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

Improving prospective memory in persons with multiple sclerosis via telehealth: A randomized feasibility study

BACKGROUND

Persons with multiple sclerosis (PwMS) can experience deficits in prospective memory (PM) or "remembering to remember," which are associated with functional difficulties. However, no cognitive rehabilitation intervention has specifically addressed improving PM in PwMS. The Telehealth PM Intervention (TPMI) provides a novel combination of two strategies-visual imagery and implementation intentions-that have each been beneficial in other populations. This study aimed to evaluate the feasibility of TPMI and its preliminary efficacy, which could be used to inform future trials.

METHODS

Participants (n = 35) were PwMS who were pre-screened and endorsed experiencing problems "remembering places they have to be" and "things they have to do." After completing a baseline evaluation, which included objective (Memory for Intentions Test; MIST) and subjective (Perceived Deficits Questionnaire; PDQ-PM) measures of PM, participants were randomized to either the active treatment (TPMI; n = 17) or active control group (Control; n = 18). TPMI was offered through remote one-on-one sessions twice a week over a four-week period. Participants were asked about treatment credibility and expectancy during the first session. The MIST and PDQ-PM were repeated at post-treatment, where treatment satisfaction was also captured. Mann-Whitney U and chi-square tests were used to examine the feasibility measures, while repeated measures ANOVAs were used to examine changes in the PM outcomes.

RESULTS

A total of 88.2 % of the TPMI group completed all eight sessions, with moderate-to-high (≥7 out of 10) treatment credibility/expectancy and satisfaction reported by 93.3 % and 86.7 %, respectively. While there were no significant effects on overall PM, the TPMI group had an improvement in objective time-based PM after adjusting for baseline differences (F(1,29) = 4.61, p = 0.040; d = 0.80). Furthermore, the TPMI group had a significant reduction in the number of time-based loss of content errors compared to the Control group, which remained significant after covariate adjustment (F(1,25) = 4.29, p = 0.049; d = 0.83).

CONCLUSIONS

TPMI is a feasible intervention, with high completion rates and moderate-to-high treatment ratings, that can be delivered remotely. Early evidence shows its potential benefit for improving time-based PM, a particular concern for PwMS, which should be further evaluated in a larger clinical trial.

Patterns of prospective memory errors differ in persons with multiple sclerosis

INTRODUCTION

Prospective memory (PM) deficits have been documented in multiple sclerosis (MS). This study aimed to explore the specific types of errors made by persons with MS (PwMS), including differences between PwMS and healthy controls (HC) and PwMS who do and do not have impairments in processing speed and/or verbal learning and memory.

METHOD

PwMS (n = 111) and HC (n = 75) completed the Memory for Intentions Test (MIST), an objective measure of PM that has five types of errors that can be coded (PM failure, task substitution, loss of content, loss of time, and random errors). The number and types of PM errors were calculated for the overall MIST and six subscales, which break down performance by types of delay (2-Minute and 15-Minute), cue (Time and Event), and response (Verbal and Action). Impairment was defined as performing < 1.5 SD on either the Symbol Digit Modalities Test (SDMT) or Rey Auditory Verbal Learning Test (RAVLT). Bivariate analyses were used to examine group differences, with post-hoc pairwise comparisons with Bonferroni corrections.

RESULTS

Nearly 93% of PwMS made at least one PM error, compared to 76% of HC (V = .24, p = .001). The most commonly made PM error by PwMS was loss of content errors (45.0%). PwMS made significantly more task substitution errors (26.4% vs. 7.6%, p < .001) and fewer loss of time errors (9.5% vs. 21.2%, p < .001) than HC. Impaired PwMS made more errors than non-impaired PwMS, specifically PM failures on time-based tasks.

CONCLUSIONS

PM errors are common in PwMS, particularly when there are longer delays and time-based cues. Not only do PwMS make more errors than demographically similar HC, but they exhibit different cognitive process failures.

