Face–name association learning in early Alzheimer's disease: A comparison of learning methods and their underlying mechanisms

Effects of a cognitive rehabilitation program based on mnemonic skills and memory compensatory strategies for older adults: A pilot study

BACKGROUND

With the aging of the population, the number of people with age-related memory complaints has also increased. The purpose of this study was to develop a cognitive rehabilitation program based on mnemonic skills and memory compensatory strategies (CRM) and to investigate the effects of CRM in community-dwelling older adults without dementia.

METHODS

This study was an open-label, single-arm, pilot study. We developed a CRM program comprising 8 weekly sessions. The study participants consisted of older adults with normal cognitive function and mild cognitive impairment (MCI). They were recruited from eight dementia counseling centers and one senior welfare center. To assess the effects of CRM, we administered the following tests at baseline and after completion of the program: Subjective Memory Complaints Questionnaire, the Short form of Geriatric Depression Scale, the Euro Quality of life-5 Dimension, and the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery.

RESULTS

Thirty-two participants completed the study. Among older adults with normal cognitive function, CRM showed significant improvement in verbal memory function. Among the older adults with MCI, CRM showed significant improvements in language ability, verbal recognition memory, nonverbal memory, attention, and processing speed.

CONCLUSION

CRM improved cognitive function in two distinct populations, older adults with normal cognitive function and older adults with MCI. Additionally, our preliminary findings suggest that older adults with MCI show cognitive improvement in both the trained and non-trained cognitive domains.

Retrieval Practice in Memory- and Language-Impaired Populations: A Systematic Review

OBJECTIVE

Neurological conditions, such as multiple sclerosis and stroke, may impair memory and language. A technique called retrieval practice (RP) may improve memory and language outcomes in such clinical populations. The RP effect refers to the finding that retrieving information from memory leads to better long-term retention than restudying the same information. Although the benefits of RP have been repeatedly observed in healthy populations, less is known about its potential applications in cognitive rehabilitation in clinical populations. Here we review the RP literature in populations with acquired memory and language impairments.

METHOD

Systematic searches for studies published before January 2020 were conducted on Elsevier, PsycARTICLES, PsycINFO, Pubmed, Web of Science, and Wiley Online Library, with the terms "retrieval practice"/"testing effect" and "cognitive rehabilitation". In addition, backward and forward snowballing were used to allow the identification of important publications missed by the initial search. Studies were included if they were peer-reviewed, empirical work in which memory or language outcome measures were compared between an RP condition and a re-exposure-control condition in patients with acquired memory or language impairments.

RESULTS

Sixteen articles fulfilled the inclusion criteria. Studies from memory-impaired samples were relatively homogeneous with respect to experimental protocols and materials and favored RP over control conditions. The results were mostly positive despite short retention intervals and predominantly single-session designs. Similarly, studies from language-impaired samples focused on naming impairments in patients with aphasia and also favored RP over name repetition.

CONCLUSION

The results indicate that RP is a viable technique for cognitive rehabilitation.

Effects of working memory intervention on language production by individuals with dementia

The purpose of this study was to investigate the effects of working memory intervention on language production by people with mild or moderate Alzheimer's disease (AD). A total of 39 AD patients, 21 with mild AD and 18 with moderate AD and 18 normal controls were given 18 sessions of working memory intervention. After these sessions, the transfer effects and maintenance effects at the 3-month follow-up were assessed. A word-span task and a digit-span task were used to evaluate working memory. Language-production abilities were compared through four tasks: a verbal fluency, a confrontation naming, a word definition, and a picture-description task. Task performances of working memory and language production were the lowest in the baseline stage and the highest in the transfer-effect stage. The three groups had transfer effects in all tasks, while the maintenance effects were limited by groups and tasks. This study proves that working memory intervention for AD patients is effective for language production. In addition, we have paved the way for working memory intervention to improve language production by AD patients in clinical settings by presenting the transfer and maintenance effect for each task of language production.

