Spaced Retrieval for Enhancing Memory: Implications for Nursing Practice and Research

A pilot study of AID-COMp: An innovative speech-language intervention for patients with early-stage major neurocognitive disorder

BACKGROUND

Major neurocognitive disorder (MND) alters cognition, memory and language, and consequently affects communication. Speech-language therapy (SLT) may alleviate communication difficulties.

AIMS

This pilot study explored the effects of intensive SLT emphasizing memory, language, and discourse impairment and complementary communication strategies, called Aid for Communication-For Persons Who Live with MND (AID-COMp).

METHODS & PROCEDURES

We employed a mixed design using quantitative and qualitative methods with four dyads, including a person living with MND (PwMND) and a family carer. The design included a control period, and we tested participants before (T1) and after 2 months without therapy (T2). AID-COMp was then provided intensively three times per week for 10 sessions and participants were tested again (T3). Participants were also involved in an individual qualitative interview after therapy ended, probing their experience and possible effects on their lives. AID-COMp included: (1) spaced retrieval to teach the use of a memory book; (2) semantic and phonological therapy for lexical access; (3) discourse treatment based on the analysis of the macrostructure and microstructure of stories in pictures and texts; and (4) PACE therapy for generalization. Carers were not included in treatment, did not attend sessions and were only involved in the evaluations. Measures included language, communication, cognitive and well-being tests. Paired t-tests (one-tailed) compared scores for the control period, that is, T1 versus T2. We compared scores after therapy (T3) with those at T2. Interviews were transcribed verbatim and analysed qualitatively.

OUTCOMES & RESULTS

For the control period, only text comprehension scores significantly decreased in PwMND. After therapy, improvements occurred on the Boston Naming Test (BNT), the Mini-Mental State Exam (MMSE) and the well-being measure for the PwMND. Carer scores were unchanged after therapy except for their perception of the PwMND's communication which improved. Qualitative findings comprised three themes: (1) understanding therapy; (2) recovering abilities and relationships; and (3) naming further needs.

CONCLUSIONS & IMPLICATIONS

We hypothesize that AID-COMp addressed the underlying impairments associated with MND and provided various tools to PwMND for composing effectively with them. Indeed, AID-COMp appears to provoke some degree of improvement of language skills, cognition and emotional well-being. These improvements may lead to more confidence in conversation and the recovery of relationships between the PwMND and their entourage. It is also possible that improvements acted positively on one another. These preliminary findings warrant further controlled studies with more participants, including a qualitative exploration of participant experiences.

WHAT THIS PAPER ADDS

What is already known on the subject MND affects cognition and communication, which are crucial to a good relationship between a carer and a person with MND. Interventions involving only PwMND have been shown to be effective, but do not address all the communication impairments in the mild stage of MND. These interventions may require many therapy sessions. Generally, SLT interventions do not examine the potential effects of an intervention on carers. What this paper adds to existing knowledge AID-COMp, an intensive intervention of 10 sessions over 1 month, was provided to people living with MND in the community. It included training the person with MND in using a memory notebook combined with semantic and phonological therapy, a new discourse therapy and PACE therapy, addressing several communication deficits. After a control period of 2 months without intervention and a 1-month intensive intervention, the results showed significant improvement in naming, cognition and communication, and PwMND well-being. Moreover, the carers witnessed the impacts of therapy in their everyday life interactions with the PwMND. What are the potential or actual clinical implications of this work AID-COMp can provide communication support for PwMND that has further benefits reported by both PwMND and carers. We described AID-COMp in detail to inspire clinicians in providing SLT for unserved PwMND. Future research studies should use controlled designs, more participants and a qualitative component.

A Clinical Pilot Study of Spaced Retrieval Practice with a Self-Generation Booster to Improve Health-Related Memory in Persons With HIV Disease

Objective

Spaced retrieval practice (SRP) and self-generation are among the most replicated and effective mnemonic strategies in the cognitive psychology literature, but their benefits have not yet been realized in healthcare settings. This study used a randomized, between-subjects design to examine the hypothesis that SRP with a self-generation booster can improve memory for health-related information among clinically referred persons with HIV (PWH), who often have difficulty acquiring new health knowledge.

Method

A consecutive series of 41 PWH referred to a county-funded urban neuropsychology clinic were enrolled. Participants were randomly assigned to learn four statements about the treatment of a mock infectious disease in either a massed study control condition (n = 20) or an SRP condition (n = 21) in which they received two distributed free recall training tests supplemented with self-generation for missed items. The primary outcome was participants’ free recall of the four treatment statements after a 20-minute delay filled with nonverbal tests.

Results

PWH participants in the SRP condition were four times more likely than controls to recall at least one treatment statement at the 20-minute delay. SRP was not related to post-test recognition or health-related decision-making performance but was associated with moderately better self-efficacy for decision-making.

Conclusions

Findings from this pilot study show the potential of SRP with a self-generation booster to improve learning and memory for health-related information among PWH in clinic.

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.

Spaced Retrieval Using Static and Dynamic Images to Improve Face-Name Recognition: Alzheimer's Dementia and Vascular Dementia

Purpose The primary objective of this study examined whether spaced retrieval (SR) using dynamic images (video clips without audio) is more effective than SR using static images to improve face-name recognition in persons with dementia. A secondary objective examined the length of time associations were retained after participants reached criterion. A final objective sought to determine if there is a relationship between SR training and dementia diagnosis. Method A repeated-measures design analyzed whether SR using dynamic images was more effective than SR using static images for face-name recognition. Twelve participants diagnosed with Alzheimer's dementia or vascular dementia were randomly assigned to 2 experimental conditions in which the presentation of images was counterbalanced. Results All participants demonstrated improvement in face-name recognition; there was no significant difference between the dynamic and static images. Eleven of 12 participants retained the information from 1 to 4 weeks post training. Additional analysis revealed a significant interaction effect when diagnoses and images were examined together. Participants with vascular dementia demonstrated improved performance using SR with static images, whereas participants with Alzheimer's dementia displayed improved performance using SR with dynamic images. Conclusions SR using static and/or dynamic images improved face-name recognition in persons with dementia. Further research is warranted to continue exploration of the relationship between dementia diagnosis and SR performance using static and dynamic images.