ZORA robot to assist a caregiver in prospective memory tasks: A preliminary study

The objective of the present study was to evaluate the interest of an assistance robot to help caregivers manage the activities of daily living of institutionalized elderly people with Alzheimer's disease. Twenty-three institutionalized persons (60% women; average age 89; average MMSE score of 20.8) with Alzheimer Disease (AD) were recruited and invited to participate in prospective memory exercise sessions, conducted either by a caregiver or by a robot (assisted by a caregiver). They were divided into two groups equivalent in age, level of education and MMSE score. In addition, the sessions were recorded in order to compare the interaction behaviors of the 2 groups, using a validated observation grid. The results showed that: 1) prospective memory tasks are better performed when offered by the caregiver; 2) when strong help linked to the recovery index is provided to perform the tasks, the robot or caregiver no longer show significant differences; 3) participants interact more with the caregiver than with the robot. Our results confirm that the use of companion robots is a promising way to help caregivers manage the daily activities of people with Alzheimer's. However, to optimize this assistance, further investigations should be conducted to improve the fluidity of interactions between the patient and the robot.

Real-world compensatory strategy use in community-dwelling mid-life and older adults: An evaluation of quality

Objective: Older adults often spontaneously engage in compensatory strategies (CS) to support everyday task completion, but factors that influence success of chosen CS remain unclear. This study examines whether real-world prospective memory (PM) task completion is better predicted by CS count or a CS quality rating. Method: Seventy mid-life and older adult participants were presented four novel, real-world PM tasks via remote assessment and encouraged to use their typical CS. The examiner captured detailed information about planned CS at task presentation (T1) and utilized CS at follow-up testing (T2). From this information, count (CS Count; quantity of CS) and quality (CS Quality; rating of CS thoroughness and utility) scores were coded separately for the planned and utilized CS. PM task performance accuracy was also coded (PM Accuracy). Results: Hierarchical regressions revealed planned CS Count and Quality did not predict PM Accuracy. In contrast, the utilized CS Quality predicted a significant amount of PM Accuracy variance over and above CS Count, global cognition, and age (R2 = .47, ΔR2 = .24, ΔF = 29.36, p < .001, f2 = .45). Furthermore, utilized CS Quality accounted for a similar amount of variance in PM Accuracy when utilized CS Count was removed from the model. Conclusions: This study's CS coding system can capture and quantify the quality of strategies, which uniquely predicts real-world PM performance. This coding system may provide researchers with a nuanced CS measure and lead to improved CS interventions designed to support everyday PM performance, such as targeted CS trainings.

Time-Based and Event-Based Prospective Memory in Mild Cognitive Impairment and Alzheimer's Disease Patients: A Systematic Review and Meta-analysis

Prospective memory (PM) is the ability to remember to perform planned actions in a future moment and it is of fundamental importance for an independent and autonomous lifestyle from development to late adulthood. Deficits in episodic memory and executive functions, which are involved in PM are characteristic features of mild cognitive impairment (MCI) and Alzheimer's disease (AD). Considering that the number of older adults is drastically increasing over the next decades, it is of great interest to understand how PM decline in healthy older adults and patients with different degree of cognitive decline. The present meta-analysis included 46 studies investigating PM performance in AD patients (17 studies) and people with MCI (24 studies); 5 studies included both clinical conditions in the same article. The 46 studies contributed a total of 63 independent samples and 129 effect sizes from 4668 participants (2115 patients and 2553 controls). Unlike previous reviews of the literature, our results with a larger and updated sample of studies confirmed lower PM abilities in AD compared to MCI and controls, although we did not observe conclusive differences between event-based and time-based PM in patients. Surprisingly, PM deficits shown by MCI and AD patients have decreased across years, in parallel to a reduction of the evidence of publication bias and an increase in the number of observations per task. We propose the use of more reliable research designs as one plausible explanation for the reduction of PM impairments.

