as a compensatory strategy when a counterpart system fails.

SUMMARY

Episodic memory, the ability to recall personal episodes, is the subtype of memory most often perceived as dysfunctional by patients and informants. Medial temporal lobe structures, especially the hippocampal formation and associated cortical and subcortical structures, are most often associated with episodic memory loss. Episodic memory dysfunction may present acutely, as in concussion; transiently, as in transient global amnesia (TGA); subacutely, as in thiamine deficiency; or chronically, as in Alzheimer disease. Semantic memory refers to acquired knowledge about the world. Anterior and inferior temporal lobe structures are most often associated with semantic memory loss. The semantic variant of primary progressive aphasia (svPPA) is the paradigmatic disorder resulting in predominant semantic memory dysfunction. Working memory, associated with frontal lobe function, is the active maintenance of information in the mind that can be potentially manipulated to complete goal-directed tasks. Procedural memory, the ability to learn skills that become automatic, involves the basal ganglia, cerebellum, and supplementary motor cortex. Parkinson disease and related disorders result in procedural memory deficits. Most memory concerns warrant bedside cognitive or neuropsychological evaluation and neuroimaging to assess for specific neuropathologies and guide treatment.

Patient views on an electronic dispensing device for prepackaged polypharmacy: a qualitative assessment in an ambulatory setting

OBJECTIVE

To collect opinions on medication management aids (MMAs) in general and on an electronic MMA (e-MMA) dispensing prepackaged polypharmacy in sealed pouches.

STUDY SETTING

The setting involved community-dwelling older adults in Basel, Switzerland, in 2013.

STUDY DESIGN

The study involved 1) a 14-day trial with the e-MMA and 2) a focus group to identify general attributes of MMAs, their applicability to the e-MMA, and possible target groups for the e-MMA.

DATA COLLECTION METHODS

Six participants using long-term polypharmacy and willing to try new technologies completed the 14-day trial and participated in the focus group. Inductive content analysis was performed to extract data.

PRINCIPAL FINDINGS

Participants rated ten of 17 general attributes as clearly applicable to the e-MMA and five as unsuitable. Attributes pertained to three interrelating themes: product design, patient support, and living conditions. Envisaged target groups were patients with time-sensitive medication regimens, patients with dementia, the visually impaired, and several patients living together to prevent accidental intake of the wrong medication.

CONCLUSION

The evaluated e-MMA for prepackaged polypharmacy met the majority of the requirements set for an MMA. Patients' living conditions, such as mobility, remain the key determinants for acceptance of an e-MMA.

Event-related brain potential correlates of prospective memory in symptomatically remitted male patients with schizophrenia

Prospective memory (PM) refers to the ability to remember to perform intended actions in the future. Although PM deficits are a prominent impairment in schizophrenia, little is still known about the nature of PM in symptomatically remitted patients with schizophrenia. To address this issue, event-related brain potentials (ERPs) were recorded from 20 symptomatically remitted patients with schizophrenia and 20 healthy controls during an event-based PM paradigm. Behavioral results showed that symptomatically remitted patients with schizophrenia performed poorly on the PM task compared with healthy controls. On the neural level, the N300, a component of the ERPs related to PM cue detection, was reliable across these two groups, suggesting a degree of functional recovery of processes supporting cue detection in patients with symptomatically remitted schizophrenia. By contrast, the amplitude of the prospective positivity, a component of the ERPs related to PM intention retrieval, was significantly attenuated in symptomatically remitted schizophrenia patients relative to healthy controls. Furthermore, a significant positive correlation between the amplitude of the prospective positivity and accuracy on the PM task was found in those patients, indicating that patients’ poor performance on this task may result from the failure to recover PM cue-induced intention from memory. These results provide evidence for the existence of altered PM processing in patients with symptomatically remitted schizophrenia, which is characterized by a selective deficit in retrospective component (intention retrieval) of PM. Therefore, these findings shed new light on the neurophysiological processes underlying PM in schizophrenia patients during clinical remission.

Age- and education-matched comparison of aging HIV+ men who have sex with men to general population on common neuropsychological assessments

Little is known about the impact of HIV and aging on cognitive functioning. This New York City cross-sectional study of aging HIV-positive gay and bisexual men assessed their neuropsychological state. Working memory and verbal abstract reasoning were relatively intact. After 55 years of age, attention abilities were impaired. Executive function impairment was present regardless of age and education. Results suggest the need for HIV-specific norms, and the use of neuropsychological assessments (i.e. baseline and over time) as a cost-effective way to assess HIV-related cognitive decline in developed and under-developed countries.