Effectiveness of different memory training programs on improving hyperphagic behaviors of residents with dementia: a longitudinal single-blind study

BACKGROUND

Hyperphagia increases eating-associated risks for people with dementia and distress for caregivers. The purpose of this study was to compare the long-term effectiveness of spaced retrieval (SR) training and SR training combined with Montessori activities (SR + M) for improving hyperphagic behaviors of special care unit residents with dementia.

METHODS

The study enrolled patients with dementia suffering from hyperphagia resident in eight institutions and used a cluster-randomized single-blind design, with 46 participants in the SR group, 49 in the SR + M group, and 45 participants in the control group. For these three groups, trained research assistants collected baseline data on hyperphagic behavior, pica, changes in eating habits, short meal frequency, and distress to caregivers. The SR and SR + M groups underwent memory training over a 6-week training period (30 sessions), and a generalized estimating equation was used to compare data of all the three groups of subjects obtained immediately after the training period and at follow-ups 1 month, 3 months, and 6 months later.

RESULTS

Results showed that the hyperphagic and pica behaviors of both the SR and SR + M groups were significantly improved (P<0.001) and that the effect lasted for 3 months after training. The improvement of fast eating was significantly superior in the SR + M group than in the SR group. The improvement in distress to caregivers in both intervention groups lasted only until the posttest. Improvement in changes in eating habits of the two groups was not significantly different from that of the control group.

CONCLUSION

SR and SR + M training programs can improve hyperphagic behavior of patients with dementia. The SR + M training program is particularly beneficial for the improvement of rapid eating. Caregivers can choose a suitable memory training program according to the eating problems of their residents.

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.

The moderating effect of nutritional status on depressive symptoms in veteran elders with dementia: a spaced retrieval combined with Montessori-based activities

AIM

To examine the long-term effects of fixed/individualized spaced retrieval combined with Montessori-based activities on nutritional status and body mass index and nutritional improvement's moderating effect on depressive symptoms for people with dementia during a specific follow-up period.

BACKGROUND

The decrease in food intake, often combined with poor nutrition, may induce depressive symptoms in people with dementia.

DESIGN

A single-blind, quasi-experimental study with repeated measures.

METHODS

Twenty-five fixed group participants received spaced retrieval combined with Montessori-based activities over 24 sessions. Thirty-eight individualized group participants received the same intervention with different sessions, which was adjusted according to each participant's learning response. Twenty-seven control group participants just received routine care. The Chinese version of the Mini-Nutritional Assessment and Cornell Scale for Depression in Dementia scores and body mass index were recorded at pre-test, posttest and 1-, 3- and 6-month follow-ups. Data were collected between July 2008-February 2010.

RESULTS

The Mini-Nutritional Assessment scores and body mass index of the fixed and individualized groups could be significantly increased over time. Additionally, the Cornell Scale for Depression in Dementia scores could be significantly reduced as a result of the improvement of the Mini-Nutritional Assessment scores arising from the individualized intervention.

CONCLUSION

The depressive symptoms of residents with dementia could be moderated by the individualized intervention through nutritional improvement. Trained clinical nurse specialists can use this individualized intervention for residents with dementia who also have poor nutrition and depressive symptoms.

Comorbidities and cognitive functioning: implications for nursing research and practice

Optimal cognitive functioning is necessary to successfully negotiate one's environment, yet medical conditions can interfere with brain health, thus negatively impacting cognitive functioning. Such comorbidities include hypertension, heart disease, diabetes, depression, and HIV, as well as others. The physiological properties of these comorbidities can reduce one's cognitive reserve and limit one's cognitive efficiency. This article provides an overview of a few common comorbidities known to affect cognitive functioning and addresses ways in which cognitive functioning may be ameliorated and protected or mitigated in lieu of cognitive declines in such clinical populations. Implications for nursing practice and research are posited.

Spaced retrieval technique--a cognitive tool for social workers and their clients

Social workers frequently work with clients who have cognitive deficits that impair their ability to perform instrumental activities of daily living and reduce their quality of life. Borrowing from the cognitive aging literature, the Spaced Retrieval Technique can be used by social workers to help their clients retain information needed for more autonomous functioning. This technique consists of recalling information over progressively longer periods of time until the information is successfully consolidated into long-term memory. The retained information may include adhering to medication regimens, keeping doctor's appointments, and remembering to pay bills. This technique is established and employed in early Alzheimer's disease, traumatic brain injury, and HIV. Implications for social work practice are posited.

Mental stimulation, neural plasticity, and aging: directions for nursing research and practice

An unprecedented increase in the number of older adults and consequent age-related cognitive declines may negatively contribute to an already overwhelmed healthcare system. Many older adults report cognitive changes and express interest in methods to maintain cognitive functioning. Mental stimulation that consists of cognitively challenging activities is a means to facilitate neural plasticity, which can increase cognitive reserve and result in maintained or improved cognitive functioning. In addition, compensatory activities may provide mental stimulation that can improve cognitive functioning and increase cognitive reserve. Several mental stimulation (e.g., education, cognitive remediation therapy) and mental compensation (e.g., spaced retrieval method, method of loci) strategies are described in this article. Because nurses have a significant amount of direct contact with older adults, these strategies have important implications for nursing practice and research.