Fluid mechanics moderate the effect of implementation intentions on a health prospective memory task in older adults

Fostering cognitive performance in older adults with a process- and a strategy-based cognitive training

       The present study investigates the impact of process-based and strategy-based cognitive training to boost performance in healthy older adults. Three groups trained with either a dichotic listening training (process-based training, n = 25), an implementation intention strategy training (strategy-based training, n = 23), or served as a non-contact control group (n = 30). Our results demonstrated that training participants improved their performance in the trained tasks (process-based training: d = 3.01, strategy-based training: d = 2.6). For untrained tasks, the process-based training group showed significant working memory (d = .58) as well as episodic memory task improvement (d = 1.19) compared to the strategy-based training and to the non-contact control group (all d < .03). In contrast, in the strategy-based training group there was a tendency towards some performance gain in a fluid intelligence test (d = .92). These results indicate that cognitive training can be tailored to improve specific cognitive abilities.

Improving goal striving and resilience in older adults through a personalized metacognitive self-help intervention: a protocol paper

BACKGROUND

Successful aging is often linked to individual's ability to demonstrate resilience: the maintenance or quick recovery of functional ability, well-being, and quality of life despite losses or adversity. A crucial element of resilience is behavioral adaptability, which refers to the adaptive changes in behavior in accordance with internal or external demands. Age-related degradation of executive functions can, however, lead to volition problems that compromise flexible adjustment of behavior. In contrast, the reliance on habitual control has been shown to remain relatively intact in later life and may therefore provide an expedient route to goal attainment among older adults. In the current study, we examine whether a metacognitive self-help intervention (MCSI), aimed at facilitating goal striving through the gradual automatization of efficient routines, could effectively support behavioral adaptability in favor of resilience among older adults with and without (sub-clinical) mental health problems.

METHODS

This metacognitive strategy draws on principles from health and social psychology, as well as clinical psychology, and incorporates elements of established behavioral change and activation techniques from both fields. Additionally, the intervention will be tailored to personal needs and challenges, recognizing the significant diversity that exist among aging individuals.

DISCUSSION

Despite some challenges that may limit the generalizability of the results, our MCSI program offers a promising means to empower older adults with tools and strategies to take control of their goals and challenges. This can promote autonomy and independent functioning, and thereby contribute to adaptability and resilience in later life.

TRIAL REGISTRATION

Pre-registered, partly retrospectively. This study was pre-registered before the major part of the data was collected, created, and realized. Only a small part of the data of some participants (comprising the baseline and other pre-intervention measures), and the full dataset of the first few participants, was collected prior to registration, but it was not accessed yet. See: https://osf.io/5b9xz.

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.

Implementation intentions speed up young adults' responses to prospective memory targets in everyday life

Prospective memory (PM), which is the ability to remember to do something in the future, is vitally important for successful everyday functioning. Although young adults demonstrate high PM abilities in laboratory settings, their abilities to complete intended actions in naturalistic settings are surprisingly low. The present study tested the effectiveness of various encoding techniques in improving young adults' performance in everyday life. Ninety-two participants were asked to remember to take photographs of receipts for a duration of seven days. The task instructions were either given alone or followed by: (a) the if-then statement, (b) visualising the task, or (c) the combination of the if-then statement plus visualisation. The if-then statement alone significantly speeded up responses to the prospective memory targets, i.e., less time elapsed between getting a receipt and taking a photograph of it. With no effect of the if-then statement on the proportion of correct PM responses, the results may suggest that the if-then statement strengthened the PM cue-intention association but did not influence the PM cue saliency.

Feasibility of a Home-Based Task-Switching Training in Middle-Aged Caregivers

The current study aimed at investigating feasibility of a self-administered task-switching training in a middle-aged working population. Eighty-one caregivers (41–62 years old) were instructed to train at home 8 times either within a 7- or 14-day interval. Only 56.7% performed more than 50% of the instructed number of training sessions. However, compliant caregivers (who completed more than 4 training sessions) showed significant training gains and transfer to an untrained task-switching task. Although transfer effects to other cognitive tasks were not found, trained participants tended to report fewer everyday memory failures than a control group. In conclusion, the implementation of a home-based task-switching training in everyday life of caregivers is possible. However, there is only limited evidence for generalization of results of previous laboratory studies. Adherence and transfer to other cognitive tasks are discussed as important challenges in conveying laboratory findings into real life.

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).