A comparison of systematic instruction, error-based learning and trial and error to train the use of smartphone memory apps after acquired brain injury: A three-armed phase II randomised controlled trial study protocol

Background:

The uptake of smartphones as external compensatory memory aids following an acquired brain injury (ABI) in rehabilitation settings is low. Potential reasons for this include professionals not having evidence-based guidelines regarding the best methods to train smartphone use and prospective users not being familiar with technology and/or having memory and learning difficulties. This paper describes the protocol of a study that aims to compare the efficacy of three training methods (Systematic Instruction, Error-based Learning and Trial-and-Error) for training the use of a smartphone reminder app, in people with ABI presenting with memory complaints.

Methods/Design:

This is a three-armed, assessor-blinded, Phase II randomised controlled trial. The estimated sample size is 51 participants aged >18 years, who are equally randomised to one of the three training groups. They are seen across four sessions: one to conduct baseline measures; one for training the use of an app and two for follow-up assessments (1- and 6-weeks post-training). The main outcome measure is proficiency of performance in tasks with the trained app. Secondary outcomes include generalisation of skills to other apps, number of errors committed while attempting the tasks, frequency of smartphone usage in general and as a memory aid and confidence in smartphone use and memory self-efficacy. Outcome measures are collected by an independent blinded assessor. Proficiency of performance, generalisation of skills and error commission are measured immediately post-training and at the two follow-up sessions. The other secondary measures are taken pre-intervention and at the two follow-up sessions.

Discussion:

This study will provide initial evidence regarding the efficacy of three different methods to train ABI survivors with memory difficulties in how to use smartphone apps as compensatory memory aids. The results could inform a larger Phase III trial and advance knowledge concerning the advantages or disadvantages of using error-reducing and trial-and-error techniques. Further, the findings could determine the potential of error-based learning as an emerging training method for people with memory impairment within rehabilitation.

Spaced Retrieval and Episodic Memory Training in Alzheimer's Disease

Introduction

This study replicated and extended the findings from the author's previous pilot study to further explore how a spaced retrieval (SR) memory training program might be effectively applied to help persons with Alzheimer’s disease (AD)  improve both short- and long-term recall of recent episodic events.

Methods

A quasi-experimental within-subject group study was conducted with 15 participants with a diagnosis of AD.

Results

Compared to a control condition, all participants were able to spontaneously recall significantly more specific details about trained events, and their recall was significantly enhanced when they were provided with cues. Although the findings indicated that people with AD were able to encode information during training, recall gains diminished by the end of the maintenance period.

Discussion

This study provides evidence that individuals with mild to moderate AD can learn and recall new episodic information through SR training. These findings support the use of SR as an intervention tool to help individuals maintain their functioning in episodic recent memory. However, more research into maintaining the long-term recall of recent episodic events is warranted.

Transfer Effects of Working Memory Intervention on Linguistic Abilities in Patients with Dementia

Purpose: Working memory training for Alzheimer’s disease (AD) patients may yield everyday cognitive- linguistic benefits by facilitating transfer effects in multiple domains. The purpose of this study was to investigate the effects of working memory intervention and differences on transfer effects in type of intervention paradigm like core training (CT) and strategy training (ST).Methods: A total of 24 patients with mild and moderate AD were divided into CT and ST group (n = 12, respectively). After CT and ST interventions, we assessed their transfer effects on linguistic abilities including reading comprehension, figurative language, word fluency, and discourse production. Results: There were three main findings. Firstly, CT group improved significantly in figurative language, word fluency, and discourse production. Secondly, ST group showed the significant intervention gains in figurative language and discourse production. Thirdly, CT group had higher transfer effects in figurative language and discourse production than ST group, while both were similar in other transfer effects.Conclusion: This study proves that effects of working memory intervention for AD patients are different in type of paradigm, and thereby presents a roadmap for increasing the efficacy and utilization of working memory intervention in clinical settings.

Language and communication non-pharmacological interventions in patients with Alzheimer's disease: a systematic review. Communication intervention in Alzheimer

Alzheimer's disease considerably compromises communication skills. Language changes become more prominent as the disease progresses. Deterioration of language and cognition reduces the ability of holding conversations, which has a negative impact on social interaction.