The Development of a Pilot App Targeting Short-Term and Prospective Memory in People Diagnosed with Dementia

BACKGROUND

According to the World Health Organization, people suffering from dementia exhibit a serious decline in various cognitive domains and especially in memory.

AIMS

This study aims to create a pilot computer app to enhance short-term memory and prospective memory in individuals with dementia using errorless learning based on their individualized needs.

METHODS

Fifteen dementia patients and matched controls, matched for age, sex, and education, were selected. Their daily routines were analyzed, and cognitive abilities were assessed using the MoCA test. Considering the participants' illness severity and daily needs, the pilot app was designed to aid in remembering daily tasks (taking medication and meals), object locations, and familiar faces and names.

RESULTS

An improvement in patients' short-term and prospective memory throughout the training sessions, but not in overall cognitive functioning was observed. A statistically significant difference between patients and healthy controls was indicated in their ability to retain information relevant to them in their short-term memory, or to remember to act in the future following schedules organized at present (p < 0.001).

CONCLUSION

This app appears beneficial for training dementia patients and healthy individuals in addressing memory challenges.

RECOMMENDATION

While the pilot app showed promise, further research with larger samples is recommended.

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.

Non-drug Therapies for Alzheimer's Disease: A Review

Alzheimer's disease (AD) is a debilitating disease leading to great social and economic burdens worldwide. During the past decades, increasing understanding of this disease enables dynamic trials for disease interventions. Unfortunately, at present, AD still remains uncurable, and therefore, developing intervention strategies for improving symptoms and slowing down the disease process becomes a practical focus in parallel with searching for a disease-modifying medication. The aim of this review is to summarize the outcomes of AD clinical trials of non-drug therapies published in the past decade, including cognitive-oriented interventions, physical exercise interventions, brain stimulation, as well as nutrition supplementations, to find out the most effective interventions in the category by looking through the primary and secondary outcomes. The outcomes of the trials could be varied with the interventional approaches, the tested cohorts, the settings of observing outcomes, and the duration of follow-ups, which are all discussed in this review. Hence, we hope to provide crucial information for application of these interventions in real-world settings and assist with optimization of clinical trial designs in this area.

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.

A Systematic Review of Prospective Memory Interventions Across Stages of Dementia-Related Disorders

BACKGROUND

There is a critical need to develop effective interventions for cognitive impairments associated with dementia-related disorders (i.e., Alzheimer's disease, frontotemporal dementia, mild cognitive impairment). Prospective memory (PM), or the ability to create and carry out future intentions, is one cognitive domain that is impaired in individuals with dementia-related disorders. Effective treatment of PM could significantly improve daily functioning, level of independence, and quality of life.

OBJECTIVE

To date, there have been a number of studies investigating potential interventions, but these interventions have not been comprehensively reviewed and compared across the stages of dementia-related disorders, as is the aim of the current review.

METHODS

This review examined 21 studies on the success of intervention strategies for prospective memory in patients with dementia-related disorders.

RESULTS

All the studies demonstrated positive effects of intervention on PM abilities, but there are questions concerning ecological validity, length of positive effects on PM, and a lack of diversity of interventions across the different stages of dementia-related disorders.

CONCLUSION

Future research should address these issues by incorporating daily functioning activities and caregiver support into the intervention process, as well as investigating these interventions at more severe stages of dementia-related disorders.

Using smartphone technology to improve prospective memory functioning: A randomized controlled trial

BACKGROUND

A decline in the ability to perform daily intentions-known as prospective memory-is a key driver of everyday functional impairment in dementia. In the absence of effective pharmacological treatments, there is a need for developing, testing, and optimizing behavioral interventions that can bolster daily prospective memory functioning. We investigated the feasibility and efficacy of smartphone-based strategies for prospective memory in persons with cognitive impairment.