Improving Prospective Memory Performance in Community-dwelling Older Adults: Goal Management Training and Implementation Intentions

Aim: The present study tested a compensatory executive intervention for prospective memory (goal management training) for the first time in older adults. Prospective memory (the ability to remember and execute a task in the future) declines with age, with significant implications for older adults' activities of daily living and quality of life. Prospective memory interventions have focused primarily on the retrospective component of prospective memory (e.g., implementation intentions). However, executive dysfunction is also implicated in age-related prospective memory decline.Methods: Community-dwelling older adults were randomly allocated to receive goal management training, implementation intentions or no intervention. Prospective memory was assessed before and after the intervention with a well-validated laboratory-based prospective memory measure. Results: Contrary to predictions, neither goal management training nor implementation intentions were successful at improving prospective memory in healthy older adults. Participants who received goal management training were more likely to have difficulty comprehending the intervention. Post-hoc analyses suggested implementation intentions improved prospective memory specifically for participants with poorer baseline prospective memory. Conclusions: These results represent important cautionary findings about the possible limitations of goal management training to improve prospective memory in older adults. Future research should also consider the role of baseline prospective memory ability in affecting response to compensatory intervention.

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.

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.

An implementation intention strategy can improve prospective memory in older adults with very mild Alzheimer's disease

OBJECTIVES

This study tested whether (1) very mild Alzheimer's disease (AD) is associated with impaired prospective memory (PM) for tasks that are supported by either spontaneous retrieval (focal PM) or strategic monitoring (non-focal PM) and (2) implementation intention (II) encoding could improve PM performance in very mild AD.

DESIGN

Thirty-eight healthy older adults and 34 with very mild AD were randomly assigned to perform two PM tasks in either the standard or the II encoding condition.

METHOD

All participants performed blocks of category decision in which they were asked to respond to a focal PM target (e.g., the word 'orange') and a non-focal PM target (e.g., words that begin with the letter 'o'). Half of the participants encoded PM instructions in the standard manner, while the other half had a stronger encoding by forming IIs. PM accuracy and category decision accuracy and reaction times were measured.

RESULTS

Participants with very mild AD showed deficits in both focal and non-focal PM performance compared to the healthy controls, reflecting deficits in both spontaneous retrieval and strategic monitoring. Participants with very mild AD in the II encoding condition showed better focal PM performance relative to those in the standard encoding condition.

CONCLUSIONS

Deficits in both focal and non-focal PM are associated with very mild AD and IIs may be a helpful behavioural intervention for the focal PM deficits.

PRACTITIONER POINTS

Multiple deficits in PM are observable in very mild AD. Implementation intentions may enhance focal PM in very mild AD. Future research using larger samples is needed to better understand the effect of II on non-focal PM tasks in healthy older adults and those with very mild AD. The use of simple laboratory PM tasks may limit the generality of our findings. Future research is needed to investigate whether IIs improve PM over a range of more realistic tasks.

Cognitive and neural plasticity in older adults' prospective memory following training with the Virtual Week computer game

Prospective memory (PM) – the ability to remember and successfully execute our intentions and planned activities – is critical for functional independence and declines with age, yet few studies have attempted to train PM in older adults. We developed a PM training program using the Virtual Week computer game. Trained participants played the game in 12, 1-h sessions over 1 month. Measures of neuropsychological functions, lab-based PM, event-related potentials (ERPs) during performance on a lab-based PM task, instrumental activities of daily living, and real-world PM were assessed before and after training. Performance was compared to both no-contact and active (music training) control groups. PM on the Virtual Week game dramatically improved following training relative to controls, suggesting PM plasticity is preserved in older adults. Relative to control participants, training did not produce reliable transfer to laboratory-based tasks, but was associated with a reduction of an ERP component (sustained negativity over occipito-parietal cortex) associated with processing PM cues, indicative of more automatic PM retrieval. Most importantly, training produced far transfer to real-world outcomes including improvements in performance on real-world PM and activities of daily living. Real-world gains were not observed in either control group. Our findings demonstrate that short-term training with the Virtual Week game produces cognitive and neural plasticity that may result in real-world benefits to supporting functional independence in older adulthood.