Comparing the effects of clinician and caregiver-administered lexical retrieval training for progressive anomia

There is a growing body of literature indicating that lexical retrieval training can result in improved naming ability in individuals with neurodegenerative disease. Traditionally, treatment is administered by a speech-language pathologist, with little involvement of caregivers or carry-over of practice into the home. This study examined the effects of a lexical retrieval training programme that was implemented first by a clinician and, subsequently, by a trained caregiver. Two dyads, each consisting of one individual with anomia caused by neurodegenerative disease (one with mild cognitive impairment and one with logopenic primary progressive aphasia) and their caregiver, participated in the study. Results indicated medium and large effect sizes for both clinician- and caregiver-trained items, with generalisation to untrained stimuli. Participants reported improved confidence during communication as well as increased use of trained communication strategies after treatment. This study is the first to document that caregiver-administered speech and language intervention can have positive outcomes when paired with training by a clinician. Caregiver-administered treatment may be a viable means of increasing treatment dosage in the current climate of restricted reimbursement, particularly for patients with progressive conditions.

Relearning of Activities of Daily Living: A Comparison of the Effectiveness of Three Learning Methods in Patients with Dementia of the Alzheimer Type

This study examined the effectiveness of three different learning methods: trial and error learning (TE), errorless learning (EL) and learning by modeling with spaced retrieval (MR) on the relearning process of IADL in mild-to-moderately severe Alzheimer's Dementia (AD) patients (n=52), using a 6-weeks randomized controlled trial design. The participants had to relearn three IADLs. Repeated-measure analyses during pre-intervention, post-intervention and 1-month delayed sessions were performed. All three learning methods were found to have similar efficiency. However, the intervention produced greater improvements in the actual performance of the IADL tasks than on their explicit knowledge. This study confirms that the relearning of IADL is possible with AD patients through individualized interventions, and that the improvements can be maintained even after the intervention.

Remediation of a naming deficit following left temporal lobe epilepsy surgery

Dysnomia is associated with temporal lobe epilepsy and may include a deficit in recalling the names of familiar people. The deficit can worsen following surgery to relieve refractory seizures. The following is a case report comparing implicit (errorless learning) and explicit (rote rehearsal) approaches to retraining face-name associations in a 52-year-old woman who was status post-amygdalo-hippocampectomy for refractory complex partial seizures. Although both approaches initially improved performance above baseline, only errorless learning resulted in stable gains during a 10-min delay and at 1-week follow-up. Initial improvements in naming with rote rehearsal were not maintained even during the 10-min delay. In patients with severe memory impairment and dysnomia, errorless learning may offer a viable rehabilitation strategy for improving naming performance.

Errorless learning of prospective memory tasks: An experimental investigation in people with memory disorders

The term prospective memory (PM) refers to memory for future intentions. PM problems are frequent in people with cognitive impairment and, because they are central to the realisation of many everyday goals, are important in rehabilitation. Event-based PM tasks (EBPM) are environmentally-cued and have primarily mnemonic demands, whereas time-based PM tasks (TBPM) require self-initiated retrieval, and have greater executive demands. Errorless learning (EL) is an encoding method that results in superior retrospective memory compared with “errorful” learning (EF). As this EL advantage (ELA) likely stems from its reduced explicit memory demands, and there is no such advantage for executive tasks, a greater ELA for EBPM than TBPM was predicted. Fourteen adults with neurological memory impairment completed PM tasks under four counterbalanced conditions: EL of EBPM, EL of TBPM, EF of EBPM, and EF of TBPM. A significant ELA was observed for EBPM (d = .63), but not TBPM (d = –.01). These results extend the evidence for EL within cognitive rehabilitation, by showing for the first time that the method can benefit future action in addition to retrospective memory. The clinical implications are also clear: errorless learning techniques may be usefully employed to support completion of day-to-day EBPM tasks.

Effects of spaced retrieval training on semantic memory in Alzheimer’s disease: a systematic review

PURPOSE

This article reports on a systematic review and meta-analysis of the effects of spaced retrieval training (SRT) on semantic memory in people with Alzheimer’s disease (AD) or related disorder.