METHODS

Fifty-two older adults (74.79 ± 7.20 years) meeting diagnostic criteria for mild cognitive impairment or mild dementia were enrolled in a 4-week randomized controlled trial. Participants were trained to use a digital voice recorder app or a reminder app to off-load prospective memory intentions. Prospective memory was assessed using experimenter-assigned tasks (e.g., call the laboratory on assigned days), standardized questionnaires, and structured interviews. Secondary dependent measures included days of phone and app usage, acceptability ratings, quality of life, and independent activities of daily living.

RESULTS

Participant ratings indicated that the intervention was acceptable and feasible. Furthermore, after the four-week intervention, participants reported improvements in daily prospective memory functioning on standardized questionnaires (p < 0.001, η_p²  = 0.285) and the structured interview (p < 0.001, d = 1.75). Participants performed relatively well on experimenter-assigned prospective memory tasks (51.7% ± 27.8%), with performance levels favoring the reminder app in Week 1, but reversing to favor the digital recorder app in Week 4 (p = 0.010, η_p²  = 0.079). Correlational analyses indicated that greater usage of the digital recorder or reminder app was associated with better prospective memory performance and greater improvements in instrumental activities of daily living (completed by care partners), even when controlling for condition, age, baseline cognitive functioning, and baseline smartphone experience.

CONCLUSIONS

Older adults with cognitive disorders can learn smartphone-based memory strategies and doing so benefits prospective memory functioning and independence.

Keeping Your Glass Half Full: Cognitive Strategy Intervention for Older Adults

When older adults experience memory dysfunction it often compromises their confidence. Older adults' confidence in their memory can be improved through interventions designed to teach strategies for improving everyday memory functioning. The present study examines the efficacy of a five-session cognitive strategy program designed to be optimistic and inclusive for older adults living in a residential community. The memory self-efficacy of participants in the intervention group improved significantly relative to a control group. Additionally, participants' knowledge of memory strategies improved overall after completion of this program. Such findings highlight the benefits of practical cognitive-behavioral interventions for bolstering older adults' confidence and knowledge of memory strategies.

Subjective Time in Dementia: A Critical Review

The capacity for subjective time in humans encompasses the perception of time's unfolding from moment to moment, as well as the ability to traverse larger temporal expanses of past- and future-oriented thought via mental time travel. Disruption in time perception can result in maladaptive outcomes-from the innocuous lapse in timing that leads to a burnt piece of toast, to the grievous miscalculation that produces a traffic accident-while disruption to mental time travel can impact core functions from planning appointments to making long-term decisions. Mounting evidence suggests that disturbances to both time perception and mental time travel are prominent in dementia syndromes. Given that such disruptions can have severe consequences for independent functioning in everyday life, here we aim to provide a comprehensive exposition of subjective timing dysfunction in dementia, with a view to informing the management of such disturbances. We consider the neurocognitive mechanisms underpinning changes to both time perception and mental time travel across different dementia disorders. Moreover, we explicate the functional implications of altered subjective timing by reference to two key and representative adaptive capacities: prospective memory and intertemporal decision-making. Overall, our review sheds light on the transdiagnostic implications of subjective timing disturbances in dementia and highlights the high variability in performance across clinical syndromes and functional domains.

Prospective memory impairment in neurological disorders: implications and management

Prospective memory is a core neurocognitive ability that refers to memory for future intentions, such as remembering to take medications and to switch off appliances. Any breakdown in prospective memory, therefore, has serious implications for the ability to function independently in everyday life. In many neurological disorders, including Parkinson disease and dementia, prospective memory deficits are common even in the earliest stages and typically become more severe with disease progression. Consequently, clinical assessment of prospective memory is of critical importance. This article provides an overview of the various manifestations and neural bases of prospective memory deficits. To facilitate clinical decision-making, validated measures of this construct are identified and their suitability for clinical practice is discussed, focusing in particular on clinical sensitivity and psychometric properties. The article concludes by reviewing the approaches that can be used to rehabilitate different types of prospective memory impairment, and algorithms to guide the evaluation and treatment of these impairments are provided.