Promoting the translation of intentions into action by implementation intentions: behavioral effects and physiological correlates

The present review addresses the physiological correlates of planning effects on behavior. Although intentions to act qualify as predictors of behavior, accumulated evidence indicates that there is a substantial gap between even strong intentions and subsequent action. One effective strategy to reduce this intention–behavior gap is the formation of implementation intentions that specify when, where, and how to act on a given goal in an if-then format (“If I encounter situation Y, then I will initiate action Z!”). It has been proposed that implementation intentions render the mental representation of the situation highly accessible and establish a strong associative link between the mental representations of the situation and the action. These process assumptions have been examined in behavioral research, and in physiological research, a field that has begun to investigate the temporal dynamics of and brain areas involved in implementation intention effects. In the present review, we first summarize studies on the cognitive processes that are central to the strategic automation of action control by implementation intentions. We then examine studies involving critical samples with impaired self-regulation. Lastly, we review studies that have applied physiological measures such as heart rate, cortisol level, and eye movement, as well as electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) studies on the neural correlates of implementation intention effects. In support of the assumed processes, implementation intentions increased goal attainment in studies on cognitive processes and in critical samples, modulated brain waves related to perceptual and decision processes, and generated less activity in brain areas associated with effortful action control. In our discussion, we reflect on the status quo of physiological research on implementation intentions, methodological and conceptual issues, related research, and propose future directions.

The effect of implementation intention on prospective memory: a systematic and meta-analytic review

Prospective memory (PM) refers to remembering to perform a planned action at a future time. Implementation intention is an encoding method in the form of "if situation Y is encountered, then I will initiate the goal-directed behavior X". It has been applied to improve PM performances. The present study conducted a systematic and meta-analytic review on the effect and mechanism of implementation intention on PM. In the meta-analysis, 36 comparisons were included. The results showed that for healthy young adults, the overall effect of implementation intention in improving PM performances was significant with a medium effect size (d = 0.445). The combined verbal and imagery form of implementation intention had a relatively larger effect size (d = 0.590). For older adults, implementation intention had a medium to large effect size on their PM performances (d = 0.680). As for the mechanism, implementation intention seemed to reduce ongoing task performances in young adults as reflected by longer reaction time (d = 0.224) though the effect size was small. The present study supports the positive effect of implementation intention on PM. The mechanism and potential implications of this promising strategy especially for clinical/sub-clinical people are discussed.

Future Directions in the Study of Health Behavior among Older Adults

The study of health behaviors and fostering health-behavior change is an important endeavor even in old age. The aim of this viewpoint article is threefold. First, we use a broad perspective for the definition of health behaviors to capture all relevant aspects of health-behavior change in older adults. Particularly, we suggest a distinction between proximal (e.g., physical activity) and distal health behaviors (e.g., social participation). Second, we recommend a stronger orientation towards processes in order to study health behaviors and the design of health-behavior change interventions. Third, we review the advantages of a developmental perspective in health psychology. Future directions in the study of health behavior among older adults are discussed.

Investigating how implementation intentions improve non-focal prospective memory tasks

Implementation intentions are a self-regulatory strategy broadly studied in the area of social cognition that can improve realization of one's goals and improve performance on prospective memory tasks. Three experiments, using a non-focal task for which the prospective memory targets were specified at the time of intention formation, investigated whether (and how) implementation intentions can improve non-focal prospective memory performance. An improvement in prospective memory performance was accompanied by an increase in the allocation of conscious resources to the prospective memory task, but not by an increase in perceived importance of the prospective memory task. The third experiment also investigated the effects of implementation intentions on recall of the appropriate action and found that accurate action recall was improved by implementation intentions. Finally, the effect of implementation intention instructions on cognitive processes that underlie non-focal prospective memory performance was investigated using a multinomial model.

Prospective memory training in older adults and its relevance for successful aging

In research on cognitive plasticity, two training approaches have been established: (1) training of strategies to improve performance in a given task (e.g., encoding strategies to improve episodic memory performance) and (2) training of basic cognitive processes (e.g., working memory, inhibition) that underlie a range of more complex cognitive tasks (e.g., planning) to improve both the training target and the complex transfer tasks. Strategy training aims to compensate or circumvent limitations in underlying processes, while process training attempts to augment or to restore these processes. Although research on both approaches has produced some promising findings, results are still heterogeneous and the impact of most training regimes for everyday life is unknown. We, therefore, discuss recent proposals of training regimes aiming to improve prospective memory (i.e., forming and realizing delayed intentions) as this type of complex cognition is highly relevant for independent living. Furthermore, prospective memory is associated with working memory and executive functions and age-related decline is widely reported. We review initial evidence suggesting that both training regimes (i.e., strategy and/or process training) can successfully be applied to improve prospective memory. Conceptual and methodological implications of the findings for research on age-related prospective memory and for training research in general are discussed.