METHOD

An initial systematic database search identified 454 potential studies. After screening and de-duplication, 35 studies that used SRT with the population of interest remained. The authors used an appraisal point system to evaluate the quality of the studies. Twelve of the 35 studies met inclusion and exclusion criteria and passed the appraisal point system cutoff. The 12 studies were classified as Level I and II evidence.

RESULTS

Although the 12 studies varied in terms of design, methodology, and quality, SRT was shown to have important positive effects on learning semantic information across the included studies.

CONCLUSIONS

The findings indicate that SRT is an effective semantic memory training technique for people with AD, and consequently, recommendations are suggested for implementing SRT in practice settings. Continued research in this domain is also warranted to address limitations and gaps in the current body of research evidence, including variability in SRT protocols, effects of dementia severity on learning outcomes, maintenance effects, generalization, and the role of explicit and implicit learning in SRT.

A literature review of spaced-retrieval interventions: a direct memory intervention for people with dementia

BACKGROUND

With the increasing prevalence of dementia, there is a pressing need to identify effective interventions that prolong independent functioning. As pharmacological interventions aimed at slowing cognitive decline have been found to have a number of limitations, research has now moved toward studying complementary non-pharmacological cognitive training interventions. This review describes the use of spaced-retrieval as a method to teach new information and reduce behavioral problems in people with dementia.

METHODS

We searched the databases PsychINFO, MEDLINE, and Scopus as well as reference lists of relevant papers to identify articles describing the use of spaced-retrieval with people with dementia. Only primary, peer-reviewed research published in English was included in this review.

RESULTS

In total, 34 studies were identified, three of which were randomized controlled trials. We found that across studies, there was wide variability with regard to design, methodology, and outcome measures used. Nonetheless, the existing research demonstrates that spaced-retrieval training can be successfully used to teach people with dementia new and previously known face- and object-name associations, as well as cue-behavior associations aimed at alleviating problem behaviors and improving functional skills. The method can also assist with the recollection of past events.

CONCLUSIONS

Current evidence indicates that spaced-retrieval training is effective in enabling people with dementia to learn new information and behavioral strategies. Future research should attempt to address the limitations outlined in this review and focus on utilizing this technique to achieve more functional and clinically relevant outcomes. Recommendations are also made with regard to investigating potential secondary benefits of spaced-retrieval and strengthening study design.

Using Spaced Retrieval to Effectively Treat Dysphagia in Clients With Dementia

Spaced retrieval (SR) is an evidence-based memory intervention that can be effective for helping people with mild to moderate dementia. It can be used to help clients reach a variety of goals, such as less repetitive questioning, better orientation, greater engagement in activities, improved appointment keeping, safe ambulation, and, in particular, safe swallowing. Thus, therapists using SR can enable clients with dementia to reach dysphagia therapy goals. Achievement of these goals can promote independence and reduce anxiety, as well as improve client-staff interactions. SR has been proven to be effective across a variety of types of dementia. It has been used successfully with clients in their homes, adult day centers, and skilled nursing facilities. It can be implemented during treatment sessions with speech-language pathologists and then maintained by family caregivers or nursing care staff.

Using mental imagery to improve memory in patients with Alzheimer disease: trouble generating or remembering the mind's eye?

This study was conducted to understand whether patients with mild Alzheimer disease (AD) could use general or self-referential mental imagery to improve their recognition of visually presented words. Experiment 1 showed that, unlike healthy controls, patients generally did not benefit from either type of imagery. To help determine whether the patients' inability to benefit from mental imagery at encoding was due to poor memory or due to an impairment in mental imagery, participants performed 4 imagery tasks with varying imagery and cognitive demands. Experiment 2 showed that patients successfully performed basic visual imagery, but degraded semantic memory, coupled with visuospatial and executive functioning deficits, impaired their ability to perform more complex types of imagery. Given that patients with AD can perform basic mental imagery, our results suggest that episodic memory deficits likely prevent AD patients from storing or retrieving general mental images generated during encoding. Overall, the results of both experiments suggest that neurocognitive deficits do not allow patients with AD to perform complex mental imagery, which may be most beneficial to improving memory. However, our data also suggest that intact basic mental imagery and rehearsal could possibly be helpful if used in a rehabilitation multisession intervention approach.

