Increasing metamemory in older adults

Memory self-efficacy and working memory

Dementia affects multiple aspects of cognitive functioning, including working memory and executive functioning. Memory self-efficacy (MSE) has previously been related to episodic memory performance and to executive functioning, but little research has examined the relations between MSE and working memory. United States older adults (N  = 197) were recruited via MTurk to complete an MSE questionnaire before completing a digit span working memory task. Hierarchical regression results revealed that the model accounted for a significant amount of variance in working memory performance after statistically controlling for several covariates, F(11, 179) = 4.94, p < .001, adjusted R2 = .19. MSE explained a large and unique portion of variance (B = 1.02, SE = 0.17, p < .001). Based on our findings, one's beliefs about their memory are positively associated with their working memory performance. These novel findings provide support for neuropsychologists to consider using MSE measures and utilizing MSE interventions.

The Power of Perception: Beliefs About Memory Ability Uniquely Contribute to Memory Performance and Quality of Life in Adults Aging with Traumatic Brain Injury

OBJECTIVE

Personal beliefs about memory ability, which comprise memory self-efficacy (MSE), can influence memory performance in healthy older adults. Self-efficacy theory also predicts that MSE biases self-perceptions of functioning more globally, potentially impacting daily activity beyond cognitive performance. People with traumatic brain injury (PwTBI) frequently report debilitating memory problems long after acute recovery, but little is known about how MSE affects health outcomes in this population. We examined demographic and clinical correlates of MSE, as well as its relationship to memory test performance and health-related quality of life (QOL), in older adults with chronic moderate-to-severe TBI (msTBI).

METHOD

One hundred fourteen adults, aged 50+ and at least 1 year post-msTBI, underwent neuropsychological testing to assess their memory functioning. Participants also self-reported levels of psychological distress, MSE (Cognitive Confidence subscale of the Metacognitions Questionnaire), and health-related QOL (Quality of Life after Brain Injury questionnaire).

RESULTS

Demographic and injury-related predictors showed weak correlations with MSE. Although the relationship between MSE and general psychological distress was robust, only the former significantly predicted memory performance. Bivariate analyses revealed significant relationships between MSE and five out of the six QOL domains assessed. Multivariate linear regression revealed a significant impact of MSE on overall QOL independent of demographic and clinical variables.

CONCLUSIONS

Our findings support a unique role for MSE in both the objective cognitive performance and subjective health of PwTBI. Increased focus on self-perceptions of ability and their impact on measured outcomes is an important step towards personalized rehabilitation for adults with chronic msTBI.

How Does Participation in Formal Education or Learning for Older People Affect Wellbeing and Cognition? A Systematic Literature Review and Meta-Analysis

Objective: To determine the effect of later-life formal education or learning on quality of life (QOL), wellbeing, mood, and cognition. Methods: A systematic literature review of interventional clinical trials and observational studies was conducted for adults aged ≥55 years who had undertaken formal education or learning programs. Outcome measures included physical activity, happiness, affective and behavioral symptoms, cognitive function, and QOL. Bias was assessed using funnel plots, Egger’s test, and leave1out analysis. Results: From 32 studies identified, we showed qualitative increases in cognitive function, life satisfaction, and self-confidence associated with learning. A meta-analysis revealed a significant pooled mean difference in MMSE scores (0.40, 95% confidence intervals = [0.12, 0.67]). Although there was a low risk of publication bias there was a high risk of sampling bias. Conclusion: Participation in formal education or learning contributed to increased wellbeing, QOL, healthy cognitive function, self-dependency, and a sense of belonging in older adults.

Effects of an intensive rehabilitation programme on patients with Huntington's disease: a pilot study

Objective: To investigate the effects of an intensive, inpatient rehabilitation programme on individuals affected by Huntington's disease.

Design: A pilot study. Within-subjects design.

Setting: Inpatient rehabilitation home of the Italian welfare system.

Subjects: Forty patients, early and middle stage of the disease, were recruited to an intensive, inpatient rehabilitation protocol.

Interventions: The treatment programme included respiratory exercises and speech therapy, physical and occupational therapy and cognitive rehabilitation exercises. The programme involved three-week admission periods of intensive treatment that could be repeated three times a year.

Main measures: A standard clinical assessment was performed at the beginning of each admission using the Zung Depression Scale, Mini-Mental State Examination (MMSE), Barthel Index, Tinetti Scale and Physical Performance Test (PPT). Tinetti and PPT were also used at the end of each admission to assess the outcomes in terms of motor and functional performance.

