The role of cognitive reserve and memory self-efficacy in compensatory strategy use: A structural equation approach

Confidence guides spontaneous cognitive offloading

BACKGROUND

Cognitive offloading is the use of physical action to reduce the cognitive demands of a task. Everyday memory relies heavily on this practice; for example, when we write down to-be-remembered information or use diaries, alerts, and reminders to trigger delayed intentions. A key goal of recent research has been to investigate the processes that trigger cognitive offloading. This research has demonstrated that individuals decide whether or not to offload based on a potentially erroneous metacognitive evaluation of their mental abilities. Therefore, improving the accuracy of metacognitive evaluations may help to optimise offloading behaviour. However, previous studies typically measure participants' use of an explicitly instructed offloading strategy, in contrast to everyday life where offloading strategies must often be generated spontaneously.

RESULTS

We administered a computer-based task requiring participants to remember delayed intentions. One group of participants was explicitly instructed on a method for setting external reminders; another was not. The latter group spontaneously set reminders but did so less often than the instructed group. Offloading improved performance in both groups. Crucially, metacognition (confidence in unaided memory ability) guided both instructed and spontaneous offloading: Participants in both groups set more reminders when they were less confident (regardless of actual memory ability).

CONCLUSIONS

These results show that the link between metacognition and cognitive offloading holds even when offloading strategies need to be spontaneously generated. Thus, metacognitive interventions are potentially able to alter offloading behaviour, without requiring offloading strategies to be explicitly instructed.

The doubtful benefits of giving the benefit of the doubt: Lenient scoring of the spatial orientation items on the mini-Mental Status Exam increases false negative rates

Lenient scoring of spatial orientation errors (SOE) on the Mini-Mental State Exam (MMSE) is common practice, even though it deviates from standard protocol and may compromise its diagnostic power. This study was designed to empirically evaluate the effect of lenient scoring on the MMSE's classification accuracy. Participants were 113 community dwelling older adults recruited for a research study, representing a wide range of range of neurological status from cognitively healthy to Alzheimer's disease. Clinical classification was determined by expert assessors based on multiple sources of clinical evidence. Lenient scoring significantly inflated MMSE total scores (d = .88, large effect), and suppressed failure rates (from 26% to 14%). Standard scoring produced superior overall classification accuracy (75% vs. 67%) over lenient scoring and, more importantly, increased sensitivity from .33 to .53, with minimal loss in specificity (from 1.00 to .95). SOEs are empirical markers of cognitive decline and should not be adjusted based on clinical judgment. Results indicate that diminished sensitivity to cognitive impairment is an unintended consequence of lenient scoring and argue against this practice.

Compensation Strategies in Older Adults: Association With Cognition and Everyday Function

BACKGROUND/RATIONALE

Compensation strategies may contribute to greater resilience among older adults, even in the face of cognitive decline. This study sought to better understand how compensation strategy use among older adults with varying degrees of cognitive impairment impacts everyday functioning.

METHODS

In all, 125 older adults (normal cognition, mild cognitive impairment, dementia) underwent neuropsychological testing, and their informants completed questionnaires regarding everyday compensation and cognitive and functional abilities.

RESULTS

Cognitively normal and mild cognitive impairment older adults had greater levels of compensation use than those with dementia. Higher levels of neuropsychological functioning were associated with more frequent compensation use. Most importantly, greater frequency of compensation strategy use was associated with higher levels of independence in everyday function, even after accounting for cognition.

CONCLUSION

Use of compensation strategies is associated with higher levels of functioning in daily life among older adults. Findings provide strong rational for development of interventions that directly target such strategies.

Subjective cognitive complaints and objective memory performance influence prompt preference for instrumental activities of daily living

INTRODUCTION

Declines in memory and executive functioning often lead to difficulties completing instrumental activities of daily living (IADLs). Prompting technologies have the potential to help promote aging in place by providing support for the initiation and accurate completion of IADLs. In this study, we evaluate preferences of older adults for different levels of prompting support based on subjective and objective measures of cognitive functioning.

METHOD

Participants were 170 community-dwelling older adults split into two cognitive complaint groups: cognitive complaints and few cognitive complaints. After completing six IADL tasks (e.g., organize a pillbox, cook), each participant was asked to make a specific error (e.g., leave stove on) on three of the tasks. They were then prompted to correct the error with one of three different prompt modes: verbal indirect, verbal direct, multimodal verbal direct and video.

RESULTS

The cognitive complaints group reported greater preference for the multimodal prompt compared to the few cognitive complaints group. The indirect prompt was the least preferred by both groups. Furthermore, participants who recalled less on objective memory measures preferred more support in terms of prompt mode. Executive functioning did not appear to be related to prompt preference.

CONCLUSION

Level of subjective cognitive complaints and objective memory performance may influence amount of support preferred in a prompt.