Systematic instruction for individuals with acquired brain injury: results of a randomised controlled trial

The goal of this study was to evaluate experimentally systematic instruction compared with trial-and-error learning (conventional instruction) applied to assistive technology for cognition (ATC), in a double-blind, pre-test-post-test, randomised controlled trial. Twenty-nine persons with moderate-severe cognitive impairments due to acquired brain injury (15 in systematic instruction group; 14 in conventional instruction) completed the study. Both groups received 12, 45-minute individual training sessions targeting selected skills on the Palm Tungsten E2 personal digital assistant (PDA). A criterion-based assessment of PDA skills was used to evaluate accuracy, fluency/efficiency, maintenance, and generalisation of skills. There were no significant differences between groups at immediate post-test with regard to accuracy and fluency. However, significant differences emerged at 30-day follow-up in favour of systematic instruction. Furthermore, systematic instruction participants performed significantly better at immediate post-test generalising trained PDA skills when interacting with people other than the instructor. These results demonstrate that systematic instruction applied to ATC results in better skill maintenance and generalisation than trial-and-error learning for individuals with moderate-severe cognitive impairments due to acquired brain injury. Implications, study limitations, and directions for future research are discussed.

Errorless learning in cognitive rehabilitation: a critical review

Cognitive rehabilitation research is increasingly exploring errorless learning interventions, which prioritise the avoidance of errors during treatment. The errorless learning approach was originally developed for patients with severe anterograde amnesia, who were deemed to be at particular risk for error learning. Errorless learning has since been investigated in other memory-impaired populations (e.g., Alzheimer's disease) and acquired aphasia. In typical errorless training, target information is presented to the participant for study or immediate reproduction, a method that prevents participants from attempting to retrieve target information from long-term memory (i.e., retrieval practice). However, assuring error elimination by preventing difficult (and error-permitting) retrieval practice is a potential major drawback of the errorless approach. This review begins with discussion of research in the psychology of learning and memory that demonstrates the importance of difficult (and potentially errorful) retrieval practice for robust learning and prolonged performance gains. We then review treatment research comparing errorless and errorful methods in amnesia and aphasia, where only the latter provides (difficult) retrieval practice opportunities. In each clinical domain we find the advantage of the errorless approach is limited and may be offset by the therapeutic potential of retrieval practice. Gaps in current knowledge are identified that preclude strong conclusions regarding a preference for errorless treatments over methods that prioritise difficult retrieval practice. We offer recommendations for future research aimed at a strong test of errorless learning treatments, which involves direct comparison with methods where retrieval practice effects are maximised for long-term gains.

Effects of different learning methods for instrumental activities of daily living in patients with Alzheimer's dementia: a pilot study

We examined whether errorless learning (EL) and learning by modeling (LM) were more advantageous than trial and error learning (TEL) in the acquisition of instrumental activities of daily living (IADL) in Alzheimer's dementia (AD) patients (n = 14). Using a counterbalanced within-subject design, participants performed 3 learning conditions. EL consisted of straightforward prompts before any action, LM focused on the modeling of each step of the tasks and standard TEL without cues was used as a control condition. The participants had to (re)learn 3 IADL. Repeated-measure analyses during learning and follow-up assessments were performed 1 and 3 weeks after learning. The LM and the EL procedures resulted in significantly better learning compared to TEL, with effect sizes (partial eta squared) of 0.42 and 0.35, respectively. This is the first controlled study to show that (re)learning of IADL is possible in patients with AD using an error-reduction approach.

Working memory task performance and chunking in early Alzheimer's disease

BACKGROUND

Chunking is a powerful encoding strategy that significantly improves working memory performance in normal young people.

AIMS

To investigate chunking in patients with mild Alzheimer's disease and in a control group of elderly people without cognitive impairment.