Results: Each three-week period of treatment resulted in highly significant ( P < 0.001) improvements of motor performance and daily life activities. The average increase was 4.7 for Tinetti and 5.21 for PPT scores. No carry-over effect from one admission to the next was apparent but at the same time, no motor decline was detected over two years, indicating that patients maintained a constant level of functional, cognitive as well as motor performance.

Conclusions: Intensive rehabilitation treatments may positively influence the maintenance of functional and motor performance in patients with Huntington's disease.

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

INTRODUCTION

The use of compensatory strategies plays an important role in the ability of older adults to adapt to late-life memory changes. Even with the benefits associated with compensatory strategy use, little research has explored specific mechanisms associated with memory performance and compensatory strategies. Rather than an individual's objective memory performance directly predicting their use of compensatory strategies, it is possible that some other variables are indirectly influencing that relationship. The purpose of this study was to: (a) examine the moderating effects of cognitive reserve (CR) and (b) evaluate the potential mediating effects of memory self-efficacy on the relationship between objective memory performance and compensatory strategy use.

METHOD

Two structural equation models (SEM) were used to evaluate CR (latent moderator model) and memory self-efficacy (mediator model) in a sample of 155 community-dwelling older adults over the age of 55.

RESULTS

The latent variable moderator model indicated that CR was not substantiated as a moderator variable in this sample (p = .861). However, memory self-efficacy significantly mediated the association between objective memory performance and compensatory strategy use (β = .22, 95% confidence interval, CI [.002, .437]). More specifically, better objective memory was associated with lower compensatory strategy use because of its relation to higher memory self-efficacy.

CONCLUSIONS

These findings provide initial support for an explanatory framework of the relation between objective memory and compensatory strategy use in a healthy older adult population by identifying the importance of an individual's memory perceptions.

Depression and executive dysfunction contribute to a metamemory deficit among individuals with methamphetamine use disorders

OBJECTIVE

Chronic methamphetamine (MA) use is associated with moderate deficits in learning and memory, but the extend to which MA users are aware of such memory deficits (i.e., metamemory) is not known.

METHODS

In the current study, 195 participants with lifetime MA use diagnoses (MA +) and 195 non-MA-using comparison subjects (MA -) underwent comprehensive neuropsychiatry research assessments, including performance-based and self-report measures of episodic memory.

RESULTS

MA use disorders, major depressive disorder (MDD), and their interaction were uniquely associated with metamemory functioning, such that MDD increased the likelihood of a metamemory deficit among MA + participants. Within the MA group, individuals who over-estimated their memory abilities demonstrated greater executive dysfunction and lower cognitive reserve.

CONCLUSIONS

Chronic MA use is associated with reduced awareness of objective deficits in memory acquisition and recall, which is particularly exacerbated by the presence of major depression. Efforts to enhance metamemory accuracy and deployment of compensatory mnemonic strategies may benefit substance abuse treatment outcomes.

Jog Your Mind: methodology and challenges of conducting evaluative research in partnership with community organizations

BACKGROUND

Jog Your Mind is a community-based program aiming at empowering elderly people to maintain their cognitive abilities using a multi-strategic approach including cognitively stimulating activities, mnemonic strategies, and strategies to promote healthy behaviors. It is offered to elderly individuals without known or diagnosed cognitive impairment by volunteers or community practitioners over ten weekly sessions. This paper describes the protocol of a quasi-experimental study designed to evaluate Jog Your Mind.

METHODS

Community responsible to recruit participants were either assigned to the experimental group (participating in the Jog Your Mind program) or to the control group (one-year waiting list). All participants were interviewed at baseline (T1), after the program (T2), and 12 months after the baseline (T3). Primary outcomes were the use of everyday memory strategies and aids and subjective memory functioning in daily life. Secondary outcomes included attitudes, knowledge, and behaviors related to cognitive vitality and cognitive abilities (memory and executive functions). Program delivery, organizational and environmental variables were recorded to document the implementation process.

RESULTS

Twenty-three community organizations recruited 294 community-dwelling elderly individuals in total at T1. Between T1 and T3, an attrition rate of 15.2% was obtained.

CONCLUSIONS

Jog Your Mind is one of the only programs targeting cognition among older adults being offered in community settings by community practitioners. The protocol described was designed with a focus on maximizing broad generalizations of the results while achieving scientific rigor. It can serve as an example to guide future research aiming to evaluate health interventions under natural conditions.