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.

How did I remember to do that? Self-reported strategy use for laboratory prospective memory tasks

The role of metacognition in prospective memory (PM) has received relatively little attention. This study combined data from several experiments to identify the strategy repertoire employed during a classic laboratory PM task and to determine whether self-reported strategy was related to performance. Participants (N = 668) completed either a focal or nonfocal PM task embedded in an ongoing lexical decision task. The results indicated that participants reported the same strategy repertoire regardless of PM task focality. Participants who reported using a strategy performed better than those who did not report using one, and this was especially true under nonfocal conditions. Self-reported strategy use was also associated with more cost to the ongoing task when the opportunity to complete the PM task was present. These findings add to what is known about the metacognitive components of PM and underscore the need for additional research in this area.

The effectiveness of virtual reality for people with mild cognitive impairment or dementia: a meta-analysis

BACKGROUND

Virtual Reality (VR) is increasingly used in health-related fields and interventions using VR have the potential to be powerful tools in patient management. The aim of this study was to synthesize the effects of VR interventions for people with mild cognitive impairment (MCI) or dementia.

METHODS

Electronic databases were searched to identify studies that used an experimental design to investigate VR intervention outcomes for patients with MCI or dementia. Studies were excluded if the intervention did not focus on VR, if relevant quantitative outcomes were not reported, or if the intended study purpose was assessment or diagnosis. Data were extracted and analyzed from studies that met criteria. To synthesize the intervention effect sizes (ES), we used random effects models to accommodate heterogeneity in the main effect and sub-group analyses. To identify the potential reason for heterogeneity and compare ES according to the moderator variables, subgroup analyses were conducted based on study characteristics and intervention outcomes.

RESULTS

Data from eleven studies that met eligibility criteria were analyzed. VR intervention delivered to participants with MCI or dementia produced small to medium effects (ES = 0.29, CI = 0.16, 0.42). The ES for studies using semi-immersive technology (ES = 0.37, CI = 0.25, 0.49) was greater than the studies using full-immersive VR (ES = 0.03, CI = -0.14, 0.21). The results showed small-to-medium effects for VR interventions affecting key outcome variables such as cognition (ES = 0.42, CI = 0.24, 0.60) and physical fitness (ES = 0.41, CI = 0.16, 0.65).

CONCLUSION

VR interventions, particularly of the semi-immersive type, are useful for people with MCI or dementia. These results should contribute to the establishment of practical guidelines for VR interventions for patients with cognitive decline.

Prospective Memory Is a Key Predictor of Functional Independence in Older Adults

OBJECTIVES

Prospective memory (PM), the ability to execute delayed intentions, has received increasing attention in neuropsychology and gerontology. Most of this research is motivated by the claim that PM is critical for maintaining functional independence; yet, there is a dearth of empirical evidence to back up the claims. Thus, the present study tested whether PM predicts functional independence in older adults using validated behavioral performance measures for both PM and functional independence.

METHODS

Fifty-eight healthy older adults performed a computerized PM paradigm, the Virtual Week task, as well as a timed version of an instrumental activities of daily living (TIADL) task. Furthermore, we assessed vocabulary, processing speed, and self-reported prospective remembering.

RESULTS

TIADL scores correlated significantly with performance in the Virtual Week task, vocabulary, and processing speed. Hierarchical linear regressions revealed that vocabulary and Virtual Week performance were significant predictors for TIADL. However, self-reported PM scores did not predict everyday functioning.

CONCLUSIONS

The findings indicate that PM is an important cognitive ability for successful and independent everyday life beyond vocabulary. Moreover, the results show a substantial incremental contribution of intact PM performance for the prediction of everyday functioning by using objective PM measures. (JINS, 2018, 24, 640-645).