Informal Caregiver Disability and Access to Preventive Care in Care Recipients

INTRODUCTION

Many informal caregivers of dependent midlife and older adults suffer from their own functional limitations. The impact of caregiver functional limitations on care recipient receipt of preventive services is unknown. The purpose of this study is to examine the association between caregiver functional limitations and decreased access to recommended preventive services in dependent care recipients.

METHODS

Dependent adults (those receiving assistance with activities of daily living or instrumental activities of daily living) and their primary informal caregiver were identified from pooled alternate years (2000-2008) of the nationally representative Medical Expenditure Panel Survey (data analyzed February-October 2014). The impact of caregiver limitations (cognitive, mobility, sensory, emotional health) on care recipient's receipt of up to seven different preventive services was assessed via survey-weighted linear and logistic regression.

RESULTS

Of the 5-year weighted estimate of 14.2 million caregiver-care recipient dyads, 38.0% of caregivers reported at least one functional limitation. The percentage of recommended preventive services received by care recipients was significantly lower if the caregiver had cognitive, mobility, or emotional health limitations. Each type of caregiver functional limitation was negatively associated with at least four different preventive services.

CONCLUSIONS

Informal caregivers burdened by their own functional impairments may face challenges in facilitating access to preventive care in dependent midlife and older adults. Policies and interventions designed to prevent or mitigate the impact of caregiver functional impairments are critical to the success of community-based models of care for dependent adults.

Enhancing prospective memory in mild cognitive impairment: The role of enactment

INTRODUCTION

Prospective memory (PM) is a fundamental requirement for independent living which might be prematurely compromised in the neurodegenerative process, namely in mild cognitive impairment (MCI), a typical prodromal Alzheimer's disease (AD) phase. Most encoding manipulations that typically enhance learning in healthy adults are of minimal benefit to AD patients. However, there is some indication that these can display a recall advantage when encoding is accompanied by the physical enactment of the material. The aim of this study was to explore the potential benefits of enactment at encoding and cue-action relatedness on memory for intentions in MCI patients and healthy controls using a behavioral PM experimental paradigm.

METHOD

We report findings examining the influence of enactment at encoding for PM performance in MCI patients and age- and education-matched controls using a laboratory-based PM task with a factorial independent design.

RESULTS

PM performance was consistently superior when physical enactment was used at encoding and when target-action pairs were strongly associated. Importantly, these beneficial effects were cumulative and observable across both a healthy and a cognitively impaired lifespan as well as evident in the perceived subjective difficulty in performing the task.

CONCLUSIONS

The identified beneficial effects of enacted encoding and semantic relatedness have unveiled the potential contribution of this encoding technique to optimize attentional demands through an adaptive allocation of strategic resources. We discuss our findings with respect to their potential impact on developing strategies to improve PM in AD sufferers.

Conscientiousness and adherence to the oral contraceptive pill: A prospective study

OBJECTIVE

We assess the association between conscientiousness and adherence to the oral contraceptive pill (OCP), and examine if such a relationship is independent of a measure of prospective memory and a range of social cognitive variables.

METHOD

Data were collected from 150 OCP users at baseline, and 99 provided follow-up data four weeks later. Conscientiousness, a range of social cognitive predictors and prospective memory were assessed at baseline. OCP adherence was measured at baseline, and again at Time 2. Data were analysed using correlation and multiple linear regression.

RESULTS

Higher conscientiousness was associated with higher overall OCP adherence in both cross-sectional (r = -0.28, p < 0.01) and prospective analysis (r = -0.34, p < 0.01). Conscientiousness predicted OCP adherence at Time 2, adjusting for OCP adherence at Time 1 (R(2) change = 0.02, p = 0.04). The association was reduced to non-significance when social cognitive predictors and prospective memory were included in the multivariable model. Prospective memory was an independent predictor of OCP adherence at Time 2.

DISCUSSION

This is the first study to identify an association between conscientiousness and OCP adherence. The association is not independent from social cognitive predictors and prospective memory. Facet-level analysis of conscientiousness and formal mediation analyses are recommended in future replications.

PROspective MEmory Training to improve HEart failUre Self-care (PROMETHEUS): study protocol for a randomised controlled trial

Background

Cognitive impairment is seen in up to three quarters of heart failure (HF) patients and has a significant negative impact on patients’ health outcomes. Prospective memory, which is defined as memory to carry out future intentions, is important for functional independence in older adults and involves application of multiple cognitive processes that are often impaired in HF patients. The objective of this study is to examine the effects of prospective memory training on patients’ engagement in HF self-care and health outcomes, carer strain and quality of life.