Influence of negative stereotypes and beliefs on neuropsychological test performance in a traumatic brain injury population

The impact of stereotype threat and self-efficacy beliefs on neuropsychological test performance in a clinical traumatic brain injury (TBI) population was investigated. A total of 42 individuals with mild-to-moderate TBI and 42 (age-, gender-, educationally matched) healthy adults were recruited. The study consisted of a 2 (Type of injury: control, TBI) × 2 (Threat Condition: reduced threat, heightened threat) between-participants design. The purpose of the reduced threat condition was to reduce negative stereotyped beliefs regarding cognitive effects of TBI and to emphasize personal control over cognition. The heightened threat condition consisted of an opposing view. Main effects included greater anxiety, motivation, and dejection but reduced memory self-efficacy for head-injured-groups, compared to control groups. On neuropsychological testing, the TBI-heightened-threat-group displayed lower scores on Initial Encoding (initial recall) and trended toward displaying lower scores on Attention (working memory) compared to the TBI-reduced-threat-group. No effect was found for Delayed Recall measures. Memory self-efficacy mediated the relation between threat condition and neuropsychological performance, indicating a potential mechanism for the threat effect. The findings highlight the impact of stereotype threat and self-referent beliefs on neuropsychological test performance in a clinical TBI population.

How you ask matters: an experimental investigation of the influence of mood on memory self-perceptions and their relationship with objective memory

Stronger relationships often emerge between mood and memory self-efficacy (MSE) than between MSE and memory abilities. We examined how social desirability, mood congruency and framing influence the mood-MSE relationship. Social desirability correlated with all self-report measures, and covarying social desirability diminished the mood-MSE relationship while enhancing the relationship between MSE and objective memory. Participants rated their memory more harshly on positively than neutrally or negatively worded MSE items. Current mood state did not affect MSE overall or when items were worded positively or neutrally. However, on negatively worded items, participants in a negative mood exhibited lower MSE than participants in a positive mood. Thus, both MSE and the mood-MSE relationship depended upon question wording. These results indicate that controlling social desirability and item framing on MSE questionnaires may reduce their confounding influence on memory self-perceptions and the influence of mood on self-reported abilities, allowing subjective memory to more accurately reflect objective memory in healthy and clinical populations.

The SeniorWISE study: improving everyday memory in older adults

We tested whether at-risk older adults receiving memory training showed better memory self-efficacy, metamemory, memory performance, and function in instrumental activities of daily living than participants receiving a health promotion training comparison condition. We followed participants for 26 months. The sample was mostly female (79%) and Caucasian (71%), with 17% Hispanics and 12% African Americans; average age was 75 years, and average education was 13 years. The memory training group made greater gains on global cognition and had fewer memory complaints, but both groups generally maintained their performance on the other cognitive measures and instrumental activities of daily living (IADLs) throughout the 24-month study period. Black and Hispanic participants made greater gains than Whites did on some memory performance measures but not on memory self-efficacy. The unexpected finding that minority elders made the largest gains merits further study. This study contributed to the knowledge base of geropsychiatric nursing by providing evidence for an effective psychosocial intervention that could be delivered by advanced practice nurses.

A framework for cognitive interventions targeting everyday memory performance and memory self-efficacy

The human brain has the potential for self-renewal through adult neurogenesis, which is the birth of new neurons. Neural plasticity implies that the nervous system can change and grow. This understanding has created new possibilities for cognitive enhancement and rehabilitation. However, as individuals age, they have decreased confidence, or memory self-efficacy, which is directly related to their everyday memory performance. In this article, a developmental account of studies about memory self-efficacy and nonpharmacologic cognitive intervention models is presented and a cognitive intervention model, called the cognitive behavioral model of everyday memory, is proposed.

Comparing the efficiency of eight-session versus four-session memory intervention for older adults

Evidence that reduced treatment achieves similar outcomes is beneficial because shorter interventions may be more cost-effective and more acceptable to participants. We examined the effects of shortening a memory intervention for elders from eight sessions to four sessions. Shortening the intervention had little impact on either self-reported or performance measures of memory and daily living activities. Small to moderate effects were associated with positive changes in both groups. When examining cost-effectiveness, an eight-session intervention produced slightly greater gains in memory performance, but at a higher cost. Future studies should systematically vary key intervention components in more diverse samples.

Cognitive impairment in heart failure

Heart failure is reaching epidemic proportions in the United States, causing a constellation of disabling symptoms. Cognitive impairment in people with heart failure may be more common than previously known with multiple etiologies from both the disease process and the treatment. Exemplars from a research study are used to illustrate the perspective of heart failure patients. Given the critical importance of memory deficits on patient education, potential nursing interventions to address the issue of cognitive impairment are described.