Thought probes during prospective memory encoding: Evidence for perfunctory processes

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

Mild cognitive impairment and prospective memory: translating the evidence into neuropsychological practice

OBJECTIVE

There has been a recent rapid development of research characterizing prospective memory performance in mild cognitive impairment (MCI) in older age. However, this body of literature remains largely separated from routine clinical practice in neuropsychology. Furthermore, there is emerging evidence of effective interventions to improve prospective memory performance. Therefore, our objective in this article was to offer a clinical neuropsychological perspective on the existing research in order to facilitate the translation of the evidence-base into clinical practice.

METHOD

By conducting a critical review of the existing research related to prospective memory and MCI, we highlight how this data can be introduced into clinical practice, either within diagnostic assessment or clinical management.

CONCLUSIONS

Prospective memory is impaired in older adults with MCI, with a pattern of performance that helps with differential diagnosis from healthy aging. Clinical neuropsychologists are encouraged to add prospective memory assessment to their toolbox for diagnostic evaluation of clients with MCI. Preliminary findings of prospective memory interventions in MCI are promising, but more work is required to determine how different approaches translate to increasing independence in everyday life.

Encoding strategy training and self-reported everyday prospective memory in people with Parkinson disease: a randomized-controlled trial

Objective To compare the effects of laboratory-based training in implementation intentions (II; experimental strategy) and verbal rehearsal (VR; control strategy) on self-reported everyday prospective memory among people with Parkinson disease (PD) and to investigate potential correlates of change in self-reported everyday prospective memory in response to this training. Method This was a randomized-controlled trial. Participants with mild to moderate PD without dementia underwent one session of training in either II (n = 25) or VR (n = 27). Then they were instructed to use their strategy as much as possible in their everyday lives to help them remember to do things. The Prospective and Retrospective Memory Questionnaire Prospective Scale (PRMQ-Pro) administered at baseline and one month after training assessed training-related change in self-reported everyday prospective memory. Baseline depressive symptoms, perceptions of the strategy (credibility, expectancy), prospective memory-related awareness, global cognition, and disease severity were correlated to PRMQ-Pro Change scores (post minus pre) to determine their association with response to training. Results The VR group's PRMQ-Pro scores declined from pre to post training, while the II group's remained stable (p = .03). This effect was driven by change in self-cued everyday prospective memory tasks. Higher baseline depressive symptoms, treatment expectancy, and global cognition related to better response to training in the II group (rs ≤ -.40, ps ≤ .05). Conclusions II training may prevent everyday prospective memory decline among people with PD. In addition, people with higher depression, stronger expectations of improvement from strategy training, or better global cognition may benefit the most from II training.

Improving Prospective Memory in Persons With Parkinson Disease: A Randomized Controlled Trial

BACKGROUND

Prospective memory (PM) is essential for productive and independent living and necessary for compliance with prescribed health behaviors. Parkinson disease (PD) can cause PM deficits that are associated with activity limitations and reduced quality of life. Forming implementation intentions (IIs) is an encoding strategy that may improve PM in this population.

OBJECTIVE

To determine the effect of IIs on PM performance in PD.

METHODS

This was a laboratory-based randomized controlled trial. Participants with mild to moderate PD without dementia (n = 62) performed a computerized PM test (Virtual Week) under standard instructions. One week later they were randomly allocated to perform it again while using either IIs or a rehearsal (RR) encoding strategy.

RESULTS

PM performance was better with the use of both strategies relative to standard instructions. This effect was larger for tasks with event-based compared with time-based cues. In addition, IIs resulted in a larger effect than RR for the nonrepeated tasks.

CONCLUSIONS

Strategies that support full encoding of PM cues and actions can improve PM performance among people with PD, particularly for tasks with cues that are readily available in the environment. IIs may be more effective than RR for nonrepeated tasks, but this finding warrants verification. Future work should address transfer of strategy use from the laboratory to everyday life. Targeted strategies to manage PM impairment could improve function and quality of life and significantly affect clinical care for people with PD.

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.