METHOD

People with mild Alzheimer's disease (n = 28) were recruited and divided according to Mini-Mental State Examination score into mild and very mild disease groups. A control group of 15 elderly individuals was also recruited. All participants performed digit and spatial working memory tasks requiring either unstructured sequences or structured sequences (which encourage chunking of information) to be recalled.

RESULTS

The control group and both disease groups performed significantly better on structured trials of the digit working memory tasks, indicating successful use of chunking strategies to improve verbal working memory performance. The control and very mild disease groups also performed significantly better on structured trials of the spatial task, whereas those with mild disease demonstrated no significant difference between the structured and unstructured spatial conditions.

CONCLUSIONS

The ability to use chunking as an encoding strategy to improve verbal working memory performance is preserved at the mild stage of Alzheimer's disease, whereas use of chunking to improve spatial working memory is impaired by this stage. Simple training in the use of chunking might be a beneficial therapeutic strategy to prolong working memory functioning in patients at the earliest stage of Alzheimer's disease.

Errorless learning and spaced retrieval: how do these methods fare in healthy and clinical populations?

While errorless learning and spaced retrieval have both proved effective in helping many patients with acquired brain injury (ABI) and dementia learn novel information, it is not clear which of these principles we should apply to target treatment most effectively. To address this issue we conducted a systematic comparison of these principles in three experiments, comparing their effectiveness in healthy controls (N = 60), patients with ABI (N = 30), and patients with dementia (N = 15). Participants were asked to learn face-name associations, and the relative effectiveness of the principles over and above trial-and-error learning was investigated. The results were remarkably consistent across experiments: Both errorless learning and spaced retrieval produced greater accuracy in name recall than did trial-and-error learning, but recall under conditions of spaced retrieval was significantly better than that under errorless learning. We discuss the implications of these findings and suggest that spaced retrieval may be the stronger memory rehabilitation principle when it comes to learning face-name associations in people with mild to moderate memory impairment.

Are two methods better than one? Evaluating the effectiveness of combining errorless learning with vanishing cues

A growing trend in memory rehabilitation is to combine learning principles to enhance treatment effects. While this makes intuitive sense, little is known about the added value of incorporating each method. A further complication is that some interventions, although primarily based on one learning principle, actually incorporate several, which again adds to the difficulty in differentiating the individual contribution of techniques. In this paper we report results of two experiments comparing the effectiveness of combining principles of errorless learning (EL) with vanishing cues (VC) relative to each in isolation. Healthy controls (N = 60), learning under standard and dual-task conditions, and patients with probable Alzheimer's disease (N = 22) took part in Experiments 1 and 2, respectively. In each experiment, participants were asked to learn greeble- or face-name associations, and memory was tested after interference or brief delay. For healthy controls, EL alone and EL + VC produced the best results, but there was no difference between these conditions. For the Alzheimer's patients, all treatment conditions (EL, VC, EL + VC) were significantly better than trial and error, and, in this case, we found that the combined method was significantly better than VC in isolation. Importantly, in both experiments there was little support for use of combined over individual learning principles.

Intermodal transfer from a visual to an auditory discrimination using an errorless learning procedure

Errorless learning is a technique developed by Terrace [Terrace, H.S., 1963a. Discrimination training with and without "errors". J. Exp. Anal. Behav. 6, 1-27] to train stimulus discriminations with few or no errors. In the first replication of the original findings, errorless learning was also shown to transfer successfully between two visual discriminations without errors [Terrace, H.S., 1963b. Errorless transfer of a discrimination across two continua. J. Exp. Anal. Behav. 6, 223-232]. In the present experiment, we extended the errorless learning procedure to an intermodal transfer, from a discrimination between red and green colors to a discrimination between high and low tones. The pigeons were divided into two groups: an Experimental Group, which learned both discriminations through errorless learning, and a Control Group, which learned them through trial-and-error. Results showed that pigeons from the Experimental Group learned the red-green discrimination with significantly fewer errors than the Control Group and that errorless learning is effective in transferring from a visual to an auditory discrimination.