Memory perception and strategy use in Parkinson's disease

Although there is growing support for the existence of memory deficits within Parkinson's disease (PD), little has been done to evaluate the extent to which PD patients demonstrate differences in their use of metacognitive strategies. In the present study, 79 PD patients (46 men and 33 women) and 49 age-matched healthy participants (19 men and 30 women) were compared on a metamemory questionnaire. PD patients reported significantly less strategy-use than age-matched controls, particularly with regards to external memory strategies (such as making lists). This suggests that auxiliary treatments such as memory strategy training might be effective in this population.

Aging Happens: Experiences of Swiss Women Living Alone

The purpose of this study was to give beginning insights into how aging is experienced by women living alone in Switzerland. A feminist methodology was used to gather and interpret 17 interviews conducted with a selected group of 9 older women living alone. Interviews were taped and transcribed for hermeneutic analysis; major themes were developed. Aging happens, Independence, Being vulnerable, Memory and aging, and If I had been a boy were the themes discovered. These experiences represent how aging is shaped by individual life courses, sociocultural conditions along with gender and class.

Memory Self-Efficacy and Memory Performance in Older Males

The study reported here was a secondary analysis of data on 157 males from a larger study of predictors of memory performance in community-dwelling elders. The males' average age was 76 years, with 13 years of education and a Mini-Mental State Exam score of 26. Measures included depression, memory performance, metamemory, and memory self-efficacy. An unusual finding was the multimodal distribution of memory self-efficacy strength scores. Using a median split, the sample was divided into low and high memory self-efficacy groups. The high efficacy group were significantly younger, had larger scores on capacity (+ = high capacity) and change (+ = greater stability). These findings provide new evidence that the memory self-efficacy of aging males influences their perceptions of cognitive performance related to memory.

Test of a nursing intervention to promote adjustment to fibromyalgia

PURPOSE

This was a test to detect whether a 4-week cognitive behavioral nursing program was effective in increasing adjustment to fibromyalgia (FM) and if the treatment effect would last over time.

DESIGN

This was a control and treatment group experimental longitudinal study with outcome measures obtained at pretest and every 3 months for 1 year.

SAMPLE

A sample of 71 subjects continued their participation throughout the first year of the study.

FINDINGS

Treatment subjects had improved posttreatment adjustment and symptom severity compared to control subjects. When subjects with high pretest psychosocial distress (n = 5) were removed from the analysis, these findings were statistically significant.

IMPLICATIONS FOR NURSING PRACTICE

The article can provide direction for developing new comprehensive nursing intervention for patients seen with orthopaedic problems. The intervention schedule may help nurses expand their use of interventions for FM patients. Orthopaedic nurses are especially suited for this challenge.

Memory improvement in assisted living elders

Part of the Cognitive Behavioral Model of Everyday Memory (CBMEM), an eight session cognitive enhancement program, entitled "Memories, Memories, Can We Improve Ours?" was tested with older adults living in an assisted living facility in the midwest. The aims of this quasi-experimental study were: to improve everyday memory, memory self-efficacy, and meta-memory. A total of 19 older adults (14 female, 5 male) with an average age of 83 years participated. For the pretest there were 16 individuals in the experimental group. The experimental group was post-tested one week after completing the intervention. At posttest memory self-efficacy scores significantly increased in the experimental group (M1 = 52.13, M2 = 68.50, where M1 represents pretest and M2 represents posttest). Total memory performance scores were not significantly different at posttest; however the prospective memory items of asking for an appointment (M1 = .56, M2 = 1.25), asking for a belonging (M1 = .62, M2 = .88), and delivering a message (M1 = 1.00, M2 = 1.19) significantly improved.

Cognitive interventions among older adults

This chapter reviews psychoeducational and/or psychosocial interventions designed to improve cognitive function in adults without cognitive impairment. Included are sections on (a) meta-analyses and other reviews; (b) cognitive aging and cognitive improvement; (c) memory training; (d) depression and memory improvement; (e) self-efficacy and aging memory; (f) maintenance of gains and subject retention; (g) comprehensive memory improvement program; and (h) future research. Several aspects of memory training now known to influence outcomes, i.e., memory performance, need to be considered in future studies. First, follow-up instruction (booster sessions) facilitates the use of these newly learned memory strategies in elders' everyday lives. Second, elders' memory self-efficacy (beliefs and confidence) impacts performance. Third, the inclusion of subjective measures in memory training is recommended. Fourth, greater emphasis needs to be placed on the modification of participants' attitudes toward aging-related memory loss. Fifth, designs must emphasize the long-term outcomes of the memory training. Sixth, establishing a relationship between a memory intervention and functional ability (IADLs) is the next step in assisting older adults to remain independent. If early failure in cognitive ability can be improved through intervention, perhaps early decline in functional independence and the need for formal services, e.g., nursing home placement, can be delayed.