Methods/design

The proposed study is a randomised, controlled trial in which 200 patients diagnosed with HF, and their carers will be recruited from 3 major hospitals across Melbourne. Eligible patients with HF will be randomised to receive either: 1) The Virtual Week Training Program - a computerised prospective memory (PM) training program (intervention) or 2) non-adaptive computer-based word puzzles (active control). HF patients’ baseline cognitive function will be compared to a healthy control group (n = 60) living independently in the community. Patients will undergo a comprehensive assessment of PM, neuropsychological functioning, self-care, physical, and emotional functioning. Assessments will take place at baseline, 4 weeks and 12 months following intervention. Carers will complete measures assessing quality of life, strain, perceived control in the management of the patients’ HF symptoms, and ratings of the patients’ level of engagement in HF self-care behaviours.

Discussion

If the Virtual Week Training Program is effective in improving: 1) prospective memory; 2) self-care behaviours, and 3) wellbeing in HF patients, this study will enhance our understanding of impaired cognitive processes in HF and potentially is a mechanism to reduce healthcare costs.

Trial registration

Australian New Zealand Clinical Trials Registry #366376; 27 May 2014. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366376&isClinicalTrial=False.

Prospective memory impairment in chronic heart failure

Although cognitive deficits are common in patients with chronic heart failure (CHF), no study to date has investigated whether these deficits extend to the capacity to execute delayed intentions (prospective memory, PM). This is a surprising omission given the critical role PM plays in correctly implementing many important CHF self-care behaviors. The present study aimed to provide the first empirical assessment of PM function in people with CHF. The key dependent measure was a laboratory measure of PM that closely simulates PM tasks in daily life - Virtual Week. A group comparison design was used, with 30 CHF patients compared to 30 demographically matched controls. Background measures assessing executive functions, working memory, and verbal memory were also administered. The CHF group exhibited significant PM impairment, with difficulties generalizing across different types of PM tasks (event, time, regular, irregular). The CHF group also had moderate deficits on several of the background cognitive measures. Given the level of impairment remained consistent even on tasks that imposed minimal demands on memory for task content, CHF-related difficulties most likely reflects problems with the prospective component. However, exploratory analyses suggest that difficulties with retrospective memory and global cognition (but not executive control), also contribute to the PM difficulties seen in this group. The implications of these data are discussed, and in particular, it is argued that problems with PM may help explain why patient engagement in CHF self-care behaviors is often poor.

Relationship of cognitive strategy use to prospective memory performance in a diverse sample of nondemented older adults with varying degrees of cognitive complaints and impairment

Although older adults typically have better performance on prospective memory (PM) tasks carried out in naturalistic settings, a paucity of research directly assesses older adults' use of compensatory strategies on such tasks. The current study investigates external memory strategy use during performance of a clinical PM test that features both short-term (in laboratory) and long-term (out of laboratory) subtasks (i.e., the Royal Prince Alfred Prospective Memory Test - RPA-ProMem. Nondemented, community-dwelling older adults (n = 214; mean age = 80.5; 68.2% female; 39.7% non-white) with mild cognitive impairment, subjective cognitive decline, and healthy controls completed the RPA-ProMem while external strategy use was permitted and recorded. Overall, participants utilized external strategies 41% of the time on the RPA-ProMem. Increased utilization of external memory strategies was significantly associated with better PM performance. Additionally, better performance on executive functioning tasks was associated with increased use of external memory strategies. Results are discussed in relation to how memory strategy use can be enhanced to improve everyday memory ability in older adults at risk for dementia.

Conscientiousness and medication adherence: a meta-analysis

BACKGROUND

Approximately a quarter to a half of all people fail to take their medication regimen as prescribed (i.e. non-adherence). Conscientiousness, from the five-factor model of personality, has been positively linked to adherence to medications in several recent studies.

PURPOSE

This study aimed to systematically estimate the strength and variability of this association across multiple published articles and to identify moderators of this relationship.

METHOD

A literature search identified 16 studies (N = 3,476) that met the study eligibility criteria. Estimates of effect sizes (r) obtained in these studies were meta-analysed.

RESULTS

Overall, a higher level of conscientiousness was associated with better medication adherence (r = 0.15; 95 % CI, 0.09, 0.21). Associations were significantly stronger in younger samples (r = 0.26, 95 % CI, 0.17, 0.34; k = 7).

CONCLUSION

The small association between conscientiousness and medication adherence may have clinical significance in contexts where small differences in adherence result in clinically important effects.