Cognitive interventions among older adults

This chapter reviews psychoeducational and/or psychosocial interventions designed to improve cognitive function in adults without cognitive impairment. Included are sections on (a) meta-analyses and other reviews; (b) cognitive aging and cognitive improvement; (c) memory training; (d) depression and memory improvement; (e) self-efficacy and aging memory; (f) maintenance of gains and subject retention; (g) comprehensive memory improvement program; and (h) future research. Several aspects of memory training now known to influence outcomes, i.e., memory performance, need to be considered in future studies. First, follow-up instruction (booster sessions) facilitates the use of these newly learned memory strategies in elders' everyday lives. Second, elders' memory self-efficacy (beliefs and confidence) impacts performance. Third, the inclusion of subjective measures in memory training is recommended. Fourth, greater emphasis needs to be placed on the modification of participants' attitudes toward aging-related memory loss. Fifth, designs must emphasize the long-term outcomes of the memory training. Sixth, establishing a relationship between a memory intervention and functional ability (IADLs) is the next step in assisting older adults to remain independent. If early failure in cognitive ability can be improved through intervention, perhaps early decline in functional independence and the need for formal services, e.g., nursing home placement, can be delayed.

Gender differences in coping and control with memory aging

This secondary analysis of data from a large study of memory perceptions among the elderly examined gender differences in control, coping, health, and metamemory and explored the influence of these factors on anxiety and depression in the elderly. Adults 55 years of age and older, 128 female and 41 males, were recruited from continuing education programs in two Southern states. Females were older than males and reported that their memories were better overall than males. There were no differences between the groups in depression, health, or memory control variables. Females had significantly greater state anxiety than males but no differences were seen in domain-specific memory anxiety or other metamemory domains. Females scored higher than males on help-seeking, existential growth, religiosity, and total coping strategies. In the two regression models the set of study variables predicted 79% of the variance in depression and 15% of the variance in memory anxiety. The addition of perceived health status to each model substantially changed each of their predictive values.

Research instrumentation and elderly subjects

PURPOSE

To address instrumentation problems in conducting research with elderly subjects.

SCOPE

The needs of older adults are considered with regard to instrument selection. Techniques for pretesting instruments are provided through illustrations from research reports and instrument development. Types of instruments are evaluated for use with older adults and methods for strengthening their applicability are provided.

SIGNIFICANCE

Instrument development is sorely needed in gerontological research. Many of the instruments currently used to study elderly subjects lack adequate testing for applicability with old and very old populations. Knowledge about instrumentation can help researchers choose appropriate instruments for elderly subjects and strive to balance subject capacity and the demands of research.

CONCLUSIONS

Four factors for consideration in selecting research instruments for use with older adults include subject (a) fatigue, (b) anxiety, (c) ethnic background, and (d) education. These factors are not adequately addressed in the current literature. Certain types of instruments may be more useful than others in studying the elderly.

Increasing Memory Self-Efficacy and Strategy Use in Hispanic Elders

This study tested the effects of a 4-week, nine-session group intervention taught in Spanish to Hispanic older adults entitled "Quieres Mejorar Tu Memoria" (Do you wish to improve your memory?). The program was based on Bandura's self-efficacy theory and was designed to increase memory self-efficacy and strategy use. A total of 33 older adults attending a senior center (mean--age = 69 years; education = 5 years; MMSE = 25) participated in the study. A booster session and a post-test were given at 3 months to the intervention group (n=22). At posttest the intervention reported greater confidence in preventing decline in their memories, and in particular greater use of the internal strategy of elaboration (2.99 vs. 3.41), and the external strategies of list (2.55 vs. 3.38) and note (3.27 vs. 3.75).

Decreasing mental frailty in at-risk elders

Frailty may be used to describe those older adults who are in precarious balance between their abilities to maintain health and function and their deficits that threaten the balance. Frailty often is described in purely physical terms, omitting the mental and psychologic aspects. When the term is applied to the mental abilities of older adults, frailty is associated with memory vulnerability in the cognitive domain and depression in the psychologic domain. Compromised thinking, anxiety, and decreased confidence in memory are symptoms of mental frailty. This article examines the effects of aging on memory and the intertwining factors of depression and self-efficacy as treatable antecedents of mental frailty in older adults. The article also describes simple assessment techniques, explores memory improvement strategies, and considers nursing implications.