Prospective memory predicts the level of community living skills in schizophrenia

Schizophrenia patients are known to have prospective memory (PM) deficits. There is no robust evidence showing that PM deficits have a major impact on community living skills in schizophrenia. The aim of this study was to examine the association between PM and community living skills in schizophrenia. Forty-four individuals with schizophrenia formed the study sample. Participants׳ psychopathology, prospective and retrospective memory, level of intelligence, and community living skills were measured with standardized instruments. In bivariate analyses, community living skills overall but not self-care correlated with PM total and subscales scores. In multivariate analyses, event-based PM was more predictive than time-based PM of the level of community living skills. In conclusion, PM has a significant impact on community living skills in schizophrenia and attention should be paid to this type of memory disturbance in rehabilitation of schizophrenia.

Event-based prospective memory is independently associated with self-report of medication management in older adults

BACKGROUND

Identifying potentially modifiable risk factors for medication non-adherence in older adults is important in order to enhance screening and intervention efforts designed to improve medication-taking behavior and health outcomes. The current study sought to determine the unique contribution of prospective memory (PM) (i.e. 'remembering to remember') to successful self-reported medication management in older adults.

METHODS

Sixty-five older adults with current medication prescriptions completed a comprehensive research evaluation of sociodemographic, psychiatric, and neurocognitive functioning, which included the memory for adherence to medication scale (MAMS), prospective and retrospective memory questionnaire (PRMQ), and a performance-based measure of PM that measured both semantically related and semantically unrelated cue-intention (i.e. when-what) pairings.

RESULTS

A series of hierarchical regressions controlling for biopsychosocial, other neurocognitive, and medication-related factors showed that elevated complaints on the PM scale of the PRMQ and worse performance on an objective semantically unrelated event-based PM task were independent predictors of poorer medication adherence as measured by the MAMS.

CONCLUSIONS

PM plays an important role in self-report of successful medication management among older adults. Findings may have implications for screening for older individuals 'at risk' of non-adherence, as well as the development of PM-based interventions to improve medication adherence and, ultimately, long-term health outcomes in older adults.

Problematic alcohol use among individuals with HIV: relations with everyday memory functioning and HIV symptom severity

Problematic alcohol use has been shown to negatively impact cognitive functions germane to achieving optimal HIV health outcomes. The present study, a secondary data analysis, examined the impact of problematic alcohol use on aspects of everyday memory functioning in a sample of 172 HIV-infected individuals (22 % female; Mage = 48.37 years, SD = 8.64; 39 % Black/non-Hispanic). Additionally, we tested whether self-reported memory functioning explained the relation between problematic alcohol use and HIV symptom severity. Results indicated that problematic patterns of alcohol use were associated with lower total memory functioning, retrieval (e.g., recall-difficulty) and memory for activity (e.g., what you did yesterday) and greater HIV symptom severity. Memory functioning mediated the relation between problematic alcohol use and HIV symptom severity. However, the direction of this relation was unclear as HIV symptom severity also mediated the relation between problematic alcohol use and memory functioning. Findings highlight the importance of integrated care for HIV and alcohol use disorders and suggest that routine alcohol and cognitive screenings may bolster health outcomes among this vulnerable population.

Prospective memory on a novel clinical task in older adults with mild cognitive impairment and subjective cognitive decline

Despite the relevance of prospective memory to everyday functioning and the ability to live independently, prospective memory tasks are rarely incorporated into clinical evaluations of older adults. We investigated the validity and clinical utility of a recently developed measure, the Royal Prince Alfred Prospective Memory Test (RPA-ProMem), in a demographically diverse, non-demented, community-dwelling sample of 257 older adults (mean age = 80.78 years, 67.7% female) with amnestic mild cognitive impairment (aMCI, n = 18), nonamestic mild cognitive impairment (naMCI, n = 38), subjective cognitive decline (SCD, n = 83) despite intact performance on traditional episodic memory tests, and healthy controls (HC, n = 118). Those with aMCI and naMCI performed significantly worse than controls on the RPA-ProMem and its subtasks (time-based, event-based, short-term, long-term). Also, those with SCD scored significantly lower than controls on long-term, more naturalistic subtasks. Additional results supported the validity and inter-rater reliability of the RPA-ProMem and demonstrated a relation between test scores and informant reports of real-world functioning. The RPA-ProMem may help detect subtle cognitive changes manifested by individuals in the earliest stages of dementia, which may be difficult to capture with traditional episodic memory tests. Also, assessment of prospective memory can help guide the development of cognitive interventions for older adults at risk for dementia.